Geriatric Dentistry E-Book

Paula K. Friedman

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 869

Veröffentlichungsjahr: 2014

Beschreibung

Geriatric Dentistry: Caring for Our Aging Population provides general practitioners, dental students, and auxiliary members of the dental team with a comprehensive, practical guide to oral healthcare for the aging population. Beginning with fundamental chapters on the psychological, environmental, and social aspects of aging, the book approaches patient care from a holistic point of view. Subsequent chapters show the importance of this information in a practical context by discussing how it affects office environment, decision?-making and treatment planning, and the management and treatment of common geriatric oral conditions. Case studies and study questions are used to illustrate application of educational presentations to practice settings. Contributed by leaders in the field, Geriatric Dentistry will strengthen readers' understanding and clinical acumen in addressing this special population.

Leseprobe

CONTENTS

Cover

Title page

Copyright page

List of Contributors

Dedication

Introduction

PART 1: Underlying Principles of Aging

Chapter 1: Aging

Aging of the US population

Trends in oral health in older adults

Oral health disparities in older adults

Functional status and oral health

Xerostomia, medications, and oral health

Cognitive function and oral health

Clinical and policy implications

References

Chapter 2: Palliative Care Dentistry

Introduction

Mucositis and stomatitis

Nutrition

Dysphagia

Nausea and vomiting

Delirium

Xerostomia and salivary gland hypofunction

Candidiasis

Cancer and quality of life

Herpes and palliative care

Depression and the oral cavity

Caries prevention

Taste disorders

Treatment planning

References

PART 2: Clinical Practice

Chapter 3: Living Arrangements for the Elderly

Introduction

Independent living/age in place

Congregate housing/retirement communities

Assisted living

Board and care home

Continuing care retirement communities

Nursing homes

Long-term care insurance

Conclusion

References

Chapter 4: Palmore’s Facts on Aging Quiz

Introduction

Tests of knowledge about older adults

Scores of recent dental graduates on the FAQ1

What is the relationship between results of tests of knowledge about older adults and good care?

Summary

References

Chapter 5: The Senior-Friendly Office

Introduction

Sensory impairments

Mobility

Electronic health records

Conclusion

References

PART 3: Decision Making and Treatment Planning

Chapter 6: Geriatric Patient Assessment

Introduction

Communication status

Physical status

Mobility status

Mental status

Nutritional status

Social support

Medical status

Summary

References

Chapter 7: Treatment Planning and Oral Rehabilitation for the Geriatric Dental Patient

Introduction

Diagnostic studies to facilitate planning and treatment

Planning for dental treatment in the older adult

Treatment planning: issues and approaches

Treatment planning: important goals

Implant restorations for the elderly

Treatment planning: important goals

Conclusion

References

Chapter 8: Informed Consent for the Geriatric Dental Patient

Informed consent

Background

Informed consent for geriatric patients

References

Chapter 9: Evidence-Based Decision Making in a Geriatric Practice

Introduction

The process

Sources of evidence

Critical appraisal of the evidence

Implementation of an evidence-based geriatric dentistry practice

EBDM in practice

Conclusion

References

PART 4: Common Geriatric Oral Conditions and their Clinical Implications

Chapter 10: Root Caries

Introduction

Prevalence and risk factors

Caries risk assessment

Pathologic factors versus protective factors

Clinical decision making

References

Chapter 11: Periodontal Disease

Introduction

Epidemiology of periodontal disease

The role of periodontal disease in oral health/overall health

Senescence of tissue

Identifying periodontal disease

Cancer, cancer therapy, and periodontal disease

Cognitive functioning

Dexterity/functional issues

Osteoporosis

Menopausal status

Implants and periodontal disease

Aspiration pneumonia

Diet and nutritional changes

Psychologic considerations

References

Further reading

Chapter 12: Endodontic Management of the Aging Patient

Introduction

The dental pulp

Management considerations

Endodontic therapy of aging patients

Endodontic treatment

Regenerative endodontics

Periodontal considerations

Conclusion

References

Further reading

Chapter 13: Oral Mucosal Lesions

Introduction

Burning mouth syndrome

Candidiasis (see also Chapter 2)

Epulis fissuratum (inflammatory fibrous hyperplasia, denture-induced fibrous hyperplasia, denture granuloma)

Geographic tongue (benign migratory glossitis)

Hairy tongue

Herpes simplex (recurrent)

Herpes zoster (shingles)

Irritation fibroma

Leukoplakia

Lichen planus

Mucous membrane pemphigoid (cicatricial pemphigoid)

Papillary hyperplasia

Pemphigus

Recurrent aphthous ulcers

Traumatic ulcerations

Varices (varix)

References

Chapter 14: Xerostomia

Introduction

Role of saliva and functions of salivary components

Defining and recognizing xerostomia and SGH

Prevalence

Effect of aging on salivary glands and flow rates

Etiology of xerostomia and/or SGH

Treatment modalities

References

Chapter 15: Prosthetic Considerations for Frail and Functionally Dependent Older Adults

Introduction

The aging population

Decision making in prosthodontics

Sociodemographic information

Health history

Tips and techniques for treating frail or functionally dependent elders

Evaluations for prosthodontic rehabilitation

Systematic evaluation of the dentition

Designing removable partial dentures for frail and functionally dependent older adults

Complete dentures

Overdentures

New or replacement complete dentures

Treatment of patients with neuromuscular deficits

Conclusion

References

Chapter 16: Medical Complexities

Introduction

Prescription and natural drug use as the window to systemic health

Polypharmacy

Tips for maximizing optimal medication compliance

Systematic review of the medication list

Emergency drugs for emergency situations

Drugs that suggest potential risk

Conclusion: an interdisciplinary approach

Clinical examples

Bibliography

PART 5: Care Delivery

Chapter 17: Delivery Systems

NURSING HOMES

Definitions

Contracts and affiliation agreements

Record keeping

Treatment delivery options

Patient referrals to outside resources

Billing

Summary

HOME VISITS

Preparation for the home visit

The visit

Record keeping

Billing/house/extended care facility call

References

Chapter 18: Portable Dentistry

Introduction

Radiographs

Suction

Portable and mobile carts

Lighting

Patient chairs (Fig. 18.7a,b)

Lathe

Computer equipment

Wraps and props

Headrests

Maintenance and repairs

Vans

Sedation

Level of care

Inventory control

Fees

Opportunity

Bibliography

Chapter 19: Promoting Oral Health Care in Long-Term Care Facilities

Introduction

Assess strengths and challenges

Collaborate

Use personnel effectively

Apply best practices

Standards (health promotion ring 1)

