This document discusses the importance of retaining teeth for an aging population. It notes that tooth loss leads to the loss of important structures and functions like mastication and speech. Retaining teeth is important for diet, quality of life, cognition, and longevity. Standards for oral health in older adults include indicators of tooth retention and disease. Studies show that fewer teeth are associated with poorer nutrition, lower quality of life, higher risk of dementia, disability, and mortality. Improving oral hygiene can reduce the risk of pneumonia in elderly patients.

1. Oral Health for an Ageing Population
Tooth loss and importance of retaining teeth for
vitality, quality of life and longevity
Martin Schimmel on behalf of Frauke Müller
Département de Médecine Interne, de Réhabilitation et de Gériatrie
Division de Gérodontologie et Prothèse Adjointe, CUMD
Hôpitaux
Universitaires
Genève

2. Lost structures
 teeth/ periodontium
 alveolar bone
 tm-joints
 gingiva / mucosa
 muscles
 nerves / vessels
Functions
 mastication
 orale perception
 occlusion
 speech
 aesthetics / physiognomy
 psycho-social aspects
physical
retention
occlusion
motor skills

3.  Current status of tooth loss
 Why retaining and restoring teeth is important ?
 Diet and teeth
 Quality of life and teeth
 Cognition and teeth
 Longevity and teeth
 Standards and priorities
 Standard indicators
 Standard set of «perception» data from patients

4. Prevalence of edentulousness in the
elderly reported for selected countries
The global burden of oral disease and risks to oral health.
PE Petersen, D Bourgeois, H Ogawa, S Estupian-Day, C Ndiaye
Bulletin of the World Health Organisation 83 (9) 2005

5. Dental Health of the Elderly Population
0,1 %0,1 %
of 65-74 yr olds have a sound dentition and no caries experience
Schiffner U: Krankheits- und Versorgungsprävalenzen bei Senioren (65-74 Jahre)
In: Institut der Deutschen Zahnärzte: DMS V, Deutscher Ärzte Verlag, Köln 2016

6. Mojon et al.
Int J Proshodont (2004)
Prognosis for the decline in edentulism
4 countries with reliable data

7. Prosthodontic Restoration and Age
Data from 2002 cited after Zitzmann et al. European J Oral Sciences 2008
Age Prostheses fixed removable C/C

8. Oral Health of Patients with Dementia
Syrjälä, H et al. Dementia and oral health among subjects aged 75 years or older. Gerodontology (2010)
Patients with dementia had an increased likelihood of having carious
teeth, teeth with deep periodontal pockets, and poor oral and denture
hygiene, compared with non-demented persons

9.  Current status of tooth loss
 Why retaining and restoring teeth is important ?
 Diet and teeth
 Quality of life and teeth
 Cognition and teeth
 Longevity and teeth
 Standards and priorities
 Standard indicators
 Standard set of «perception» data from patients

10. Prevalence of Malnutrition in Institutionalized Persons
Pauly L et al. Nutritional situation of elderly nursing home residents. Z Gerontol Geriat 40:3 3-12 (2007)

11. Edentate
n=287
1-10 teeth
n=131
21+ teeth
n=123
Energy (Kcal) 1583 1700 1842
Protein (g) 60 66 71
Fat (g) 64 67 67
Non-starch Polysaccharide (g) 11 13 16
Calcium (mg) 722 825 884
Vitamin A (μg) 1036 1374 1268
Vitamin C (mg) 60 82 83
Niacin (mg) 27 33 32
Vitamin E (mg) 8 10 12
SHEIHAM A et al.: The Relationship among Dental Status, Nutrient intake and
Nutritional Status in Older People. J Dent Res 80: 408-413 (2001)

12. tooth loss ↑
calcium and vit D
and protein intake ↓
BMD ↓
altered
food choice
(von Wovern 2001; Geuers 2000;Millwood 2000)

13. Transformation of a complete denture to an
implant-overdenture : effect on nutrition
RCT with 255 participants aged 65 years or older
Randomisation
 Conventional complete dentures (n=114)
 Conventional upper and lower implant-overdentures (n=103)
Outcome parameters (1-year observation period)
 fibre intake
 macro- and 9 micro-nutriments
 total energy (kcal)
Hamdan N, Albuquerque R, Gray-Donald K, Feine J: A Mandibular Implant Overdenture: Is It A
Nutritionally Significant Choice? J Dent Res 92(Spec Iss A):231, 2013
Implant-overdentures cannot improve the nutritional intake of
edentulous persons

14. chewing capacity
nutritional state
food choice
psychosocial
factors
psychological
factors

15. BMI and Mortality in Elderly Patients
Weiss A. et al. Journal of General Internal Medicine, 23(1) 19-24 (2007)
n = 470 hospitalized
patients
age 81.5 years
observation period 4.2
years
In elderly patients, a high BMI is associated with a reduced mortality

16.  Current status of tooth loss
 Why retaining and restoring teeth is important ?
 Diet and teeth
 Quality of life and teeth
 Cognition and teeth
 Longevity and teeth
 Standards and priorities
 Standard indicators
 Standard set of «perception» data from patients

17. Social Aspects
communication
social interactions
Signs of Age:
functional impairment
Oral Health related Quality of
Life (OHRQOL)
Psychological
appearance
self-esteem
Pain / Discomfort
acute / chronic
modified after INGLEHART 2002

