Oral Healthcare and the Frail Elder

Foreword xv  Preface xvi  List of Contributors xix  1 Demography of Aging and Frailty, and the Epidemiology of Oral Conditions 1 W. Murray Thomson, Moira B. Smith, Fernando Neves Hugo, and Philippe Mojon  Demography of Aging and Frailty 1  The Aging Population 1  Conceptualizing Aging 1  Multimorbidity 2  Frailty 3  Oral Frailty 4  Importance of the Life-Course 4  Epidemiology of Oral Conditions in Older People 5  Edentulism and Incremental Tooth Loss 5  Dental Caries 7  Periodontitis 7  Oral Mucosal Lesions 7  Dry Mouth 9  Muscular and Joint Disorders 9  Conclusion 10  References 10  2 Challenges with Noncommunicable Diseases and Frailty 16 Michael I. MacEntee, Paul Allison, Denise Laronde, and Bruce Wallace  Noncommunicable Disease 16  Frailty 18  Noncommunicable Diseases of the Mouth 19  Dental Caries 19  Periodontal Disease 21  Tooth Loss 23  Oral Cancers 24  Risks for Noncommunicable Diseases of the Mouth 25  Sugar 25  Tobacco 25  Alcohol 26  Aging 26  Immune System and Oxidative Stress 26  Other Risks 27  Social Determinants 27  Conclusion 28  References 28  3 Theoretical Perspectives on Frailty, Oral Health- Related Quality of Life, and Well- Being in Old Age 37 Michael I. MacEntee, Dominique Niesten, Mario A. Brondani, and Maha M. Al-Sahan  Health 38  International Classification of Functioning 39  Oral Health 40  Comfort, Well-Being, and Quality of Life 42  The Myth of Measurement 42  Frailty 43  Oral Frailty 44  Managing Ill-Health and Frailty 45  A Metatheory 45  A Clinical Scenario 46  Conclusion 47  References 47  4 Communities and Frail Elders 54 C. Peter Owen, Michael I. MacEntee, Rodrigo Marino, Victor Minichiello, and Gladys Meriting Thokoane  What Is a Community? 54  Culture and Ethnicity 55  Culture and Acculturation 55  Ethnicity 56  Communities of Elders 56  Barriers to Equitable Healthcare 57  Agism 57  Racism 58  Migration 59  Equitable Healthcare and Cultural Competence 60  Health Advocacy 61  Conclusion 63  References 63  5 Oral Healthcare Policy, Equity, Economics, and Political Action for Aging Populations 68 F.A. Clive Wright, Michael I. MacEntee, Joke Duyck, Moira B. Smith, Bruce Wallace, and C. Peter Owen  Purpose of Policy 68  Categories of Public Health Policy 69  Uniqueness of Health Policy 70  Forming Health Policy 70  Equality and Equity 71  Agism 71  Adopting Health Policy 72  Financial Policies 73  Analyzing and Assessing Health Policy 73  Global Strategy on Oral Health 76  The Challenge 76  Promoting Oral Healthcare Policies 76  Oral Healthcare Workforce 78  Pyramid of Primary Oral Healthcare 78  Conclusion 79  References 80  6 The Influence of the Mouth and Mouthcare on the Body-Image and Social Interactions of Frail Elders 87 Leeann Donnelly, Laura Hurd, Alison Phinney, and Michael I. MacEntee  Body-Image and Oral Health 87  Social Isolation, Loneliness, and Depression 88  Clinical Implications 89  Oral Health and Social Interactions 90  Clinical Script 90  Conclusion 92  References 92  7 Ethical and Moral Considerations for Oral Healthcare of Frail Elders 96 Michael I. MacEntee, Mario A. Brondani, Nico Creugers, Shafik Dharamsi, and Mary E. McNally  Healthcare Ethics 96  Frailty 97  Ethical Theory and Principles in Healthcare 97  Patient-Centered Care, Care Ethics, Narrative Ethics, and Feminism 98  Moral Distress 99  Moral Injury 100  Surrogate Decision-Makers 100  Ethical Dilemmas 101  Socially Responsible Care 101  Universal Health Coverage 101  Professional Responsibilities 102  Elder Abuse 102  Reporting Abuse 103  Identifying and Managing Elder Abuse 103  An Ethical Framework 104  Clinical Context 105  Clinical Scripts 106  Complexities 106  References 109  8 Educating a Workforce for Dental Geriatrics 115 Matana Kettratad-Pruksapong, Shiva Khatami, Linda Slack-Smith, Jirakate Madiloggovit-Lower, Leonardo Marchini, C. Peter Owen, and Michael I. MacEntee  Teaching and Learning Dental Geriatrics 115  Exposure to Frailty 116  Postgraduate Education 116  Cultivating Clinical Reasoning 116  Promoting Compassion 118  Healthcare-Teams 119  Conclusion 120  References 120  9 Chronic Orofacial Pain and Movement Disorders in Old Age and Frailty 125 Pierre J. Blanchet, Limor Avivi-Arber, Barry J. Sessle, and Gilles J. Lavigne  Assessing Pain 125  Age-Related Changes in Processing Pain 126  Mechanisms of Processing and Modulating Pain 