Geriatric Dental Medicine, An Issue of Dental Clinics of North
America
Visit the link below to download the full version of this book:
https://medipdf.com/product/geriatric-dental-medicine-an-issue-of-dental-clinics
-of-north-america/
Click Download Now
Geriatric Dental
Medicine
Editors
JOSEPH M. CALABRESE
MICHELLE M. HENSHAW
DENTAL CLINICS OF
NORTH AMERICA
www.dental.theclinics.com
April 2021 Volume 65 Number 2
ELSEVIER
1600 John F. Kennedy Boulevard Suite 1800 Philadelphia, Pennsylvania, 19103-2899
http://www.dental.theclinics.com
DENTAL CLINICS OF NORTH AMERICA Volume 65, Number 2
April 2021 ISSN 0011-8532, ISBN: 978-0-323-77844-2
Editor: John Vassallo;
[email protected]Developmental Editor: Ann Gielou M. Posedio
ª 2021 Elsevier Inc. All rights reserved.
This periodical and the individual contributions contained in it are protected under copyright by Elsevier, and the
following terms and conditions apply to their use:
Photocopying
Single photocopies of single articles may be made for personal use as allowed by national copyright laws. Per-
mission of the Publisher and payment of a fee is required for all other photocopying, including multiple or sys-
tematic copying, copying for advertising or promotional purposes, resale, and all forms of document delivery.
Special rates are available for educational institutions that wish to make photocopies for non-profit educational
classroom use. For information on how to seek permission visit www.elsevier.com/permissions or call: (+44)
1865 843830 (UK)/(+1) 215 239 3804 (USA).
Derivative Works
Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internal cir-
culation within their institutions. Permission of the Publisher is required for resale or distribution outside the
institution. Permission of the Publisher is required for all other derivative works, including compilations and
translations (please consult www.elsevier.com/permissions).
Electronic Storage or Usage
Permission of the Publisher is required to store or use electronically any material contained in this periodical, includ-
ing any article or part of an article (please consult www.elsevier.com/permissions). Except as outlined above, no part
of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the Publisher.
Notice
No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions
or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular,
independent verification of diagnoses and drug dosages should be made.
Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publi-
cation does not constitute a guarantee or endorsement of the quality or value of such product or of the claims
made of it by its manufacturer.
Dental Clinics of North America (ISSN 0011-8532) is published quarterly by Elsevier Inc., 360 Park Avenue South,
New York, NY 10010-1710. Months of issue are January, April, July, and October. Business and Editorial Offices:
1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899. Periodicals postage paid at New York,
NY and additional mailing offices. Subscription prices are $313.00 per year (domestic individuals), $846.00
per year (domestic institutions), $100.00 per year (domestic students/residents), $366.00 per year (Canadian individ-
uals), $888.00 per year (Canadian institutions), $100.00 per year (Canadian students/residents) $428.00 per year (in-
ternational individuals), $888.00 per year (international institutions), and $200.00 per year (international students/
residents). International air speed delivery is included in all Clinics subscription prices. All prices are subject to change
without notice. POSTMASTER: Send address changes to Dental Clinics of North America, Elsevier Health Sciences
Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043. Customer Service (or-
ders, claims, online, change of address): Elsevier Health Sciences Division, Subscription Customer Service,
3251 Riverport Lane, Maryland Heights, MO 63043. Tel: 1-800-654-2452 (U.S. and Canada). Fax: 314-447-8029.
E-mail:
[email protected] (for print support); journalsonlinesupport-usa@elsevier.
com (for online support).
Reprints. For copies of 100 or more, of articles in this publication, please contact the Commercial Reprints
Department, Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Tel.: 212-633-3874; Fax:
212-633-3820; E-mail:
[email protected].
The Dental Clinics of North America is covered in MEDLINE/PubMed (Index Medicus), Current Contents/Clinical
Medicine, ISI/BIOMED and Clinahl.
Printed in the United States of America.
