James P. Newton

European College of Gerodontology: undergraduate curriculum guidelines in Gerodontology

Effective undergraduate teaching of gerodontology to present and future dental students is important if good oral health care of older people is to be assured. A review of the undergraduate curriculum for gerodontology is presented and indicates the need for a knowledge base from which new graduates can develop a special interest in care of older patients. The aim is improved care of older patients, satisfaction for teaching staff involved and improved professional standing for Dentistry. Motivation of students could also be achieved by the positive match between rising patient awareness and ethical responsibility of the profession for those older patients. As it stands, the undergraduate curriculum should include topics on specific care for the elderly and other patient groups, which extend the competences already agreed by the Association for Dental Education in Europe (ADEE). The logistics of teaching these topics will need co-ordination of those staff with appropriate skill and interest, preferably as a development of existing curriculum content.

A comparison of reflex depressions of activity in jaw-closing muscles evoked by intra- and peri-oral stimuli in man.

The effects on activity in the masseter muscle of applying electrical stimuli to discrete areas within the mouth or on peri-oral skin were studied electromyographically in 8 subjects. In all subjects, the intra-oral stimuli produced two phases of depressed masseteric activity with mean latencies of 14 ms and 47 ms. By contrast, this shorter latency response was generally not obtained with peri-oral stimuli: responses evoked from vermilion-border skin had an intermediate latency (mean 25 ms) and consisted of either one or two periods of depressed activity, while the responses to stimulation of the hairy skin of the lip generally consisted of a single phase of depressed activity, the time course of which was similar to the later phase produced by intra-oral stimuli (mean latency, 48 ms). These findings were consistently obtained with both single and short trains of electrical stimuli and contrast with reports that intra- and peri-oral stimuli produce similar reflexes. The finding that the short-latency reflex depression of masseteric activity could be evoked only by stimulating nerves supplying intra-oral tissues is consistent with the notion that this reflex may play a role in functions such as mastication, and indeed may indicate that the reflex exists specifically for such a purpose.

Dentistry for the elderly: A review and an assessment of the future

The current decline in requirements for treatment in younger sections of the population provides an opportunity for the dental profession to increase the level of care provided for the elderly. Significant changes occur in the mouth as a consequence of ageing, and knowledge of these is of importance in determination of normality. Surveys have shown that, in many countries, the elderly present a dismal picture as regards oral health. They require encouragement to seek advice or treatment on a regular basis, and the treatment itself should be easily available and appropriate.

From bad to worse - the potential for 2009.

Whenever one opens a newspaper, turns on the radio or television or surfs the Internet, the news of the financial situation of individuals and countries worldwide appears to be continuing to deteriorate. Unfortunately, in these circumstances there is a tendency to look for somebody to blame, be it politicians, bankers or the price of oil. It would also appear that as a result of the global nature of the crisis, there is a significant likelihood that the recession will last a significant amount of time and for some countries may turn into a depression. History relates how disastrous this was in the 1930s, the mistakes that were made then and the legacy that lasted for a generation. Few, if any, still alive, will have been part of that, but may be aware of the significant hardship that had to be endured by their relatives. As with all these crises, certain groups are always affected and the older adult is one of the most significant. Over many years this group has been encouraged to save for their old age and to place their savings in funds that would gain interest and grow in size. Many of them now use the interest they earn to improve their state pension, but with the central banks reducing their interest rates to virtually zero, the impact on these savings has been catastrophic, particularly as this elderly group of savers is said to number over 12 million. Although the reduction in interest rates has been of help to those paying a mortgage to buy a house, they only constitute around 20% of the population with the other 80% being potential savers. Somehow one feels that the chorus of anguish from borrowers is silencing the pain of the majority. We are all also aware of the effect of the credit crunch on the value of people’s property, this being particularly profound in the UK and USA. In the UK, many older adults have used the value of their homes to release some cash to pay for the fees of their residential or nursing home. Now with the sliding value of their houses, which in many cases runs into tens of thousands of pounds, they are having to deal with significant shortfalls and are unable to pay many of their bills. Even if they wish to sell their homes, nobody wants to buy them, either because they cannot borrow the money, they are concerned about losing their job, do not want to make a new commitment or are hoping that the price might fall even further. Many children are often more than willing to help out but according to Help the Aged, fees can start at around £460 a week for residential care and over £660 for nursing homes and these sums are beyond the means of many caring families. Similar issues are found in America as many older people cannot sell their own homes and are therefore unable to move into retirement homes as they cannot meet the