Commitment (health promotion ring 2)

Caregiver education and training (health promotion ring 3)

Assessment and clinical care: health promotion ring 4

Daily mouth care: health promotion ring 5

References

Chapter 20: Dental Professionals as Part of an Interdisciplinary Team

Introduction

THE ORAL HEALTH–OVERALL HEALTH RELATIONSHIP

Historical retrospective: focal infection theory of disease

Current understanding: the mouth–body connection

Oral and system conditions – interrelationships

INTERPROFESSIONAL CARE

Dental–medical collaboration

Dental–rehabilitation collaboration

Dental–nursing collaboration

Dental–pharmacy collaboration

Dental–dietician collaboration

Dental–social worker collaboration

Interprofessional geriatric dental care

Strategies for successful interprofessional consultations

EXPANSION OF THE DENTAL WORKFORCE

Access to care for older adults

The impetus behind the initiative to expand the dental workforce

Historical perspective

From planning to action: Minnesota

Dental workforce expansion status in other states

Summary

References

PART 6: Future Vision

Chapter 21: Planning for the Future

Introduction

The continuum of aging

Health and social policies for older adults

“Medically necessary” oral health care

Expanding the evidence base

Focus on the future: innovation to improve the oral health of vulnerable elders

Advancing a policy agenda to improve the oral health of vulnerable elders

Summary

References

Answer Section

Chapter 14: Multiple choice questions

Chapter 17: Multiple choice questions

Chapter 18: Discussion questions

Chapter 20: Discussion questions

Index

Access the Companion Website

End User License Agreement

List of Tables

Chapter 01

Table 1.1 Trend of edentulism by racial/ethnic groups (1999–2008) (%) (weighted)

a

Chapter 02

Table 2.1 Impact of oral problems in palliative care

Table 2.2 The pH of artificial saliva agents

Chapter 03

Table 3.1 Sample of week’s activities in an assisted living facility

Table 3.2 Comparison and cost of different living options

a

Chapter 04

Table 4.1 Palmore’s Facts on Aging Quiz

a

Table 4.2 Mean Facts on Aging Quiz scores by country of training

Table 4.3 Mean Facts on Aging Quiz scores by gender

Table 4.4 Changes in Facts on Aging Quiz scores with time by selected variables

Chapter 07

Table 7.1 Common global issues and some possible approaches

Table 7.2 Common dental issues and possible approaches

Chapter 09

Table 9.1 Journals of interest to a geriatric practice sorted by impact factor

a

Chapter 11

Table 11.1 Medications and symptoms as risk factors for periodontal disease

Chapter 13

Table 13.1 Topical antifungal agents

Table 13.2 Systemic antifungal agents

Table 13.3 Medications used to treat recurrent herpetic infections

Table 13.4 Topical analgesics

Table 13.5 Medications (in order of increasing potency) for treatment of ulcerative lesions

Chapter 14

Table 14.1 Subjective symptoms and clinical findings associated with xerostomia and/or salivary gland hypofunction

Table 14.2 Examples of frequently used medications causing xerostomia

Table 14.3 Antifungal agents for treatment of oral candidiasis

Table 14.4 Examples of saliva replacement products (salivary substitutes) commercially available

Chapter 16

Table 16.1 Polymedicine checklist

Table 16.2 Diabetes and associated diseases: impact on oral health care

Chapter 17

Table 17.1 Alert and oriented (A&O)

Chapter 19

Table 19.1 Roles in long-term care (LTC) can extend far beyond clinical care

Table 19.2 Terminology

Table 19.3 Regulatory requirements direct and shape practice

Table 19.4 Assessing your readiness to be an oral health champion

Table 19.5 Training lessons learned

Table 19.6 Oral assessments in long-term care (LTC)*

Table 19.7 Preventive oral health strategies for dependent older adults

Chapter 20

Table 20.1 Common oral side effects associated with drugs or drug classes

Table 20.2 Potential interprofessional collaboration for dental professionals

Table 20.3 Dental professionals’ guide to interprofessional consultation

Table 20.4 Written consultation content and example

Table 20.5 Links and resources

Table 20.6

Required content of a dental therapy CMA in Minnesota

a

Table 20.7 Delegated duties of Minnesota dental therapists (DTs) and advanced dental therapists (ADTs)

a

Chapter 21

Table 21.1 Prevalence of chronic diseases and disability or limitations by age group, 2006

a

Table 21.2 Medicare coverage of dental services as specified in statute or by the Health Care Financing Administration

a

List of Illustrations

Chapter 01

Figure 1.1 Predicted rate of edentulism.

Chapter 02

Figure 2.1 Palliative care team treating the patient and family.

Figure 2.2 Oral problems in palliative care.

Figure 2.3 Formulation for sugar-free nystatin solution.

Figure 2.4 Nystatin popsicles.

Figure 2.5 Nystatin suspension plus lubricant.

Figure 2.6 Radiograph of jaw (see Case study 2).

Figure 2.7 Oral fistula resulting from radiotherapy (see Case study 2).

Chapter 03

Figure 3.1 Summary of the results of an American Association of Retired Persons’ survey on seniors’ choices for living arrangements.

Figure 3.2 (a,b) Theresa Dewar, aged 83, leaving her unassisted living facility to move to a nursing home with the help of Lois Halligan.

Figure 3.3 (a,b) Photographs from McMinnville, Oregon Continuing Care Retirement Community.

Figure 3.4 Theresa Dewar now in her new Florida nursing home.

Chapter 05

Figure 5.1 Example of vision affected by cataracts (a) as compared to normal (b).

Figure 5.2 Example of vision affected by glaucoma (a) as compared to normal (b).

Figure 5.3 Example of vision affected by diabetic retinopathy (a) as compared to normal (b).

Figure 5.4 Example of vision affected by age-related macular degeneration (a) as compared to normal (b).

Figure 5.5 Example of vision affected by hemianopia or hemianopsia (a) as compared to normal (b).

Figure 5.6 Examples of good contrast (left) versus not so good contrast (right).

Figure 5.7 The two-person transfer. (a) First clinician stands behind the patient. (b) Second clinician initiates the lift.

Figure 5.8 An example of a bad waiting area design for older patients. This waiting area has deep chairs that are low to the ground. While there is good ambient light there is no task lighting for reading. The floors are highly reflective and will be slippery if they get wet. There is no place to put down any papers. The only small table has a plant on it. There is much room for improvement in this waiting area.

