Linda C. Niessen

Oral health changes in the elderly. Their relationship to nutrition.

Poor oral health is not a result of normal aging, but rather reflects systemic disease, use of medications, inadequate nutrition, or lack of preventive dental care. The primary care physician usually sees elderly patients much more often than does the dentist and thus has an important role in maintenance of good oral health status. He or she thus should be familiar with normal orofacial anatomy and should routinely include a complete oral examination in the general physical examination. A patient with poor oral health should be referred to a dentist for necessary treatment and preventive care.

Women’s Oral Health: Why Sex and Gender Matter

This article examines the differences and interaction between sex and gender, and how they affect womens oral and general health. The authors provide a definition of womens health, and examples of how this definition can be used to describe various oral health conditions and diseases in women. The article reviews the research on sex and gender and provides examples of their interactions. Examples of oral diseases that affect primarily women are reviewed. Advice for clinicians on the diagnosis, management, and prevention of these conditions is provided.

A national imperative: Oral health services in Medicare

Harold C. Slavkin, DDS; for The Santa Fe Group D ental benefits are not included in Medicare despite the reality that more Americans are living well beyond their 65th birthdays. In the United States, 10,000 people turn 65 every day, which drives the increasing cohort of seniors. Today, the number of seniors—47 million—essentially will double by 2050 according to demographers, and there is no doubt that oral health and general well-being are inextricably bound together. Many conditions that plague the body are manifested in the mouth, a readily accessible vantage point from which to view the onset, progression, and management of numerous systemic diseases. Periodontal diseases are generated by microorganisms that readily can enter the general circulation and cause bacteremia, resulting in adverse systemic effects that can promote conditions such as atherosclerosis. Study investigators assert that adverse cardiovascular effects from periodontal diseases are due to a few highrisk oral microorganisms associated with the pathogenesis of atherosclerosis via increased lipoprotein concentrations, endothelial permeability, and binding of lipoproteins in the arterial intima. In this guest editorial we assert that oral bacteria influence the pathogenesis of atherosclerosis and a number of other chronic degenerative diseases. We argue that sufficient scientific and health economic evidence support providing oral health benefits to older adults through the Medicare mechanism. Oral chronic degenerative diseases, such as periodontal diseases, often cause tooth mobility and tooth loss and serve as a portal for microorganisms, their by-products, and host-generated inflammatory mediators to enter the bloodstream, and they are associated with conditions in other parts of the body—pulmonary disease, type 2 diabetes, and cardiovascular diseases. Furthermore, periodontal diseases share genetically determined risk factors with other chronic degenerative diseases with an inflammatory response such as ulcerative colitis, juvenile arthritis, and systemic lupus erythematosus. These conditions are associated closely with increased production of proinflammatory cytokines that serve as indicators of susceptibility to severe chronic degenerative diseases. The same cytokines expressed in inflammation in type 2 diabetes, cardiovascular diseases, and obesity also are expressed within periodontal diseases. It is now evident that there is a confounding relationship among oral infections, host inflammatory response, and host genetic characteristics. Major scientific discoveries support the thesis that oral health care begins during prenatal care and extends over the human life span. Authors of a number of reports highlight significant benefits of prevention interventions in early childhood and thereafter. Despite these advances, according to

Aging and the Oral Cavity

Many myths surround aging and the oral cavity. The stereotype of a grandmother going to bed with her teeth in a cup on the nightstand will fade rapidly as the baby boomers (those Americans born between 1946 and 1964) reach older adulthood in the twenty-first century.

Investing in success versus paying for failure: Maryland oral health case history: Maryland oral health case history

Between 1980 and 2000, for every

Oral health status of a long term care, veteran population

1.00 spent on Texas higher education,

Oral health assessment by nursing staff of Alzheimer's patients in a long‐term‐care facility

7.00 was spent on Texas corrections (1). As a society, why are we more willing to pay for failure than invest in our residents’ success? And why does it take the death of a child from a preventable disease like dental caries to finally mobilize a state and its citizens to take action to improve oral health? As we have heard at the Maryland Oral Health Summit, it took the tragic death of a young boy, Deamonte Driver, from an infection caused by untreated dental caries to change the public will in Maryland and create an appetite to fund oral health preventive, education, and care delivery initiatives. First, enabling legislation, although unfunded at the time, and an Action Committee which was in place, provided a framework and structure to act quickly when public will, appetite, and energy align to support these actions. Second, I applaud the state of Maryland for funding the initiatives that were outlined by the Action Committee. The state mobilized various funding sources to address the needs implementing an oral health surveillance system, staffing the state Department of Oral Health, working to better understand and improve oral health literacy, and increasing reimbursements to dentists to provide dental care to Medicaid patients. As we have since seen, other tragic deaths from dental diseases have occurred but have not resulted in the same action as we have seen in Maryland. Access to needed dental care is an issue almost every state is addressing in some form, as are health professional associations, foundations, and local dental societies (2-6). As we reflect on Maryland’s activities and how they made a difference, ideas/learnings from Maryland have emerged that may work in other communities. To this end, I offer the following considerations and recommendations: • Develop a model template for enabling legislation and a Dental Action Committee for each state. Even if unfunded, it provides an infrastructure that facilitates action quickly should it be needed. Oral health success results from both shortand long-term investments. • Our long-term investment in oral health must remain population-based preventive and education measures. Community water fluoridation is facing renewed challenges as states and local communities attempt to balance their budgets. We MUST not trade immediate balancing of state or local budgets for the long-term health of our population. The short-term trade-off will result in increased costs to the state Medicaid programs to care for children and adults who have resultant pain and suffering from dental caries. • Our short-term investments must continue to fund and provide oral health services for children and vulnerable populations who currently suffer from dental diseases. We cannot abandon them and run the risk of serious adverse health consequences, needless pain, suffering, and decreased life potential. A recent study showed that children in North Carolina who have poor oral health were three times more likely to miss school as a result of dental pain and more likely to perform poorly in schools (7). • We must continue to strengthen our safety net of dental care delivery by enabling them to increase their effectiveness and efficiency, through programs like Safety Net Solutions. • I applaud the support provided by the communities of interest, the dental public health community that served as the convener, the private practice dental community, the Note: These comments reflect the opinions of the author only and not any organization with which she is affiliated. Journal of Public Health Dentistry . ISSN 0022-4006