Differences between inhibitory jaw reflexes evoked by stimulation of tooth pulp and across the adjacent alveolar process in man

100 000 to

Social perception in the clinical dental encounter: the matched-guise technique re-visited

500 000 down payment. In addition, the average annual cost of living in a nursing home is over

Hungry mouths, now and in the future--how will our elders fare?

67 000 (MetLife Market Survey of Nursing Home and Home Care Costs, 2006). It also is estimated that there are 4.27 million houses in the USA that are on the market to be sold but it is difficult to find out how many of these are owned by people over 65 years (The New York Times, 21 November 2008). These issues are having a detrimental effect in the other direction as retirement and residential care homes are finding that their occupancy rates are falling rapidly and vacancies are up to 20% or even 30% in the state of Florida. In an effort to reduce the problem, the Department of Housing and Urban Development in the USA administers housing for the elderly by subsidising it through local housing authorities. This type of support is normally available to adults over the age of 62 having an income which is below 80% of the median for the place where they live. In addition, care is taken to ensure that the rent they pay is no more than 30% of their income. This process appears to provide a solution for some of the problems facing the elderly in these difficult times. Recently, there was the Annual Conference of the European Association of Homes and Services for the Aging (EAHSA, Brussels, 2008) where, amongst other matters, they considered the effect of the credit crunch on the older adult. They reported that in France, Italy, the Netherlands, Germany and Belgium, the provision of care homes for the elderly had not been so adversely affected by the credit crunch as it had in the UK, but that new projects were being hampered by the difficulty in borrowing money. It was also reported that in Europe, there was little differential with regard to costs for care in the private or public sector. Consideration was given to the potential new models of care housing as the market for housing for the elderly was considered as one having important growth potential. This was particularly relevant in Germany where only 1% of all homes were suitable for older people. An interesting statistic that arose from another presentation was the fact that

The credit crunch – the potential impact on older people

OBJECTIVE In humans, stimulation of nerves in or around teeth can evoke inhibitory jaw reflexes. Previous studies had suggested that there may be subtle differences in the timings of the responses. The aim of the present study was to investigate this by comparing reflexes evoked by electrical stimulation of a tooth and of the adjacent tissues in individual subjects. DESIGN Experiments were performed on 9 volunteers (3 male, 6 female). EMG recordings were made from the masseter muscle ipsilateral to the stimuli, whilst the subjects maintained a steady level of activity in the muscle. Reflexes were evoked by applying stimuli to an incisor tooth (pulpal stimuli) or across the adjacent alveolar process (transalveolar stimuli), using bipolar electrodes. RESULTS Two inhibitory responses were evoked in most (8/9) subjects. The first occurred at a shorter latency after transalveolar than after pulpal stimulation (12.3+/-0.5 ms vs 19.4+/-1.5 ms; P=0.0014, paired t-test). For technical reasons, it was not possible to make such comparisons for the second inhibitory responses in all the subjects. In 5 subjects where such a comparison was possible, the mean latency of the transalveolar-evoked response was again shorter than that of the pulpal-evoked response (56.4+/-2.8 ms and 58.8+/-5.3 ms, respectively), but this difference was not significant (P=0.5). CONCLUSIONS It appears that inhibitory jaw reflexes evoked from around the teeth are faster than those from the dental pulp. This observation could be due to differences between the peripheral afferent and/or the central pathways mediating the reflexes.

Neglect - a consequence of austerity?