126  Afferent Nerve Fibers 127  Pain Processing and Modulation 127  Pain-Related Sensorimotor and Other Functions of the CNS 127  Orofacial Pain 128  Temporomandibular Disorder (TMD) Pain 128  Management of TMD Pain 128  Lesion or Disease of the Cranial Nerves 128  Trigeminal Neuralgia 128  Other Trigeminal Neuropathic Pain 129  Postherpetic Neuralgia 129  Idiopathic Orofacial Pain Conditions 130  Burning Mouth Syndrome 130  Persistent Idiopathic (Atypical) Facial Pain 131  Persistent Idiopathic Dentoalveolar Pain (Atypical Odontalgia) 131  Movement Disorders and Orofacial Pain 132  Oromandibular Dystonia 132  Management of Oromandibular Dystonia 132  Oral Dyskinesia 132  Management of Oral Dyskinesia 133  Stereotypies 133  Management of Stereotypies 133  Bruxism 133  Management of Bruxism 134  Parkinson Disease 134  Management of Parkinson Disease 134  Conclusion 135  References 138  10 Nutritional Consequences of Oral Health in Frail Elders 143 Paula Moynihan, Kazunori Ikebe, and Rena Zelig  Changing Nutritional Needs of Frail Elders 143  Energy Requirements 143  Protein 144  Micronutrients 144  Vitamins 144  Minerals 145  Hydration 145  Malnutrition/Undernutrition in Elders 145  Malnutrition/Undernutrition Prevalence in Facility and Community Settings 146  Reasons for Malnutrition 146  Consequences of Malnutrition 148  Assessing Malnutrition in Older People 148  Interventions for Patients with, or at Risk of, Malnutrition/Undernutrition 150  Diet and Oral Health in Frail Elders 151  Diet and Dental Caries in Frail Elders 151  Oral Function and Nutrition 152  Importance of Oral Health in Preventing Frailty 153  Impact of Prosthodontics on Diet 153  Wearing Dentures 153  Dentures and Eating-Related Quality of Life 154  Dietary Advice with Tooth Loss 154  References 154  11 Dry Mouth and Medications 160 W. Murray Thomson and Chao Shu Yao  The Salivary System 160  Nerve Supply 161  The Role of Saliva 163  What Is Dry Mouth? 165  How Do We Measure Dry Mouth? 165  Prevalence and Impact of Dry Mouth 167  Medications and Dry Mouth 168  Managing and Preventing Dry Mouth 173  Conclusion 175  References 175  12 Dementia, Sleep Apnea, and Dysphagia 180 Michael I. MacEntee, Fernanda Almeida, B. Lynn Beattie, Najla Chebib, and Frauke Müller  Dementia 180  Diagnostic Challenges 183  Care-Resistant Behavior 183  Preparing for the Worst 185  Home Care and Prophylaxis 185  Sleep and Aging 187  Common Sleep Disorders in Old Age 187  Insomnia 187  Restless Legs Syndrome (RLS) and Periodic Limb Movements in Sleep 187  REM Sleep Behavior Disorder 187  Sleep-Disordered Breathing 188  OSA and Complete Dentures 189  Swallowing, Dysphagia, and Pneumonia 189  Swallowing 189  Oral Phases 190  Pharyngeal and Esophageal Phases 190  Dysphagia 191  Aspiration 192  Pneumonia 193  Controversy 194  References 195  13 A Framework for Assessing Oral Healthcare Programs in Residential Care Facilities 200 Matana Kettratad-Pruksapong, Joke Duyck, Michael I. MacEntee, Arminee Kazanjian, and B. Lynn Beattie  Challenges 200  Healthcare Accountability 200  Quality of Care-Assessment 200  Program Evaluation 201  Meaningful Outcomes in Residential Care 202  Residential Facilities 203  Conclusion 205  References 205  14.1 Mitigating the Effects of Harmful Commodities on Dental Caries and Periodontal Diseases: Section 1: Dental Caries 208 Alan A. Deutsch, W. Murray Thomson, and Michael I. MacEntee  Caries Through the Life-Course 208  Caries Risk 209  Risk Assessment 209  Prevention and Management 210  Dietary Sugars 210  Saliva 211  Fluorides 211  Oral Hygiene 213  Conclusion 214  References 214  14.2 Mitigating the Effects of Harmful Commodities on Dental Caries and Periodontal Diseases: Section 2: Periodontitis and Gingivitis 217 Jim Yuan Lai, Howard C. Tenenbaum, Michael B. Goldberg, and Elaine Cardoso  Periodontitis as a Noncommunicable Disease 217  Pathogenesis 217  Mitigation and Management 218  Periodontitis and Other Noncommunicable Diseases 218  Diabetes 219  Managing Periodontal Conditions for Frail Elders with Diabetes 219  Hypoglycemic Emergency 220  Cardiovascular Diseases 220  Epinephrine and Cardiovascular Disease 221  Treatment Sessions 221  Anticoagulants and Postsurgical Bleeding 221  Conclusion 222  References 223  15 Treatment Planning, and Integrating Oral and General Healthcare 226 C. Peter Owen, Joke Duyck, Barbara Janssens, David