ORAL HEALTH FOR AN AGEING POPULATION FORUM
Prevention of tooth loss and dental pain for reducing the global burden of oral disease
Susan Hyde
FDI World Dental Congress 2016 Poznań
2024: The FAR, Federal Acquisition Regulations, Part 31
Prevention of tooth loss and dental pain for reducing the global burden of oral disease (Susan Hyde)
1. Prevention of tooth loss
and dental pain for
reducing the global
burden of oral diseases
FDI World Dental Congress
Oral Health for an Ageing Population
Poznan, Poland September 7-10, 2016
Susan Hyde, DDS, MPH, PhD
Sophie Dartevelle, DDS
Veronique Dupuis, DDS, PhD
Boipelo P. Mariri, DDS, MS
September 10, 2016
2. Outline
• Life course approach
• Global burden of oral diseases
– Community-dwelling
– Homebound and long-term care residents
• Disease models, risk assessment
• Effectiveness, cost analysis, and
recommendations for preventive interventions
– Seattle Care Pathway
– Alternative models of care
– Interprofessional opportunities
• Oral health policy
2
3. Thomson et al.
Community Dent
Oral Epidemiol.
2004
Centers for
Disease Control
and Prevention.
USDHHS 2013.
Life-course Approach to Oral Health
• Caries and periodontal disease are chronic
conditions, highly prevalent, largely irreversible,
and cumulative in nature
– Social inequities follow the life course
– Unconscious bias affects oral health and treatment
• Older adults present with wide-ranging clinical
needs and levels of wellbeing
– Two-thirds of older Americans have multiple chronic
diseases
– Functional limitation decreases the ability for self-
care
– Polarized delivery of dental care during the last year
of life
Chen et al. J Am
Dent Assoc 2013.
4. Global Burden Untreated Caries = 35%
4Image = http://www.map-menu.com/
47%
20%
21%19% coronal
14% root
Age-standardizedKassebaum et al.
J Dent Res 2015.
5. Global Burden Severe Periodontitis = 11%
5Image = http://www.map-menu.com/
10%
51%
19%
Aged 65+ yearsKassebaum et al.
J Dent Res 2014.
6. Global Burden Severe Tooth Loss = 2.3%
6Image = http://www.map-menu.com/
Aged 65+ years
30%
9%
19%
Average
19 teeth
Kassebaum et al.
J Dent Res 2014.
7. Global Burden Oral Diseases
7Image = http://www.map-menu.com/
Oral Conditions Combined = 15 million DALYs
Average Health Loss = 224 years/100,000 population
Economic Burden = $USD442 billion
Marcenes 2013.
Listl 2015.
8. Frail Older Adults
• Oral disease estimates of homebound adults
– Poor oral health (79% caries), high unmet need (34%
pain) and preference for in-home dental services (94%)
• Oral disease estimates in long-term care
– 59% of dentate have untreated caries (34% major-
urgent treatment needs), 74% gingivitis
– 50% of edentulous don’t have dentures
• Assessment, daily oral care, and referral
– Assessment = 78% performed by nurses
– Daily oral hygiene = 25% missing products, 16%
received assistance
– Barriers to care = shortage of dental professionals,
complexity of patient and environment, cost of dental
care, insurance status, and low reimbursement
8
MA Dept Pub
Health Office of
Oral Health 2010.
Dharamsi et al. J
Dent Educ 2009.
Coleman and
Watson. J Am
Geriatr Soc 2006.
Ornstein et al. J
Am Geriatr Soc
2015.
9. Multifactorial Model Dental Caries
9Image = http://www.nap.edu/read/13086/chapter/4
Fisher-Owens et
al. Pediatrics
2007.
12. Root Caries Prevention
Recommendations
• Community-dwelling older adults: triclosan-
fluoride or amorphous calcium phosphate-
fluoride toothpaste
• Frail older adults: 5000ppm fluoride toothpaste
and quarterly-application of
chlorhexidine/fluoride varnish or yearly silver
diamine fluoride is effective to decrease
progression and initiation of root caries
12
Gluzman et al.
Spec Care Dent
2013.
Wierichs et al. J
Dent Res 2015.
Gluzman et al.
Spec Care Dent
2013.
13. Multifactorial Model Periodontitis
13
Image = https://static-content.springer.com/image/art%3A10.1186%2F1472-6831-15-
S1-S6/MediaObjects/12903_2015_Article_521_Fig2_HTML.jpg
Mariotti and Hefti.
BMC Oral Health
2015.
16. Periodontitis Prevention
Recommendations
• Daily oral hygiene more effective for removing
plaque and preventing gingivitis than periodic
prophylaxis
– Powered toothbrushes, interdental brushes or floss,
triclosan toothpaste, chlorhexidine, and Listerine
provide adjunctive plaque control
– Repeated and tailored oral hygiene instruction is key
• Interventions which reduce plaque and
gingivitis do not translate into preventing
periodontitis or tooth loss
16
Matthews 2014.
Van Leeuwen 2014,
Yaacob 2014,
Poklepovic 2013,
Riley 2013, Van
Strydonck 2012.
Tonetti 2015.
Riley 2013,
Wayatt 2007.
17. No Dependency Pre Dependency Low Dependency Medium
Dependency
High Dependency
Description Fit, exercises
regularly
Well-controlled
chronic disease
Chronic disease
affects oral
health,
independent
Chronic disease,
ADL dependency,
home-bound
Complex medical
management,
long-term care
Assessment Oral health risk
assessments
Salivary flow Cause of
increasing
dependency
Polypharmacy,
ability to tolerate
treatment
Medical,
pharmacy, diet
assessments
Prevention 1100ppm F paste Powered brush, F
rinse
5000ppm F
paste, F varnish
Recall q3 months,
chlorhexidine
Silver diamine
fluoride
Treatment Full range of
treatment options
Plan easy
maintenance
treatment with
long-term viability
Repair/replace
strategic teeth to
maintain
shortened arch
Maintain
shortened dental
arch, F-releasing
restorations, ART
Palliative care
Communication Oral hygiene
instructions
Oral:systemic
health
connections
↑ dependency =
↑ oral health risk
Health care team,
caregivers
Director of
Nursing, family,
caregivers
.
Pretty et al.
Gerodontology 2014
18. 18
Alternative Models of Care
Small Private Group Practice Large Corporate/Non-Profit
Solo Cooperative Collaborative Interprofessional
Business Model
Practitioner Organization
Mertz, Wides.
Oral Health
Workforce
Research Center
2015.
19. Interprofessional Opportunities
• Prevention
– Common risk factor approach
• Collaborative care model
– Diabetes toolkit for pharmacy, podiatry, optometry,
and dentistry
• Long-term care
– Increased presence of dental providers
– Training care providers in assessment and daily oral
care
MA Dept Pub
Health Office of
Oral Health 2010.
http://www.cdc.go
v/diabetes/ndep/to
olkits/ppod.html
Image = https://interprofessional.ucsf.edu
Watt. Community
Dent Oral
Epidemiol 2007.
21. Summary
• Untreated caries, periodontitis, and tooth loss
are prevalent among older adults
– Caries prevention treatments shown to reduce new
lesions
– Periodontitis prevention treatments not shown to
reduce attachment loss or tooth loss
• Assessment, prevention, treatment, and
communication must be provided appropriate to
the level of dependency
– Chronic disease prevention and management can
benefit from interprofessional collaboration
• Evidence-based practice needs to inform oral
health policy
21
Notes de l'éditeur
25-30 minutes, 2-1/2 hours total, 5 speakers, 25 min discussion