Figure 5.9 An example of a good waiting area design for older patients. Notice the overhead lighting and the task lighting. The chairs have arms and although cushioned for comfort but are not overstuffed and difficult to get up from. There are no throw rugs and there is emergency lighting should power be lost. One thing to notice is the glass table tops that have sharp corners. Either a bumper around the edge of the table or a rounded edge may be more friendly to older adults should someone bump into the table.

Chapter 06

Figure 6.1 Percentage of persons with limitations in activities of daily living by age group: 2009.

Figure 6.2 Abnormal Clock Drawing Test (CDT) results from Mini-cog Assessment.

Figure 6.3 Dental images from patient case demonstrating the characteristics of disease presentation in the elderly (see Case study 4 and text for more details).

Figure 6.4 Illustration of homeostenosis.

Chapter 07

Figure 7.1 (a,b) Single implants used as root form anchors for porcelain fused to metal crowns (PFMs).

Figure 7.2 (a,b) Single implant placed on the upper right to retain and support a partial denture.

Figure 7.3 Multiple implants support an implant fixed bridge, upper right, and crowns. Note the anterior cantilever pontics at tooth sites no. 6 and no. 11, which are kept out of occlusion to minimize lateral forces.

Figure 7.4 (a,b) Two implants with a bar and clip attachment system.

Figure 7.5 (a,b) Two maxillary implants to retain a maxillary complete denture. Note that the full palate will provide tissue support and that the denture flanges have been constructed to help maximize conventional denture retention.

Figure 7.6 (a,b) Four implants in the maxillary arch and four implants in the mandibular arch. Implant overdentures were constructed that are totally implant supported with no tissue support. (c) Four implants in each arch with retentive ball attachments and gold caps used to retain and support maxillary and mandibular overdentures.

Chapter 10

Figure 10.1 Primary root caries under heavy plaque accumulation: teeth nos. 22–27.

Figure 10.2 Tooth no. 11 shows secondary caries apical to a root carious lesion previously restored with amalgam.

Figure 10.3 Root caries are clinically detectable on most remaining teeth. The clinical crown of tooth no. 11 is completely missing due to caries. Arrow shows an example of root caries.

Figure 10.4 Radiographs taken to determine the extent of the carious lesions (see case study for details).

Chapter 11

Figure 11.1 Dependency ratios for the USA, 2010–2050.

Figure 11.2 Patient with inflamed gingiva and plaque and tartar (calculus) build-up.

Figure 11.3 Patient displaying inflamed gingiva with plaque and tartar (calculus) build-up

Figure 11.4 Patient displaying gingival recession and root exposure.

Figure 11.5 Patient with root caries.

Chapter 12

Figure 12.1 (a) Histologic section of the dental pulp complex of a young tooth (15 years old). Note the dense odontoblast and cell-rich zones. (b) Histologic section of the dental pulp complex of a 59-year-old patient. Note the lesser number of odontoblasts present.

Figure 12.2 (a) Histologic section of the dental pulp complex of a young tooth (15 years old). Note the highly vascularized tissue. (b) Histologic section of the dental pulp complex of a second 59-year-old patient. Note the lesser number of odontoblasts present. Also note the calcifications found in the pulp tissue.

Figure 12.3 (a) A 9-year-old patient with typically young incisors. Note the size of the root canal systems and the incomplete root end development of the three teeth pictured. (b) A 44-year-old patient with restored maxillary central incisors. Note the great change in the size of the root canal spaces, partially attributed to the mesial and distal deposition of tertiary dentin due to composite placement. (c) Maxillary right lateral incisor and central incisor of a 73-year-old patient. Note the absence of restorations with no history of trauma. When compared to Fig. 12.9, the physiologic deposition of secondary dentin is evident.

Figure 12.4 Periapical radiographs of a premolar taken of a male patient at three times over a 40-year period. (a) Mandibular first premolar at age 33. The root canal system can be seem to the apex of the tooth. (b) The same tooth at age 52. (c) The same tooth at age 73 years. The same pattern is seen in a second patient at the same time frames (d, e, f).

Figure 12.5 (a) Low power photomicrograph of an unstained root canal space (ground section) of an upper central incisor typical of a 26–30-year-old individual. Note the size of the root canal space (Original mag. ×20). (b) Low power photomicrograph of an unstained root canal space (ground section) of an upper central incisor typical of a over 71-year-old individual. Secondary dentin fills the entire pulp chamber of the root canal space. Note that the secondary dentin formation is tubular as opposed to atubular dentin. Its formation is due to age and not to caries or placement of restorations.

Figure 12.6 (a) Radiograph of a lower left first molar with little or any coronal structure remaining in a 67-year-old male patient. The patient’s dentist suggests the tooth’s removal and placement of a crown-restored implant. Note the thinness of the root canal systems, probably due to tertriary dentin formation. (b) Radiograph of the same tooth after endodontic therapy and placement of a crown.

Figure 12.7 (a) Radiograph of a lower right first molar in a 71-year-old male patient. Note the large carious lesion at the distal gingival margin below the restoration with successful root canal therapy in the second molar. (b) The caries has been removed and packed with amalgam and the tooth has a second root canal treatment. This case was seen by a periodontist who told the patient that it could not be retained and a crown restored implant would be a better treatment.

Figure 12.8 (a,b) Radiographs of a 73-year-old male patient. Note the almost complete calcification of the root canal systems of the maxillary second premolar and first and second molars. The premolar became sensitive to percussion and biting (Tooth Sleuth®). Endodontic surgery was carried out with placement of a reverse fill amalgam rather than remove the crown.

Chapter 13

Figure 13.1 Pseudomembranous candidiasis.

Figure 13.2 Erythematous candidiasis.

Figure 13.3 Denture stomatitis.

Figure 13.4 Angular chelitis.

Figure 13.5 Median rhomboid glossitis.

Figure 13.6 Hyperplastic candidiasis.

Figure 13.7 Geographic tongue.

Figure 13.8 Hairy tongue.

Figure 13.9 Recurrent intraoral herpes.

Figure 13.10 Irritation fibroma.

Figure 13.11 Leukoplakia.

Figure 13.12 (a) Reticular lichen planus. (b) Erosive lichen planus.

Figure 13.13 Papillary hyperplasia.

Figure 13.14 (a) Minor aphthous ulcers; (b) Major aphthous ulcers; (c) Herpetiform aphthous ulcers.

Figure 13.15 (a) Angular chelitis; (b) poor oral hygiene with debris present; (c) denture stomatitis. See case study for further details.

Chapter 14

Figure 14.1 Dry, cracked (arrows) lips in an elderly patient with medication-induced xerostomia.

Figure 14.2 Dry, red and depapillated, fissured tongue.