MacDonald, Chao Shu Yao, Alan A. Deutsch, and Michael I. MacEntee  Integrating Oral and General Health 226  Integrated Care 227  Assessing the Need for Care 228  Age 228  General Health 229  Communications 229  Social and Financial Status 229  Environment 230  Mobility 230  Cooperation 232  Clinical Assessment—Screens 232  Screening by Dental Personnel 232  Screening by Nondental Personnel 232  Radiography 233  Planning Protocols 235  Infections 236  Contamination 236  Control 237  Waste Management 237  Disinfecting Environmental Surfaces and Fomites 237  Conclusion 238  References 239  16 Care and Management of Frail and Osteoporotic Elders with Special Emphasis on Minor Oral Surgery 245 Michael M. Bornstein and Pedro Molinero-Mourelle, Minor Oral Surgery for Elders—General Considerations 246  Local Anesthesia 246  Sedation and General Anesthesia 247  Presurgical Considerations 247  The Osteoporotic Patient 247  Antiresorptive Therapy 249  Respiratory Conditions 249  Cardiovascular Diseases 251  Antibiotic Prophylaxis 251  Antiplatelet and Anticoagulant Drugs 252  Diabetes Mellitus 254  Psychological Disorders 255  Cancer 255  Recommendations and Conclusion 255  References 256  17 Oral Rehabilitation of the Frail Elder 260 C. Peter Owen, Shane White, Gerald McKenna, Sabrina Maniewicz, Nico Creugers, Michael I. MacEntee, and Frauke Müller  Endodontic Rehabilitation 261  Epidemiology and Diagnosis 261  Endodontic Outcomes 261  Patient Considerations 262  Technical Challenges 262  Restoring Endodontically Treated Teeth 263  Structurally Weak Teeth 263  Partial Tooth-Loss 265  Shortened Dental Arch 265  Resin-Bonded Fixed Dental Prostheses 265  Metal-Ceramic Prostheses 265  Fiber-Reinforced Composite 266  Removable Dental Prostheses 267  Tooth-Supported Overdentures 268  Complete Tooth-Loss 269  Mucosa-Borne Complete Dentures 269  Relining Removable Dentures 270  Duplicating Dentures 271  Labeling Removable Dentures 272  Implant-Supported Prostheses 272  Dental Restorations and Prostheses 275  Digitally Constructed Prostheses 275  Cross-Infection During Dental Treatment 275  Denture Hygiene 276  Sleep Apnea and Denture Use 276  Conclusion 276  References 277  18 Integrating Oral Health in Palliative Medicine 286 Martin Schimmel, Frauke Müller, Chao Shu Yao, Stephen Sonis, and Michael Wiseman  Dentistry in Palliative Care 286  Oral Health in Palliative Care 288  Therapies 289  Radiation Therapy 289  Chemotherapy 289  Immunotherapy and Targeted Therapy 289  Oral Health and Terminal Illness 290  Oral Mucositis 290  Treating Oral Mucositis 291  Scoring Mucositis 291  Preventing and Treating Mucositis 292  Oral Hygiene and Dental Caries 292  Dry Mouth 293  Fungal Infections 293  Taste Disorders and Dysphagia 295  Nausea and Vomiting 295  Dentistry 296  Conclusion 296  References 297  19 Mobile Dental Services 303 Murali Srinivasan, Barbara Janssens, David MacDonald, and Frauke Müller  Preferences of Frail Elders 304  Service Models 304  Fixed Dental Clinics 304  Mobile Dental Clinics 305  Mobile Equipment 305  Portable Domiciliary Care 306  Mobile Clinic in a Vehicle 307  Lighting Mobile Clinics 307  Setting-up Mobile Dental Services 308  A Mobile Clinic 309  Equipment and Instruments 309  Organization 309  Costs 310  Scope of Mobile Services 310  Cost-Effectiveness 311  Challenges 311  Mitigating Challenges 312  Setting-up Mobile Equipment 312  Conclusion 313  References 313  20 Communications and Teledentistry 316 Chris Wyatt, Mario A. Brondani, Leeann Donnelly, Nicholas Tong, and Shunhau To  Introduction 316  Principles of Communication 316  Person-Centered Communication 317  Communication Strategies 318  Institutional Communication 318  Community Dental Clinic Communication 319  Interprofessional Communication 319  Medical and Dental Records 321  Teledentistry 322  Teledentistry Referrals 322  Conclusion 325  References 325  21 Oral Healthcare for Frail Elders in Low- Income Communities 329 C. Peter Owen, Matana Kettratad-Pruksapong, Matshediso Mothopi-Peri, Frankie Hon Ching So, F.A. Clive Wright, and Michael I. MacEntee  Global Expenditures on Health 329   Appropriatech 330  Responses to Constrained Resources 332  Australia and New Zealand 332  Canadian Indigenous Communities 333  Hong Kong 335  South Africa 335  Thailand 336  Conclusion 336  References 336  22 Summary 340 Michael I. MacEntee  Index 341