Geriatric Dental Medicine
Contributors
EDITORS
JOSEPH M. CALABRESE, DMD
Associate Dean of Students, Director of Geriatric Dental Medicine, Clinical Professor,
Department of General Dentistry, Boston University Henry M. Goldman School of Dental
Medicine, Attending Dentist, Department of Medicine, Hebrew SeniorLife, Attending
Dentist, Boston Medical Center, Boston, Massachusetts
MICHELLE M. HENSHAW, DDS, MPH
Associate Dean, Global and Population Health, Professor, Department of Health Policy
and Health Services Research, Boston University Henry M. Goldman School of Dental
Medicine, Boston, Massachusetts
AUTHORS
JOSEPH M. CALABRESE, DMD
Associate Dean of Students, Director of Geriatric Dental Medicine, Clinical Professor,
Department of General Dentistry, Boston University Henry M. Goldman School of Dental
Medicine, Attending Dentist, Department of Medicine, Hebrew SeniorLife, Attending
Dentist, Boston Medical Center, Boston, Massachusetts
HELEN CHEN, MD
Chief Medical Officer, Hebrew SeniorLife, Assistant Professor of Medicine, Division of
Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
Massachusetts
RONALD ETTINGER, BDS, MDS, DDSc, DDSc(hc)
Professor Emeritus, Department of Prosthodontics, The University of Iowa College of
Dentistry and Dental Clinics, Iowa City, Iowa
PAUL S. FARSAI, DMD, MPH
Clinical Professor, Department of General Dentistry, Boston University, Henry M. Goldman
School of Dental Medicine, Boston, Massachusetts; Private Dental Practice, Swampscott,
Massachusetts
ELISA M. GHEZZI, DDS, PhD
Adjunct Clinical Assistant Professor, University of Michigan School of Dentistry, South
Lyon, Michigan
JENNIFER HARTSHORN, DDS
Clinical Associate Professor, Department of Preventive and Community Dentistry, The
University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
MICHELLE M. HENSHAW, DDS, MPH
Associate Dean, Global and Population Health, Professor, Department of Health Policy
and Health Services Research, Boston University Henry M. Goldman School of Dental
Medicine, Boston, Massachusetts
iv Contributors
JUDITH A. JONES, DDS, MPH, DScD
Professor, University of Detroit Mercy School of Dentistry, Detroit, Michigan
STEVEN KARPAS, DMD
Clinical Assistant Professor, Department of General Dentistry, Boston University Henry M.
Goldman School of Dental Medicine, Boston, Massachusetts
MATTHEW MARA, DMD, EdM
Clinical Instructor, Department of General Dentistry, Boston University Henry M. Goldman
School of Dental Medicine, Boston, Massachusetts
LEONARDO MARCHINI, DDS, MSD, PhD
Associate Professor, Department of Preventive and Community Dentistry, The University
of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
SARAH L. MEYER, MLIS
Assistant University Librarian, University of Florida Health Science Center Libraries,
Gainesville, Florida
ROSEANN MULLIGAN, DDS, MS
Charles M. Goldstein Professor of Community Oral Health and Associate Dean,
Community Health Programs and Hospital Affairs at the Herman Ostrow School of
Dentistry of USC with a joint appoint at the Leonard Davis School of Gerontology of the
University of Southern California, Los Angeles, California
LINDA C. NIESSEN, DMD, MPH, MPP
Dean and Professor, College of Dental Medicine, Vice Provost for Oral Health Affairs,
Kansas City University of Medicine and Biosciences, Joplin, Missouri
KADAMBARI RAWAL, BDS, MSD, FASGD, FICD, FACD
Clinical Assistant Professor, Department of General Dentistry; Attending Dentist,
Department of Medicine, Hebrew SeniorLife; Faculty Practice, Dental Health Center,
Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
FRANK A. SCANNAPIECO, DMD, PhD
Professor and Chair, Department of Oral Biology, School of Dental Medicine, University at
Buffalo, The State University of New York, Buffalo, New York
ANNETTY P. SOTO, DMD
Clinical Assistant Professor, Division of General Dentistry, Department of Restorative
Dental Sciences, University of Florida College of Dentistry, Gainesville, Florida
PIEDAD SUAREZ DURALL, DDS, MS
Associate Professor of Clinical Dentistry and Interim Division Chair, Dental Public Health
and Pediatric Dentistry, Section Chair of Geriatrics and Special Patients, Director of the