Figure 14.3 Root caries, plaque accumulation and dry erythematous oral mucosa due to medication-induced dry mouth.

Figure 14.4 Erythematous, dry palatal mucosa (mucositis) with white plaques indicative of an opportunistic fungal infection caused by

Candida albicans

.

Figure 14.5 (a,b) Posterior bitewing radiographs illustrating multiple primary and secondary caries lesions in a 64-year-old woman with dry mouth and hyposalivation.

Figure 14.6 Maxillary periapical radiograph illustrating multiple interproximal recurrent caries on anterior teeth in a 64-year-old woman with dry mouth and hyposalivation.

Figure 14.7 Mandibular periapical radiograph illustrating multiple recurrent caries lesions on anterior teeth in a 64-year-old woman with dry mouth and hyposalivation.

Figure 14.8 Panoramic radiograph demonstrating the status of dentition at the initial visit.

Figure 14.9 Mandibular periapical radiograph illustrating the anterior teeth after delivery of dentures and prior to radiotherapy for head and neck cancer.

Figure 14.10 Dry palatal mucosa with localized erythema and soreness secondary to radiation and medication-induced xerostomia.

Figure 14.11 Mandibular periapical radiograph illustrating gross caries and retained root tips of anterior teeth in a 59-year-old man with radiation and medication-induced xerostomia. Patient received radiation for treatment of SCCA of the tongue and throat a year ago. Note white plaques on the tongue that are indicative of candidiasis (arrow).

Figure 14.12 Root caries on the remaining mandibular teeth in a 59-year-old man who a year ago received radiation therapy for oral cancer. The teeth were caries free prior to radiotherapy.

Figure 14.13 Dry, pale mucosa in a patient with xerostomia and hyposalivation.

Figure 14.14 Gross coronal caries on mandibular anterior teeth in a patient with xerostomia and hyposalivation.

Figure 14.15 Multiple caries and heavily restored dentition in a patient with xerostomia and hyposalivation.

Chapter 15

Figure 15.1 Worn complete maxillary denture and worn mandibular teeth with ill fitting removable prosthesis (RPD)

Figure 15.2 Orthopantomograph showing resorbed anterior maxilla and worn mandibular teeth

Figure 15.3 Periapical radiographs showing worn dentition and periapical lesion on no. 25

Figure 15.4 (a–d) The restored dentition

Figure 15.5 Maxillary arch, showing the patient’s fixed partial denture, which is removable, and the extensive caries of the abutments

Figure 15.6 Mandibular arch, showing the loss of crowns on teeth nos. 27 and 28

Figure 15.7 Orthopantomograph showing the remaining dentition

Figure 15.8 Shows the immediate maxillary complete denture and the immediate mandibular interim resin removable prosthesis (RPD) in occlusion which restored the patient’s esthetics and function

Figure 15.9 Shows the patient’s healed arches after a year. He has not had any more caries on the abutments and states that he is using the PreviDent® 5000 gel

Figure 15.10 The terminal dentition flowchart for decision making.

Chapter 17

Figure 17.1 Patient information sheet.

Figure 17.2 Consultation form.

Figure 17.3 Algorithm for case study. MCD, Medicaid; MD, medical doctor; SNF, skilled nursing facility.

Chapter 18

Figure 18.1 An over 500 lb patient in an assisted living facility. (Aribex NOMAD-Pro® and DEXIS® images.)

Figure 18.2 A contagious patient in an isolation room setting. (Aribex NOMAD-Pro® and DEXIS® images.)

Figure 18.3 Ergonom-X® self-developing Dental Film.

Figure 18.4 Aseptico portable cart with suction, single canister, and single water bottle.

Figure 18.5 Mobile carts: DNTL Works Port-Op II (left); Forest Dental Cart model 5910 (right).

Figure 18.6 Head lights.

Figure 18.7 Patients can sit in their own wheelchair (a) or chair (b).

Figure 18.8 Rainbow Wrap® (a) and Rainbow® Knee Belts (b).

Figure 18.9 Molt mouth gag.

Figure 18.10 Rainbow® wrap and Jennings prop.

Figure 18.11 Isolite® 5-in-1.

Figure 18.12 Assistant serving as patient’s headrest.

Figure 18.13 Nitrous oxide mask and Open Wide® mouth rest.

Figure 18.14 At the very least, we aim for pain-free and infection-free treatment.

Figure 18.15 Portable hygiene kit with hygienists treating an Alzheimer’s patient in a nursing home.

Figure 18.16 Bed-bound patient having a denture fabricated and delivered at a facility.

Figure 18.17 Ella Mae’s tooth no. 6 is extruded and acutely painful. She joked that she was very “long in the tooth.” (See Case study 1 for more details)

Figure 18.18 DEXIS® instant digital imaging with NOMAD® handheld portable X-ray unit and a laptop computer. (See Case study 1 for more details)

Figure 18.19 The tooth is anesthetized and extracted bedside, providing relief of pain, and restoring normal function to Ella Mae’s quality of life. (See Case study 1 for more details)

Figure 18.20 Two teeth supporting a bridge fracture, causing pain upon closure. (See Case study 2 for more details)

Figure 18.21 The teeth to be extracted are anesthetized. (See Case study 2 for more details)

Figure 18.22 The fractured teeth are extracted bedside. (See Case study 2 for more details)

Figure 18.23 The bridge and fracture teeth are removed. (See Case study 2 for more details)

Chapter 19

Figure 19.1 An oral health promotion model with application to a variety of long-term care (LTC) settings. Created by Wener, Bertone, and Yakiwchuk, 2012

Figure 19.2 Training slide that helps to establish “common ground.” Created by Wener, Bertone, and Yakiwchuk, 2012.

Figure 19.3 Training slide that translates “invisible” oral disease into a visible wound to which caregivers can relate. Reference: Slade

et al.

(2000). Intraoral photograph permission from J. Morreale. Created by Wener, Bertone, and Yakiwchuk, 2012.

Figure 19.4 Training slide that changes the perception of daily mouth care from that of grooming to preventing infection. Created by Wener, Bertone, and Yakiwchuk, 2012.

Figure 19.5 Tailor content to participants needs based on their role in supporting oral health in long-term care. Photographs depict training using a preclinical dental laboratory and reusable product kits. Created by Wener, Bertone, and Yakiwchuk, 2012.

Figure 19.6 Training slide that introduces caregivers to new products helpful for dependent older adults.

Figure 19.7 Training slide to emphasize the impact of effective daily mouth care for both residents and caregivers. Created by Wener, Bertone, and Yakiwchuk, 2012.