This study investigated whether student dentists’ ratings of a female putative patients personality, communication skills and dental condition in an audiotaped dentist–patient interaction related to patient socio-economic status (SES), as operationalised by accent type. Thirty-nine student dentists in their second pre-clinical year of study, and 62 with two or three years of clinical training in the BDS programme at a British University Dental School took part. Pre-clinical students judged the ‘working class’ patients condition to be more psychosomatic in origin than experienced students. All students rated the ‘middle class’ patients communication skills more highly, e.g. grammar. Personality judgements were not a function of perceived patient SES, save for intelligence. Context effects in experienced students’ stereotyping of the putative dentist were also found: he was perceived as friendlier and more informative when interacting with the ‘middle class’ patient. These findings have relevance for both the clinical literature, which has sometimes under-represented the complexity of stereotyping processes operating in practitioner–patient encounters, and for theory-building in social cognition/perception.

Terminal illness - the right to choose.

A report entitled ‘Global and Farming Futures’ published in January of this year by Foresight, a UK Government think tank, has suggested that there needs to be fundamental changes in food production throughout the world. By 2050, there could be potentially an extra 2.4 billion people to feed with very little extra land on which to grow that food. The report has involved over 400 experts and has considered food production from farming on land and in the sea. It states that the major threats to food production come from climate changes, competition for water supplies, competition for energy resources, and changes to the dietary requirements and choices of the population with a move towards greater meat and dairy consumption. Professor Sir John Beddington, the Head of the Foresight Programme, reported that current systems for food production are failing in a number of ways with resources being used at a faster rate than they can be replaced; however that is not the end of it as food consumption is not evenly distributed with a billion people who over-consume, a billion who suffer from ‘hidden hunger’ and latterly and more importantly, a billion who are going hungry. He also stated that by 2050, ‘the world will need 50% more energy, 30% more water and last but not least, 40% more food’ (Sir John Beddington, 24.01.11). The report has three main findings; firstly, the threat from food shortages is already present and it is predicted that the cost of food will rise substantially over the next few decades; not good news for our increasing number of older adults with limited financial resources; secondly, sustainability needs to take centre stage to allow resources to stand any chance of being replenished: and thirdly, as with many of these issues, ‘there is no quick fix’, but reducing or eliminating the amount of food that is wasted or thrown away is a must! In the area of food waste it is suggested that up to 40% of food that is bought by people in developed countries is actually thrown away. The French national agricultural and development research agencies (INRA and CIRAD) found that this was equivalent to 800 calories per person. It has also suggested three main areas for change; firstly, reduction of waste as already mentioned could significantly increase the availability of food to deprived groups and populations; secondly, balancing supply and demand to allow modification to the environmental impact of food production; and thirdly, by reducing trade barriers and protectionism that can disadvantage deprived countries and their populations. The report states that there is an urgent need to add food production to the wider world agendas including climate change, international development and biodiversity. It has also been suggested that one of the ways out of this dilemma is a move towards and even embracing the use of genetically modified (GM) crops. Scientists have stated that there need to be the equivalent of a second ‘green revolution’ but this time it is essential that it is not to the detriment to the environment. If there is genetically modified produce that is safe for human and animal consumption, safe for the environment and can solve particular problems, then it should be used. However, other problems could arise from new diseases, drought and changes in the properties of farm land and the sea and great care would need to be taken as there is ‘no silver bullet’. Professor Charles Godfray, who chaired the expert group, reported that more food needs to be produced in a more sustainable manner and country’s should have no expectation of becoming self-sufficient. However, the downside of all of this will ultimately mean that food prices will increase probably of the order of 50% by 2050. For some country’s, particularly poorer ones with large populations and a low level of food production, such as Pakistan and Nigeria, the risk is quite large as opposed to those that can produce large quantities of food but have relatively small populations, such as New Zealand and Argentina. To give some specific examples, the Argentineans have been growing GM crops since the mid 1990s doubling the countries grain production and in Eastern Europe large areas of grain-growing land are not used (The Telegraph, 14.01.11). The UK Environment Secretary, Ms Caroline Spelman is reported as stating that by investing in the poorer countries, they might be in a better position to support their own populations and be able to deal with potential hikes in food prices. Also the potential for countries to protect themselves and their food producers by trade barriers must also be avoided. It is interesting to note that in a leading article in The Independent (25.01.11) there was clear