Special Patients Clinic of the Herman Ostrow School of Dentistry at USC, Adjunct
Associate Professor, Leonard Davis School of Gerontology, University of Southern
California, Los Angeles, California
LISA A. THOMPSON, DMD
Program Director, Geriatric Dental Fellowship, Harvard School of Dental Medicine,
Boston, Massachusetts
Geriatric Dental Medicine
Contents
Dedication ix
Joseph M. Calabrese and Michelle M. Henshaw
Preface: Geriatric Dental Medicine xi
Joseph M. Calabrese and Michelle M. Henshaw
Demographics and Oral Health Care Utilization for Older Adults 241
Joseph M. Calabrese and Kadambari Rawal
The population of older adults is projected to increase dramatically as
Baby Boomers continue to reach age 65 into 2029. This article discusses
key shifts in this demographic, including changes in overall health status
and living arrangements, that can aid in defining older adults and their
medical needs. It also highlights the changes in dental use patterns and
the increase in demand for comprehensive dental services for older adults
in recent years. The article focuses on the fact that oral health contributes
to overall health and the dental workforce must be prepared to treat older
adults in their practices.
Oral Health Disparities and Inequities in Older Adults 257
Michelle M. Henshaw and Steven Karpas
The number of individuals 65 and older living in the United States is
increasing substantially and becoming more racially and ethnically diverse.
This shift will affect the demographics of the patient population seeking
dental care. It will also impact the future treatment needs of older adults.
In older adults, similar to the general adult population, oral health dispar-
ities continue to exist related to race, ethnicity, gender, and socioeco-
nomic level. Dental practitioners must understand these changes in
order to meet the challenges of providing oral health care to the increasing
numbers of diverse, medically compromised, and cognitively impaired
older adults.
Physiology of Aging of Older Adults: Systemic and Oral Health Considerations—
2021 Update 275
Lisa A. Thompson and Helen Chen
Most oral health care providers encounter older adults in their practices
and can play a critical role in supporting independence and quality of life
for this aging cohort. Physiologic and structural oral cavity changes asso-
ciated with normal aging may affect the presentation and oral health care
of older adults. This article reviews the normative aging of dentition and
oral structures and physiologic changes associated with normal aging,
including cardiovascular, metabolic, and musculoskeletal changes, and
how they may affect oral health. Oral health providers should be aware
vi Contents
of normal aging processes when they plan care or schedule procedures for
older adults.
Geriatric Phenotypes and Their Impact on Oral Health 285
Roseann Mulligan and Piedad Suarez Durall
Older adults have multiple morbidities that can impact oral, systemic, and
psychological health. Although each disorder requires consideration from
the provider before treatment, by assessing the common phenotypic pre-
sentations of older adults, we can better understand, select, and coordi-
nate treatment modifications that would need to be considered and
implemented for dental care.
Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia 307
Frank A. Scannapieco
Aspiration pneumonia (AP), inflammation of the lung parenchyma initiated
by aspirated microorganisms into the lower airways from proximal sites,
including the oral cavity, is prevalent in, and problematic for, the elderly,
especially those in institutions, and for those with several important risk
factors. Many factors influence the pathogenesis of AP, including
dysphagia, poor oral hygiene, diminished host defense, and underlying
medical conditions. This article reviews the epidemiology, microbiology,
pathogenesis, and prevention of AP, focusing on the role of poor oral
health as a risk factor for, and on dental care for the prevention and man-
agement of, this important infection.