Figure 19.8 Training slide that reinforces individualizing mouth care based on level of independence. Created by Wener, Bertone, and Yakiwchuk, 2012.

Figure 19.9 Training slide that provides helpful strategies for individuals that exhibit care resistant behavior (CRB). From Jablonski

et al.

(2011a; 2011b). Created by Wener, Bertone, and Yakiwchuk, 2012.

Figure 19.10 Poster providing the message that oral health is part of total health. Used with permission from the Winnipeg Regional Health Authority and the University of Manitoba Centre for Community Oral Health.

Chapter 20

Figure 20.1 Clinical manifestations of xerostomia. Rampant root caries and coronal caries resulting in unsupported and fractured enamel of mandibular anterior teeth. Note the dry, fissured tongue in the background.

Figure 20.2 The dentition of Ms. W. Note the severity of the gingival inflammation and the supperative fluids accumulating in the buccal vestibules, as well as the flaring teeth.

Figure 20.3 A close up of Ms. W.’s marginal gingiva and the purulent suppuration from the gingival sulci.

Figure 20.4 Ms. W.’s mouth after extractions, alveoloplasty, and suture placement.

Figure 20.5 Ms. W.’s extracted teeth. Observe the many granulomas clinging to several of the teeth roots.

Chapter 21

Figure 21.1 Older population by age from 1900 and projected through 2050. Projections for 2010 through 2050 are from US Census Bureau (2008), Table 12. The source of the data for 1900–2000 is US Census Bureau (2002), Table 5. This table was compiled by the US Administration on Aging using the Census data noted.

Figure 21.2 The PACE model of integrated and team-managed care for older patients. DME, durable medical equipment; OT/PT, occupational therapy/physical therapy.

Figure 21.3 Steps in clinical decision making for geriatric dental patients.

Guide

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Table of Contents

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xi

Geriatric Dentistry

Caring for Our Aging Population

Edited by

Paula K. Friedman DDS, CAGS, MSD, MPH

Past President, American Society of Geriatric Dentistry

Professor and Director

Geriatrics and Gerontology Section

Department of General Dentistry

Henry M. Goldman School of Dental Medicine

Boston University

Boston, MA

USA

This edition first published 2014© 2014 by John Wiley & Sons, Inc.

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List of Contributors

Douglas Berkey, DMD, MPH, MSProfessor (Emeritus)University of Colorado School of Dental MedicineAurora, CO, USA

Mary Bertone, RDH, BScDHCentre for Community Oral HealthFaculty of DentistryUniversity of ManitobaWinnipeg, MB, Canada

Jayne E. Cernohous, DDSAssociate ProfessorDepartment of Dental HygieneMetropolitan State UniversitySt. Paul, MN, USA

Elisa M. Chávez, DDSAssociate ProfessorDepartment of Dental PracticeDirector, Pacific Dental Program at Laguna Honda HospitalUniversity of the PacificArthur A. Dugoni School of DentistrySan Francisco, CA, USA

Jessica De Bord, DDS, MSD, MAPediatric DentistChildren’s VillageYakima, WA, USA;Affiliate Assistant ProfessorDepartment of Pediatric DentistryUniversity of WashingtonSeattle, WA, USA

Teresa A. Dolan, DDS, MPHVice President and Chief Clinical OfficerDENTSPLY InternationalYork, PA, USA;Professor and Dean (Emeritus)University of Florida College of DentistryGainesville, FL, USA

Diane Ede-Nichols, DMD, MHL, MPHChairpersonDepartment of Community DentistryNova Southeastern University College of Dental MedicineFort Lauderdale, FL, USA

Ronald L. Ettinger, BDS, MDS, DDSc, DABSCDProfessorDepartment of ProsthodonticsDows Institute for Dental ResearchUniversity of Iowa College of DentistryIowa City, IA, USA

Ruth S. Goldblatt, DMD, FAGD, FASGD, DABSCDAssociate Clinical ProfessorDepartment of Craniofacial SciencesUniversity of Connecticut, School of Dental MedicineFarmington, CT, USA

Harold E. Goodis, DDSProfessor EmeritusUniversity of California School of DentistrySan Francisco, CA, USAChief Executive Officer/Chief Academic OfficerBoston University Institute for Dental Research and EducationDubai, UEA

Dick Gregory, DDSSchool of DentistryUniversity of CaliforniaSan Francisco, CA, USA

Saroj Gupta, DDSDepartment of PeriodonticsUniversity of MarylandBaltimore, MD, USA

Kelly A. Halligan, DDS, PCPrivate PractitionerColorado Springs, CO, USA

Timothy J. Halligan, DMD, ABGD, DABSCDDirector, Advanced Education in General Dentistry (AEGD)Consultant Surgeon General Hospital DentistryUnited States Air Force Dental CorpsColorado Springs, CO, USA

Jadwiga Hjertstedt, DDS, MSClinical Associate ProfessorDepartment of Clinical ServicesMarquette University School of DentistryMilwaukee, WI, USA

Susan Hyde, DDS, MPH, PhD, FACDAssociate Professor of Preventive and Restorative Dental SciencesChair, Division of Oral Epidemiology and Dental Public HealthInterprofessional Education Faculty Lead, DentistryDirector for Dentistry, Multidisciplinary Fellowship in GeriatricsSchool of DentistryUniversity of CaliforniaSan Francisco, CA, USA

Deborah A. Jacobi, RDH, MAAssociate DirectorHelping Services for Northeast IowaDecorah, IA, USA

Teresa E. Johnson, DDS, MS, MPH, FASGD, DABSCDEducation and Quality Assurance DirectorApple Tree DentalMinneapolis, MN, USA

Peter Y. Kawamura, DDS, MS, FASGD, DABSCD, FACDStaff Geriatric Dentist/ProsthodontistDepartment of Veterans Affairs Medical CenterSan Francisco, CA, USA

Bassam M. Kinaia, DDS, MSAssociate ProfessorDepartment of Periodontology and Dental HygieneUniversity of Detroit-Mercy School of DentistryDetroit, MI, USA

Harvey Levy, DMD, MAGD, DABSCDDepartment HeadFrederick Memorial HospitalFrederick, MD, USA

Paul Mulhausen, MD, MHSChief Medical OfficerTelligenWest Des Moines, IA, USA

Miriam R. Robbins, DDS, MSClinical Associate ProfessorDirector, Special Needs ClinicAssociate ChairDepartment of Oral and Maxillofacial Pathology, Radiology, and MedicineNew York University College of DentistryNew York, NY, USA

