A Wellness Model for the Aging Population
One certainty amid the national debate regarding healthcare reform is that increasing demands will be placed on the healthcare system as baby boomers become seniors in the next 20 years. In dentistry, this demographic shift will impact service mix, spending patterns, and clinical practices.
With age, baby boomers will bring greater need for general dental attention than past cohorts of seniors. This is partly because they will have better oral health histories and lower rates of edentulism and a growing clinical awareness of the associations between oral health and overall health.
Chronic Conditions Boosting Demand
Nearly one third of seniors have heart disease, which is commonly associated with atherosclerotic disease, and almost one in five people have received a diagnosis of diabetes. An estimated 15% of the overall population has low bone mineral density (osteopenia or osteoporosis), most of whom are females older than 50 years. As the senior population grows, dental practitioners will become increasingly involved in identifying symptoms of chronic systemic conditions and integrating dental care within the context of medical treatments. Recent research has contributed to a growing awareness that oral health and overall health are closely linked both symptomatically and causally. Often, these associations occur in patients with chronic conditions, such as atherosclerotic disease, diabetes, and osteoporosis—all of which disproportionately affect seniors.
Periodontal inflammation is associated with an elevated systemic inflammatory state and increased risk of major atherosclerotic events, such as myocardial infarction and stroke, as well as altered glycemic control in people with diabetes. Interventional trials suggest periodontal therapy, which decreases the intraoral bacterial bio-burden and reduces periodontal inflammation, can significantly impact the systemic inflammatory status. There is insufficient but suggestive evidence for a possible causal relationship between periodontal and atherosclerotic diseases (including ischemic heart disease, peripheral arterial disease, and ischemic stroke), with slightly stronger evidence for ischemic stroke. If future studies show consistent associations, periodontal disease may be elucidated as an independent and potentially modifiable risk factor for atherosclerotic disease.
Evidence consistently reveals diabetes is a risk factor for increased severity of gingivitis and periodontitis. Conversely, periodontitis is a risk factor for worsening glycemic control in patients with diabetes and may increase the risk for diabetic complications. Evidence suggests periodontal therapy is associated with improved glycemic control in many patients with diabetes and periodontal disease. While the association between periodontal disease and several chronic systemic conditions has been demonstrated in recent years, the most consistently supported interaction has been between periodontal disease and diabetes. Because inflammatory periodontal disease and diabetes are closely linked, dental and medical teams must work together to provide optimal care for their patients with diabetes.
The dental team also may be in the position to suspect or help identify osteoporosis. Such a suspicion would be based on risk factors identified in the patient’s medical history, as well as clinical and radiographic findings. In patients with osteoporosis, the jaws are susceptible to accelerated alveolar bone resorption, and these patients have a greater incidence of tooth loss and residual ridge resorption. Osteoporosis may affect the severity of pre-existing periodontitis.
Excerpt from: Ferguson DA, Steinberg BJ, Schwien T. Dental Economics and the Aging Population. Compend Contin Educ Dent. 2010;31(6):418-425.
Reference available at http://www.dentalaegis.com/cced/2010/08/dental-economics-and-the-aging-population