Oral Implications of Polypharmacy in Older Adults 323
Annetty P. Soto and Sarah L. Meyer
Over the next several decades, rates of aged populations will increase
rapidly. These populations are susceptible to multimorbidities and poly-
pharmacy (concurrently, prescribed 5 or more medications). Many medi-
cations have side effects that manifest orally. Therefore, it essential to
possess current pharmacologic knowledge to diagnose and treat oral im-
plications of commonly prescribed medications. This article details com-
mon medication-induced oral lesions and patient assessment of risk
factors for polypharmacy and provides a template to integrate medication
reconciliation into dental clinical practice.
Cognitive Impairment in Older Adults and Oral Health Considerations: Treatment
and Management 345
Paul S. Farsai
Current research aims at improving early detection and treatment of cogni-
tive impairment (CI), particularly in patients at high risk for progression to
dementia. It is important to treat signs and symptoms as early as possible
to normalize quality of life. In older cognitively impaired patients, dentists
and physicians should consider polypharmacy, uncontrolled cardiovascu-
lar risk factors, depression, metabolic or endocrine derangements,
delirium due to intercurrent illness, and dementia, all of which may
Contents vii
increase risk for CI and other negative outcomes. An interdisciplinary team
approach is a necessity for a responsible and safe treatment sequence.
Consideration in Planning Dental Treatment of Older Adults 361
Ronald Ettinger, Leonardo Marchini, and Jennifer Hartshorn
When caring for the oral health of frail and functionally dependent older
adults, it is important to understand their general health and oral health
problems to make a diagnosis. There are multiple treatment strategies
available to care for their needs; many may not be evidence based. Dental
treatment planning for older adults is as much art as science and requires
clinicians to understand how patients are functioning in their environments
and how oral health care fits into their needs and lifestyle. This article dis-
cusses a variety of treatment planning techniques and illustrates the prob-
lem with a longitudinal case history.
Interdisciplinary Education and Health Care in Geriatric Dental Medicine 377
Matthew Mara
Geriatric patients are more likely to have multiple medical comorbidities,
physical limitations, and mental impairments that warrant careful consider-
ation while providing patient care. Dentistry, along with other health care
professional programs, incorporate interprofessional education (IPE) ex-
periences to provide students with skills they need to deliver collaborative
care in their future practice. Health professional programs should consider
geriatric training in simulated learning environments, adult day programs,
nursing homes, long-term care facilities, and home care experiences to
provide students valuable IPE experiences. Lastly, this article presents a
call to action for professional organizations to consider offering continuing
education courses in IPE.
Innovations in Geriatric Oral Health Care 393
Elisa M. Ghezzi, Linda C. Niessen, and Judith A. Jones
Older adults are retaining their teeth and need strategies for a lifetime of
oral health care. Daily prevention and professional preventive care have
the most significant impacts on reducing oral disease in the aging popula-
tion. Providers of oral health care extend beyond traditional dental profes-
sionals to include caregivers and health care providers through
teledentistry and interprofessional collaboration. Dental and aging organi-
zations advocate for the inclusion of a dental benefit in Medicare to
address access to care. Innovations in geriatric oral health care involve ad-
vances in clinical oral health care, delivery and models of care, funding,
research, education, and policy.
viii Geriatric Dental Medicine
DENTAL CLINICS OF NORTH AMERICA
FORTHCOMING ISSUES RECENT ISSUES
July 2021 January 2021
Radiographic Interpretation for the Dentist Implant Surgery
Mel Mupparapu, Editor Harry Dym, Editor
October 2021 October 2020
Biologics and Biology-based Regenerative The Journey to Excellence in Esthetic
Treatment Approaches in Periodontics Dentistry
Alpdogan Kantarci, Andreas Yair Y. Whiteman and David J. Wagner,
Stavropoulos, and Anton Sculean, Editors Editors
January 2022 July 2020
Adolescent Oral Health Controlled Substance Risk Mitigation in the
Deborah Studen-Pavlovich, Editor Dental Setting
Ronald J. Kulich, David A. Keith, and
Michael E. Schatman, Editors
SERIES OF RELATED INTEREST
Atlas of the Oral and Maxillofacial Surgery Clinics
http://www.oralmaxsurgeryatlas.theclinics.com
Oral and Maxillofacial Surgery Clinics
http://www.oralmaxsurgery.theclinics.com
THE CLINICS ARE AVAILABLE ONLINE!