Ralph H. Saunders, DDS, MSProfessorEastman Institute for Oral HealthUniversity of RochesterRochester, NY, USA

Mary R. Truhlar, DDS, MSInterim DeanProfessor and ChairDepartment of General DentistrySchool of Dental MedicineStony Brook UniversityStony Brook, NY, USA

Mickey Emmons Wener, RDH, BS(DH), MEdSchool of Dental HygieneFaculty of DentistryUniversity of ManitobaWinnipeg, MB, Canada

Michael Wiseman, DDS, M SND, RCS(Edin), FASGDAssistant ProfessorFaculty of DentistryMcGill UniversityMontreal, QC, Canada;Chief of DentistryMount Sinai HospitalMontreal, QC, Canada

Bei Wu, PhDProfessorSchool of Nursing and Global Health InstituteDuke UniversityDurham, NC, USA

Carol-Ann Yakiwchuk, RDH, BScDH, MHSFaculty of DentistryUniversity of British ColumbiaVancouver, BC, Canada

Janet A. Yellowitz, DMD, MPH, FASGD, DABSCDDirector, Geriatric DentistryDirector, Special Care DentistryAssociate ProfessorDepartment of PeriodonticsUniversity of Maryland Dental SchoolBaltimore, MD, USA

Dedication

This book is dedicated to a number of significant individuals in my life:

My mother, Beatrice Gibbs, who demonstrated every day of her life what it meant to age successfully. She was my inspiration, my supporter, and a role model of a woman achiever in a time when there were very few women pushing boundaries.

My husband Emanuel, who encouraged me throughout the extensive and demanding writing and editing process. He never complained about the amount of time I spent on this legacy project. He shares my passion for accomplishing goals, and I am grateful for his continual support.

My patient, committed, responsive, and receptive contributors. The book could not have happened without all of you.

Introduction

Caring for and about our aging population has been a priority for me since I was a child. I had a close relationship with my grandmother and grandfather. They were warm, wonderful people. When my grandmother was in her 60s, she developed Alzheimer’s disease. It was painful to witness her slow, inexorable decline. My grandfather was a strong man in his youth – a wrestling champion, in fact, before he immigrated to the United States. But he too suffered the wounds and arrows of aging. Although he retained his mental sharpness, his physical status belied his mental acuity.

From the moment that each of us is born, we are aging. For some, the prospect of aging is a very serious matter. And there is no doubt that there may be serious issues associated with aging, including health issues, mental status, financial considerations, and housing and transportation challenges. However, there is humor associated with the aging process. Consider that aging is a very relative term. To a teenager, someone aged 25 is “old.” Many of our patients, themselves senior citizens (often in their late 80s), refer to neighbors, friends, co-residents in assisted living facilities as “they are so old,” when, in fact, the people to whom they refer are in their 90s and the person speaking may be aged 88 or 89. New phraseology has arisen to describe our aging phenomenon, such as “60 is the new 40,” or professionally speaking, “Age is just a number; it is functional status that counts.” Here is an important fact about the US population:

The age cohort of 85 and older is the most rapidly growing age cohort in the country, and the subset of that population called the “centenarians” is the quickest growing segment percentage-wise.

The rapidly growing baby boomer cohort in the USA is turning 65 at the rate of approximately 10 000 people per day, and will continue to do so for approximately 15 more years by the time this book is published. The paradox that faces us is that although the aging population is increasing, to a large extent they are invisible – in a social sense, in a healthcare sense, and in a public policy sense.

The “demographic imperative,” or the mandate of the numbers, makes clear that the training of all health professionals must include information about how to care for our aging population. This book was conceived on the premise that there were a number of very good books on geriatric dentistry that were robust reviews of the literature and full of evidence-based information and conclusions. There is far less resource information available on the practical aspects of treating and caring for elders, a “how to” guide, of sorts. This book is intended to address that void in the literature. The intended audiences are widely defined: dental students, dentists, hygiene students, hygienists, mid-level providers, allied (non-dental) health providers, and the lay public. Each of the author contributors was charged with providing the most practical information possible in their assigned/chosen area. We tried to include case studies, where appropriate, in each chapter to illustrate the content in a practical clinical application.

The reader will note a number of terms used throughout the book that are intended to be synonymous. They were not changed out of respect for the integrity of each contributor’s work. Throughout the text, the terms “aged,” “geriatric,” “older adults,” “senior citizens,” and “elders” are all interchangeable. Terms like “cognitively impaired,” “Alzheimer’s disease,” and “dementia” are similarly synonymous. We did not make all chapters read with the same terminology because all of those terms are commonly used in discussions by and with patients and families. Although the editor contributed to each and every chapter, the editor elected not to include her name as a co-author because the primary work of each chapter is that of the listed contributors.

A word about the process of writing and editing a book: I am confident that few of the contributors fully understood the magnitude of the time commitment that each was making in agreeing to participate in this endeavor. We are fortunate to have a combination of well-known, esteemed experts in the field and some newer authors whose contributions are equally valued. Our original timeline was extended a little bit due to a number of factors; the overarching theme for people not being able to meet original commitments is that “life happens.” During the process of writing this book, we collectively experienced health, marriage, birth, death, illness, and recovery. Despite the powerful impact of life on the authors, people maintained their dedication and commitment to getting the job done. The motivation that drove everyone, I believe, was that we each want to leave a legacy of our knowledge and experience to pass on to dental providers of the future. There is no doubt that techniques, methodology, and materials may change over time, but the underlying tenet of the importance of caring for our aging population will always remain the same.

The book is organized into six sections: Underlying Principles of Aging, Clinical Practice, Decision Making and Treatment Planning, Common Geriatric Oral Conditions and their Clinical Implications, Care Delivery, and Future Vision. Each section contains a number of chapters and topics. In the section on Underlying Principles of Aging (Part 1), we will learn about implications for the oral cavity, racial and ethnic disparities in oral status and aging, death and dying, palliative care, and functional status. The next section (Part 2) is Clinical Practice. In this section, legal and financial considerations for the provider including living arrangements (assisted living and continuous care communities), informed consent, and advanced directives/living will, the Palmore’s “Facts on Aging” attitudinal instrument, and practical tips and techniques for creating a senior-friendly dental office are discussed. Part 3 covers Decision Making and Treatment Planning. In this section, assessing the elderly patient, treatment considerations, and evidence-based practice are covered. Part 4 addresses common geriatric oral conditions and their clinical implication. In this section, we learn about root caries, periodontal disease, diseases of the pulp, diseases of the oral mucous membranes, xerostomia, prosthetic considerations, and medical complexities. Part 5 focuses on care delivery, including delivery systems – nursing home dentistry, portable dentistry, home visits, and senior centers. Additionally, this section informs the reader about oral health care in long-term care facilities (including policies and practice); dental professionals as part of an interdisciplinary team and the expanding oral health team. The final part, Part 6, consists of a visionary and challenging chapter “Planning for the Future,” which includes political implications and potential professional initiatives. Chapters may complement/supplement other chapters, but each is designed to provide information independent of other chapters.