18. 32-25 24-21 20-17 16-9 8-1
0
1
2
3
4
5
6
7
8
<30 Jr 30-49 50-69 70+
0
1
2
3
4
5
6
7
8
age [ years]
Data from Steele et al.: How do age and tooth loss affect oral health impacts and qulaity of life? Community Dent Oral
Epidemiol 32:107-14 (2004)
OHIPscore
no of teeth present
Oral Health Related Quality of Life (OHRQoL)
evaluated by OHIP-14 ( Oral Health Impact Profile )

19.  Current status of tooth loss
 Why retaining and restoring teeth is important ?
 Diet and teeth
 Quality of life and teeth
 Cognition and teeth
 Longevity and teeth
 Standards and priorities
 Standard indicators
 Standard set of «perception» data from patients

20. Tooth Loss, Dementia and Neuropathology
- the Nun Study -
Sample
144 participants of the Nun Study, age 75-98 years
Observation period
10 years with annual follow-up examinations
Outcome measure
number of teeth
neuropathologic findings at autopsy (n=118)
Participants with the fewest teeth had the highest risk of
prevalence and incidence of dementia
Edentulism or very few (1-9) teeth may be predictors of
dementia late in life
Sparks Stein P et al. (2007) Tooth loss, dementia and neuropathology in the Nun Study JADA 138: 1314-22

21. Interplay of Mastication, Nutrition, Cognition & ADL
Weijenberg et al. (2011) Neuroscience and Biobehavioral Reviews 35: 438-497
ADL
Nutrition
Mastication Cognition
CORRELATION
CAUSAL /
-longitudinally observed
-chance and bias eliminated
-consistent associations
-cause precedes effect
-dose-response gradient
-association is specific
The results of animal and human experimental studies suggest a
causal relationship between mastication and cognition
These findings have compelling implications for the care for the
frail and elderly, suffering from dementia

22.  Current status of tooth loss
 Why retaining and restoring teeth is important ?
 Diet and teeth
 Quality of life and teeth
 Cognition and teeth
 Longevity and teeth
 Standards and priorities
 Standard indicators
 Standard set of «perception» data from patients

23. Presence of Natural Teeth and
21-Year Mortality
Holm-Pedersen P. et al. Tooth Loss and Subsequent Disability and Mortality in Old Age J Am Geriatr Soc 56: 429-35 (2008)
573 nondisabled 70-year old Danes, medical and dental examination, interview
Mortality obtained from the National Death Register
Being edentulous or having
1-9 teeth was associated with
onset of disability at age 75
and 80 years
Persons being edentulous at
age 70 were sign. higher at
risk of mortality 21 years later
(Hazard ratio 1.26, 95% CI 1.03-1.55)

24. Number of Teeth – a Predictor of Mortality
in 70-year old Subjects
0 1-9 10-19 ≥ 20 No of teeth
7-year mortality
Osterberg T, Carlsson GE, Sundh V, Mellström D
Number of teeth – a predictor of mortality in 7’-year old subjects. Community Dent Oral Epidemiol 36(3): 258-68 (2008)

25. Preventive Effect of Oral Hygiene on Pneumonia in
Elderly People in Hospitals and Nursing Homes
Approximately 1 in 10 cases of death1 in 10 cases of death from pneumonia in
institutionalised elderly may be prevented by improving oral hygiene
 Absolute Risk Reduction (ARR) from 6.6% to 11.7%
 Relative Risk (RR) 0.30 to 0.61
 Number Needed to Treat (NNT) from 9 to 15
Sjögren et al. Journal of the American Geriatric Society 56: 2124-2130 (2008)

26.  Current status of tooth loss
 Why retaining and restoring teeth is important ?
 Diet and teeth
 Quality of life and teeth
 Cognition and teeth
 Longevity and teeth
 Standards and priorities
 Standard indicators
 Standard set of «perception» data from patients

27. Standard Indicators for Oral Health
Structural Indicators
Number of teeth
Prevalence of fixed and removable prostheses
Attachment loss
Ridge resorption
Functional Indicators
Chewing efficiency
Plaque Index (PI), Denture Plaque Index
Indicators of Pathology
DMFT
CPITN
SBI
Prevalence of oral individual diseases

28. Clinical Oral Assessment Tools
Reproducible, reliable, proven validity, simple, quick, requiring minimal
dental equipment, without necessity for chairside assistance
Dental professionals / *Nurses/Hygienists
OHX Oral Health Index Burke et al. 1995
CODE Clinical Oral Disorder in Elders Index McEntee et al. 1999
*OAG Oral Assessment Guide Isaksson et al. 2000
*THROAT THROAT Dickinson et al. 2001
*ROAG Revised Oral Assessment Guide A.Dept Health&Ageing 2003
Also applicable in demented patients
*ADOH Activities of Daily Oral Hygiene Bauer et al. 2001
*MPS Mucosal Plaque Score Index Henriksen et al. 1999
*BOHSE Brief Oral Health Status Examination Kayser-Jones et al. 1995
List after Chalmers (2005)

29. Standard set of «perception» data from patients
Quality of life
OHIP 49, OHIP 20, OHIP 14, OHIP-Edent
GOHAI
Denture satisfaction
DSI (McGill)
Self reported disease / problems with teeth or dentures
Prevalence
Participation in leisure and social interactions

30. Thank you very much for your kind attention
Département de Médecine Interne, de Réhabilitation et de Gériatrie
Division de Gérodontologie et Prothèse Adjointe, CUMD
Hôpitaux
Universitaires
Genève