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 Muller
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 Muller
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 Muller, 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 Muller
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