Everyone who worked on this book is a champion. The contributors each gave of himself or herself to make this the best book possible. My liaison with Wiley Blackwell, Nancy Turner, gave regular guidance and support and was an additional invaluable interface with the authors. It is our collective hope and expectation that the many years of expertise reflected in the pages of these chapters will help to reinforce the importance of oral health to overall health in our aging population, and moreover will provide the tools, techniques, and resources for those committed to improving the oral health status of our aging population. We hope that you will use the valuable contents to benefit someone you care for, care about, or will care for in the future.

Paula K. Friedman, DDS, MSD, MPH

Editor

PART 1Underlying Principles of Aging

Chapter 1Aging: Implications for the Oral Cavity

Bei Wu

School of Nursing and Global Health Institute, Duke University, Durham, NC, USA

Aging of the US population

The US aging population is increasing. The US older population, that is individuals aged 65 and older, reached 40.3 million in 2010. This is an increase of 5.3 million compared to the 2000 census. The percentage of the US population aged 65 and older also increased from 2000 to 2010. In 2010, the older population represented 13.0% of the total population, an increase from 12.4% in 2000 (Vincent & Velkoff, 2010). In the USA, by 2030 it is projected that there will be about 72.1 million older people, more than twice their number in 2000. Individuals aged 65 and older are expected to grow to become 19% of the US population by 2030 (Administration on Aging, 2012). By 2050, it is projected that there will be about 88.5 million older adults, 20.2% of the US population (US Census Bureau, 2008a).

Ethnic diversity

The US population is becoming increasingly diverse, and this is true for the aging population too. In the USA, among those aged 65 and older in 2050, 77% of the elder population are projected to be White-alone, down from 87% in 2010. Within the same age group, 12% are projected to be Black-alone and 9% are projected to be Asian-alone in 2050, up from 9% and 3%, respectively, in 2010. The Hispanic proportion of the older population is projected to quickly increase over the next four decades. By 2050, 20% of the US population aged 65 and over are projected to be Hispanic, up from 7% in 2010. The smallest race groups are projected to see the largest growth relative to their populations. Among the population aged 65 and older, it is projected that in 2050, the American Indian and Alaska Native-alone population will be 918 000, up from 235 000 in 2010, and the Native Hawaiian and Other Pacific Islander-alone population will be 219 000, up from 39 000 in 2010 (Vincent & Velkoff, 2010). There is also a trend of increasing number of old-old (age 75 and older) and oldest-old (age 85 and older) populations in the USA. The old-old and oldest-old carry much of the chronic disease burden in the population.

In the USA, among those aged 65 and older in 2050, the White-alone population will comprise approximately 77% of the aging population, whereas in 2010 the racial composition of the elder population was 87% White-alone, 9% Black, 3% Asian-alone, 7% as Hispanics, and 0.6% American Indian and Alaska Native. Between 2010 and 2030, the percentage of minority elders will increase much faster than the White population. The White population aged 65 and older is projected to increase by 59% compared with an average increase of 160% for older minorities, including Hispanics (202%), African Americans (114%), American Indians, Eskimos and Aleuts (145%), and Asians and Pacific Islanders (145%) (Administration on Aging, 2012).

While an increasing number of studies have examined oral health disparities across race/ethnicity in the USA, a limited number of such studies have been conducted for older adults. Policy makers, public health officials, and other healthcare providers need to better understand how social factors, along with medical conditions, may contribute to racial/ethnic disparities in oral health with the demographic transitioning to a more diverse older population in the USA (US Census Bureau, 2008b).

A report from the Surgeon General (US Department of Health and Human Services, 2000) noted ongoing racial/ethnic disparities in oral health across all ages, and it stressed the need for research to explain these differences. The first step towards explaining the disparities is to know how oral health differs between the groups.

Trends in oral health in older adults

There is substantial evidence that oral health in the USA has significantly improved in the past four decades. Dye et al., using data from the National Health and Nutrition Examination Survey (NHANES, III, 1988–1994) and NHANES 1999–2004, found that the oral health of the USA has substantially improved during this period (Dye et al., 2007). Specifically, Dye et al. show that the rates of periodontal disease and caries have decreased for most age groups.

Edentulism, or complete tooth loss, is one of the most important indicators of oral health. Edentulism reflects both the accumulated burden of oral diseases and conditions and the result of dental extraction treatment (Sanders et al., 2004). Studies suggest that edentulism significantly affects quality of life, self-esteem, and nutritional status (Nowjack-Raymer & Sheiham, 2003; Slade & Spencer, 1994; Starr & Hall, 2010). In economically developed countries, the trend of edentulism has declined consistently. For example, in England and Wales, the prevalence of edentulism for the adult population declined from 37% in 1968 to 12% in 1998 (Kelly et al., 2000). In Australia, the prevalence of edentulism for the adult population declined from 20.5% in 1979 to 8.0% in 2002. Among Australian older adults aged 65 and older, the reduction for males was from 59.7% to 26.5%, and for females was from 71.5% to 40.3% (Sanders et al., 2004). Similarly in the USA, the few studies available on middle-aged and older adults have shown that edentulism in these age groups has been dropping for the past several decades. One study revealed that within the period of 1971 and 2001, for those in a low socioeconomic position (SEP), the prevalence of edentulism declined from 50% to 32% in adults aged 55–64 and from 58% to 43% in adults aged 65–74; the comparable declines for these age groups for individuals in a high SEP were from 22% to 6% and from 30% to 9%, respectively (Cunha-Cruz et al., 2007). A report conducted by the US National Centers for Health Statistics using the US National Health and Nutrition Surveys of 1988–1994 (NHANES III) and NHANES 1999–2004 found that the prevalence of edentulism declined in the USA over these two time periods from 34% to 27% among adults aged 65 and older (Dye et al., 2007).

