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DEALing with the TSUNAMI of DISINTEGRATING Dentistry in the

coming DECADES?

Dr. Jon Strom, DDS, FACD

RETENTION! RETENTION! RETENTION!

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RETENTION 1

Transition from Edentulous to Dentate Seniors1800’s to 1st half of 1900’s Surgical Extraction Dentures for Young Adults (Wales, Que.)Post WW II . Preventative Dentistry PrevailsBaby Boomers :Schools 1950’s- Health 2020’s

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Geriatrics and FRAIL ELDERLY!

Over 65’s outnumber Children and Young Adults as of 2016!

Chronic DiseasePolypharmacy and Xerostomia impact Oral

Hygiene StatusLack of mobility of Frail Elders inhibits Dental

Visits

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BABY BOOMERS

Dental History:Edentulous 1st 50 years of 20th CenturyAntibiotics changes the next 50 yearsDentists acquire hi-speed rotor, flourides and

hygienists. Population becomes more Dentulous.Peripheral Seal on Full Dentures loses

importance. Implants lock Dentures in place.Increased Dentate Population needs extra care

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SILVER TSUNAMI

Numbers of Frail Elderly about 22 per Dentist3,000 Dentists in BC, so 66,000 patients need

more oversight to maintain good oral health!Many are not accessing Dental Care. Need for

education and special protocol.Average patient over 65 visits Dentist every

Two Years. Inadequate supervision if General Health is compromised.

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Not FRAIL ELDERS

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Restorations Retain Teeth

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Dentition Retained for a lifetime

Adults are retaining Natural Dentition longer and Living Longer.

Good Oral Hygiene isof greater significance as Chronic Health Problems appear!

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Who is A FRAIL ELDER?

Slow Walkers:10 Seconds to walk 3 Meters!Unable to Stand from Seated Position with Arms crossed over Chest!

Hard of HearingComprehension and Memory DifficultyBette Davis said OLD AGE IS NOT FOR SISSIES! THE GOOD NEWS IS: IT DOESN’T LAST THAT LONG!

Poor oral hygiene & Elders

RETENTION #2

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MEDICAL / DENTAL DISCONNECT

MEDICARE and Dental Care disconnect

MEDICARE :Coverage from Tonsils on Down

POLYPHARMACY : Oral Side Effects ignored

DENTISTRY: Out of Pocket Expense. Value?

LONG TERM CARE: Not Cognizant of Problem

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Dental Health and Aging

No relationship with age and Oral HealthRelationship between Chronic Diseases and

HygieneDissociation of Medical Profession from

implications of Oral Health and Medical Prognosis.

Dental Care restricted to Dental Clinics. Need for Outreach Protocol becomes obvious!

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Oral Hygiene

Gingival Sulcus infection source of BacteremiaPneumonia if inspiration occurs!

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Alzheimers

Affects 4% of 75 Year Olds, 16% over 75, and 32% over 95 years of Age

This still means over 70% of over 90’s are mentally sharp!

Need some autonomy in Oral Hygiene CareIn Future Robotics may assist!

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Parkinson’s and Chronic Disease

Parkinson’s. XerostomiaPolypharmacy. Overuse of Drug TherapyLack of Information about side effects of

drugsXerostomia (Dry Mouth). Saliva production

and pH not often Considered.

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The Players Involved

A frail ELDER with Cognitive Problems may haveDecision makers involvedSuch as: Trustee, Spouse,Family Facilitator,

Doctor, Nursing Aide,Assigned Caretaker, Long Term Care

Facility Protocol must be consideredPrivacy Laws and Security Regs add Red Tape

and Complicate Treatment decisions

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RETENTION #3

26 % of Elders access Dental Office every Two Years Only 50% see value in maintaining Oral HealthPerception is: will lose teeth anywayDo not perceive General Health Status and Healthy

Mouth are relatedFamily, caregiver and Trustees not engagedCan this destructive perception be overcome?BY WHOM? -----PRACTICING DENTIST!

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Inform, Inform, Inform

Modern Information SYSTEMSWEBSITESMARTPHONESIntraOral cameras-3DE-mail: Text & PhotosOffice Ambassador for Frail EldersOffice ProtocolOral Science -Courses& Products

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PHOTO, SHARE, INTERNET

Oral Condition emailed for analysisA picture is worth 1,000 words

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PROTOCOL SUGGESTED

Early Education on Importance of Oral Health if General Health is Compromised

Present implications to patient before health is compromised. Age 60 is suggested

Provide healthy Patient with information in an Introductory Brochure. Provide Website Links.

Assure him that your Dental Clinic wishes to provide him appropriate care for his Lifetime

Have a Staff Member trained to so instruct on your office protocol

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Areas of Special Concern

Diet changes needed of special significanceList of drugs being used.Need for Hydration and

Oral rinses to mitigate Xerostomia.Effective Tooth Brushes and Toothpastes for each

stage of inhibited physical ability.Use of Xylitol Lozenges to inhibit Caries.Proper use of Chlorihexidrine Gels and Flouride

applications.Pilocarpine Lollipops to stimulate Saliva Production.

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Other Oral Hygiene Aids

WaterPikChewbrush PotentialChewstick Irony of toothbrush technology!Sanitation Issues.Bacterial

exposure.Ultraviolet,etc.Spending on Pets in US.$61 Billion.$6.5 in

Canada55-64 Year Olds spent most of any Age Group.

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BLIZZIDENT

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Prototype MOUTH BRUSH

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Need to ENROLL ALL PLAYERS

Need to Co Ordinate Health Care protocol for the Frail Elder

All need to be on Same Song SheetProvide as much Autonomy as possible for PatientSpecial needs in Nutrition, Drug Side effects,Oral

Hygiene instruments and Oral Hygiene Aids.Regular supervision and Updates for all PlayersWho will oversee this Co-ordinated Care?

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DIET & NUTRITION

Affects Oral Environment: pH of saliva, amount of saliva, Oral Flora, Calculus deposits, Bacterial constituents. Hydration

Refined Carbohydrates detrimental. WHO position.Sweden has AdoptedNew Nutritional Guidelines(FAT GOOD_REFINED CARBS BAD)Instruction and inception of a strict protocol needed

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DEAD FILESPatient Retention skills listed in Courses for DentistKeeping an on-file Patient beats enrolling a new one! Enroll all 65+ Patients into Lifetime ProgramPrepare them for Special Needs Your clinic Provides!3,000 Dentists in BC. Each G.P. has 22 Frail Elders.They often disappear from the Practice.Be prepared for Aging Dental Special needsInform them beforehand that Your office has a

Retention Protocol for FUTURE NEEDS!

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ONLINE RESOURCES

USERS are Patients, Dental Staff, Family, MD, Pharmacist

ACCESS LEVELS to Info and Protocols: Dentist,Staff,(Office Ambassador)

Patients, Ambassador, Family Support, Caretakers

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RETENTION, RETENTION, RETENTION

THE MESSAGE IS THIS: The DENTIST is the SOURCE to RETAIN

PATIENTS FOR A LIFETIMESO the PATIENT is ENABLED to RETAIN THEIR

TEETH AND DENTAL HEALTH FOR THEIR LIFETIME.

HOW: BY USING NEW TECHNOLOGY TO REACH OUT AND KEEP THE PATIENT INFORMED FOR THEIR LIFETIME.

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Who’ll care for the rapidly aging?

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Dr. Jon Strom, DDS, FACD

RETENTION! RETENTION! RETENTION!

/JONSTROMDDS