santa fe group
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Santa Fe Group. TACKLING DENTURE DISABILITY. Oral Health For the Elderly: Challenges and Opportunities 28 June 2007 Santa Fe, NM. Jocelyne Feine McGill University. Percent Edentulous Among U.S. Adults, by Age Group: 1960-2002. NCHS, National Health and Nutrition Examination Surveys. - PowerPoint PPT PresentationTRANSCRIPT
Santa Fe GroupSanta Fe Group
Oral Health For the Elderly:Challenges and Opportunities
28 June 2007Santa Fe, NM
Oral Health For the Elderly:Challenges and Opportunities
28 June 2007Santa Fe, NM
Jocelyne FeineMcGill University
Percent Edentulous Among U.S. Adults, by Age Group: 1960-2002Percent Edentulous Among U.S.
Adults, by Age Group: 1960-20028.
0
20.0
36.3
49.4
60.3
9.0
16.0
33.4
45.8
2.8
9.3
20.1
28.6
37.0
7
1.5 5.
0
13.5
23.9 28
.58
0
10
20
30
40
50
60
70
35-44 45-54 55-64 65-74 75-79
HES I (1959-62)
NHANES I (1971-74)
NHANES III (1988-94)
NHANES 1999-2002
NCHS, National Health and Nutrition Examination Surveys
The Impact of EdentulismThe Impact of Edentulism
General Health and Quality of Life
• Comfort • Nutrition
• Ability to chew• Food choice
• Ability to socialize• Intimate activities
General Health and Quality of Life
• Comfort • Nutrition
• Ability to chew• Food choice
• Ability to socialize• Intimate activities
Edentulism and General HealthEdentulism and General Health
1. Edentulous individuals have poorer nutrition than those who are dentate (Lee at al, 2004; Sheiham et al, 2001; Joshipura et al, 1996; Krall et al, 1998; Fontijn-Tekamp et al, 1996; Papas et al, 1998; Greksa et al 19995; Mojon et al; 1999).
2. Edentulous elders have an increased risk of systemic diseases (Johansson et al, 1994; Joshipura et al, 1996; Hamasha et al, 1998; Elter et al, 2003; Morais et al, In preparation).
3. Edentulous elders have significantly greater morbidity and earlier mortality than dentate elders (Shimakazi et al, 2001; Hamasha et al, 1998; Joshipura et al, 1996).
1. Edentulous individuals have poorer nutrition than those who are dentate (Lee at al, 2004; Sheiham et al, 2001; Joshipura et al, 1996; Krall et al, 1998; Fontijn-Tekamp et al, 1996; Papas et al, 1998; Greksa et al 19995; Mojon et al; 1999).
2. Edentulous elders have an increased risk of systemic diseases (Johansson et al, 1994; Joshipura et al, 1996; Hamasha et al, 1998; Elter et al, 2003; Morais et al, In preparation).
3. Edentulous elders have significantly greater morbidity and earlier mortality than dentate elders (Shimakazi et al, 2001; Hamasha et al, 1998; Joshipura et al, 1996).
Edentulous Denture-Wearing Elders are at Risk for DiseaseEdentulous Denture-Wearing Elders are at Risk for Disease
1.Prevention of tooth loss2.Therapy to improve
chewing ability and nutrition.
1.Prevention of tooth loss2.Therapy to improve
chewing ability and nutrition.
OSSEOINTEGRATED INTRAORAL IMPLANTSOSSEOINTEGRATED INTRAORAL IMPLANTS
Societal
Preference
Ethics & Equity
Economic Evaluation
Clinical Efficacy
Effectiveness
Meso (i.e. hospital
administrators)
Micro (i.e. Patients &
physicians)
Macro (i.e. government)
Health Policy
Health Technolog y Assessment
Decision-Making
From Health Technology Assessment to Health Policy From Health Technology Assessment to Health Policy
Reducing Cost of CareReducing Cost of Care
• Complex traditional prosthetic techniques are no better than simplified techniques to fabricate high quality conventional dentures (Kawai et al, 2005; Carlsson, In Press).
• Inexperienced new dentists are able to provide equally effective and satisfactory simple mandibular implant overdentures than experienced prosthodontists (Esfandiari et al, 2007).
• Complex traditional prosthetic techniques are no better than simplified techniques to fabricate high quality conventional dentures (Kawai et al, 2005; Carlsson, In Press).
• Inexperienced new dentists are able to provide equally effective and satisfactory simple mandibular implant overdentures than experienced prosthodontists (Esfandiari et al, 2007).
Healthcare Professional
Cost-Effectiveness AssessmentsCost-Effectiveness Assessments
Mandibular 2-implant overdentures opposing maxillary conventional dentures are more cost-effective (OHQoL) on the long term than are complete conventional dentures (Heydecke et al, 2005).
Mandibular 2-implant overdentures opposing maxillary conventional dentures are more cost-effective (OHQoL) on the long term than are complete conventional dentures (Heydecke et al, 2005).
Technology TransferMicro Level
Technology TransferMicro Level
Peer-reviewed journals
Continuing education / courses
Legal precedent
Professional schoolsPeer practice
Health supply company
Advertisements Hospital policies
Clinical practice guidelines
Dis
sem
inatio
nof
kn
ow
led
ge
TECHNOLOGY
Healthcare Professional
“I got a bone to pick with you,
girlie!”
“I got a bone to pick with you,
girlie!”
McGill Consensus Conference:
Mandibular Overdentures on 2 Implants: Minimal Standard of Care for Edentulous Patients
McGill Consensus Conference:
Mandibular Overdentures on 2 Implants: Minimal Standard of Care for Edentulous Patients
At what point does our canine colleague have an obligation:
1) To inform his patients of new effective therapies?2) To provide such therapies to his patients?
At what point does our canine colleague have an obligation:
1) To inform his patients of new effective therapies?2) To provide such therapies to his patients?
Technology TransferTechnology Transfer
Health Care Professional
Treatment Plan (alternative therapies)
Informed consent
Treatment of choice
Patient
Duty of care
Economic Economic factorsfactors
Standard of Standard of carecareSocial factorsSocial factors
Access to care
Ethical and moral issues
Legal and professional
issues
Negligence
Malpractice
You may stop the postman
from delivering the message, but, at some
point, ignorance of the evidence is no defense!
You may stop the postman
from delivering the message, but, at some
point, ignorance of the evidence is no defense!
1. Demonstrate improved health and QoL2. Demonstrate cost-effectiveness3. Apply political and social pressure
Meso and Macro Levels
WHO WILL SPEAK FOR ME?