In the USA, minority elders have been identified as a key demographic group at greatest risk for edentulism (US Department of Health and Human Services, 2000). Black elders, in particular, have higher rates of edentulism than non-Hispanic Whites and Mexican Americans (Dye et al., 2007; Schoenborn & Heyman, 2009; Wu et al., 2011a). One study reported that the rates of edentulism among Blacks were declining, even though they were still higher than other ethnic groups (Dye et al., 2007). This study reported that the rates of edentulism for Black elders declined from 38% in 1988–1994 to 33% in 1999–2004 (Dye et al., 2007). For Whites, the percentages were much lower: 34% in 1988–1994 and 26% in 1999–2004. By comparison, Mexican American adults had even lower edentulism rates (27% and 24%, respectively).

Information regarding edentulism for Asian Americans and Native Americans is very limited. A recent report determined that 21% of Asian Americans aged 65 and older had lost all of their teeth compared to 25% of Whites. Asian Americans also had the lowest percentage of edentulism compared to other minority groups (Schoenborn & Heyman, 2009). The Third Oral Health Survey conducted by the Indian Health Service in 1999 found that 21% of Native American adults aged 55 and older were edentulous, representing a decrease of 5% over 15 years (Indian Health Services, 2001).

One recent study examined the trend of edentulism among adults aged 50 and older in five ethnic groups: Asians, Blacks, Hispanics, Native Americans, and non-Hispanic Whites (Wu et al., 2012a). This study used the National Health Interview Survey (NHIS), which is a cross-sectional household interview survey conducted annually. Ten waves of NHIS data were aggregated from 1999 to 2008. Eligible respondents were those aged 50 and older who completed the question on tooth loss. The sample included 616 Native Americans, 2666 Asians, 15 295 Blacks, 13 068 Hispanics, and 86 755 non-Hispanic Whites. Self-reported responses to a question about whether the individual had lost all upper and lower natural teeth were used to determine edentulism. Results show that for the past 10 years, there was an overall declining trend of edentulism for all racial and ethnic groups, except for Native Americans (Table 1.1). Table 1.1 presents the predicted rate of edentuliusm adjusting for time, sociodemographic characteristics and level of education. In 2008, Native Americans had the highest rate of edentulism (23.98%), followed by Blacks (19.39%), Whites (16.90%), Asians (14.22%), and Hispanics (14.18%). Figure 1.1 presents the trend of predicted rate of edentulism adjusting for time, sociodemographic characteristics and level of education.

Table 1.1 Trend of edentulism by racial/ethnic groups (1999–2008) (%) (weighted)a

From Wu et al. (2012a).

Year

White

Black

Hispanic

Asian American

Native American

1999

21.49

24.62

17.78

17.04

33.20

2000

21.18

23.74

17.60

13.54

34.02

2001

20.20

23.02

17.71

11.88

31.78

2002

19.77

22.42

16.68

13.55

29.72

2003

18.90

21.78

16.21

15.88

29.67

2004

18.80

20.60

15.44

14.09

28.12

2005

17.98

20.65

15.13

13.57

24.72

2006

17.58

20.62

15.20

15.26

30.18

2007

17.05

19.58

14.74

14.08

27.07

2008

16.90

19.39

14.18

14.22

23.98

aThe predicted rates of edentulism were calculated adjusting for time, race/ethnicity, sociodemographic characteristics, and level of education.

Figure 1.1 Predicted rate of edentulism.

From Wu et al. (2012a).

This is the first study to provide national estimates for the rate of edentulism and associated trends over time for five major ethnic groups in the USA simultaneously: Native Americans, Asian Americans, Blacks, Hispanics, and non-Hispanic Whites. Significant disparities in edentulism exist across these ethnic groups. Relative to Whites, Blacks and Native Americans had a higher rate of edentulism, whereas the rate of edentulism was lower among Hispanics and Asians. After controlling for covariates (e.g., sociodemographic characteristics, smoking, and common chronic conditions), Blacks and Hispanics were less likely to be edentulous than White respondents, while Native Americans were still more likely to be edentulous. In contrast, when covariates were included in the models, no significant differences were found between Asian Americans and Whites in edentulous rates. Overall, there was a significant downward trend in edentulism rates between 1999 and 2008; however, oral health disparities, as measured by rates of edentulism, increased among Native Americans over time compared to Whites.

The improvement in tooth retention was not equally distributed across the five racial and ethnic groups examined in this study. Native Americans, in particular, were at a significant disadvantage. Compared to Whites, Native Americans were more likely to lose natural teeth over time, but the risk became smaller after controlling for individuals’ socioeconomic status, health behaviors, and medical conditions. This study found that edentulism has continued to decline across the USA during the past decade. This comprehensive study supports previous reports about edentulism among adult populations collected in earlier time periods and across selected racial/ethnic groups (Dye et al., 2007; Indian Health Services, 2001; Schoenborn & Heyman, 2009).

One study found that current smoking and fewer years of education were two of the covariates most strongly associated with being edentulous (Wu et al., 2012a). Others have attributed the declining edentulous rate to the decrease in smoking and the increasing years of education among more recent cohorts (Cunha-Cruz et al., 2007). The authors also found that selected medical conditions were associated with edentulism; these were generally consistent with previous research (Holm-Pedersen et al., 2008). Self-reported memory problems and needing assistance with routine activities were also associated with increased risk of edentulism. Given the fact that the information on covariates was not collected prospectively, the authors cannot determine whether the factor preceded the edentulism. Many other factors could also contribute to the decrease of the edentulous rate, such as the introduction of fluoridation through community water treatment (Adair et al., 2001) and fluoridated toothpaste and mouth rinse (Featherstone, 1999; Marthaler, 2004). Health practices such as dietary supplements, and professionally applied or prescribed fluoride gel, foam, and varnish may also contribute to improved tooth retention (Adair et al., 2001; Marthaler, 2004; Weyant, 2004). Others point to advancements in dental technologies and treatment modalities, changes in patient and provider attitudes and treatment preferences (Starr & Hall, 2010), improved oral hygiene, and regular use of dental services (Eklund, 1999; Starr & Hall, 2010; Truman et al., 2002).

Oral health disparities in older adults

Some studies have reported that older Hispanic and Black Americans have more missing teeth, and decayed teeth than their White counterparts (Kiyak et al., 2002; Quandt et al., 2009; Randolph et al., 2001; Watson & Brown, 1995). Using the US National Health and Nutrition Examination Survey (NHANES 1999–2004), a Centers for Disease Control and Prevention (CDC) report found that both Blacks and Mexican Americans have a higher prevalence of untreated tooth decay and missing teeth than Whites (Dye et al., 2007). However, Mexican American adults were least likely to have lost all teeth compared to Whites and African Americans (Dye et al., 2007). In fact, a few studies have suggested that older Black adults have even worse oral health than Hispanics (Borrell et al., 2004; Craig et al., 2001; Kiyak et al