Access your subscription at:
www.theclinics.com
Geriatric Dental Medicine
Dedication
This edition is dedicated to our parents, patients and students. Without the guidance
that our parents provided to help show us the way, nothing would be possible. To our
patients for trusting us to always do what is best for their oral health, overall health and
well-being. Lastly to our students for listening to us, learning from us, challenging us,
flourishing before our eyes and motivating us to always try to do our very best.
Joseph M. Calabrese, DMD
Boston University Henry M. Goldman
School of Dental Medicine
635 Albany Street, G-158
Boston, MA 02118-2308, USA
Michelle M. Henshaw, DDS, MPH
Boston University Henry M. Goldman
School of Dental Medicine
560 Harrison Avenue, Room 301
Boston, MA 02118, USA
E-mail addresses:
[email protected] (J.M. Calabrese)
[email protected] (M.M. Henshaw)
Dent Clin N Am 65 (2021) ix
https://doi.org/10.1016/j.cden.2021.01.002 dental.theclinics.com
0011-8532/21/ª 2021 Published by Elsevier Inc.
This page intentionally left blank
Geriatric Dental Medicine
Preface
Geriatric Dental Medicine
Joseph M. Calabrese, DMD Michelle M. Henshaw, DDS, MPH
Editors
Welcome to the Geriatric Dental Medicine issue of Dental Clinics of North America.
Given that older adults will become a greater percentage of your patients, we designed
this issue to provide you with an overview of this special population’s health and oral
health needs as well as strategies to address these needs within your own practice and
through referrals. This issue covers key concepts from demographic trends, to the
challenges inherent in financing oral health care for older adults, to emerging technol-
ogy. This issue also explores the value of working together as part of the health care
team to reach the goal of delivering the highest-quality oral health care to older adults
regardless of their complex medical status or if they are a long-term care resident.
Even when that means making the difficult decision that the most appropriate treat-
ment option is no treatment (do no harm).
The dental field has evolved from a “tooth fixer” to today where we play an integral
role in the overall health and well-being of our patients as the dental medicine compo-
nent of an interprofessional health care team. Throughout our careers in Geriatric
Dental Medicine, we have worked alongside some of the most dedicated, thoughtful,
and compassionate health care workers anywhere. We hope that this issue inspires
you to expand your practice to include developing collaborations with nutritionists,
physical therapists, occupational therapists, and other members of the health profes-
sions that can positively impact the health of your patients.
Ultimately, the quality of a product is due in large part to the sum of all its parts. We
set the bar high and asked some of our esteemed colleagues to help author the 10 ar-
ticles in this issue. We could not be more pleased with the results and feel that, in this
case, the value of the issue as a whole exceeds the individual articles. We hope that
you will find the information presented of great relevance and utility in your practice.
Dent Clin N Am 65 (2021) xi–xii
https://doi.org/10.1016/j.cden.2021.01.001 dental.theclinics.com
0011-8532/21/ª 2021 Published by Elsevier Inc.
xii Preface
We would like to formally acknowledge the hard work and dedication of our contrib-
uting authors, and last, but not least, the outstanding team at Elsevier.
Joseph M. Calabrese, DMD
Boston University Henry M. Goldman
School of Dental Medicine
635 Albany Street, G-158
Boston, MA 02118-2308, USA
Michelle M. Henshaw, DDS, MPH
Boston University Henry M. Goldman
School of Dental Medicine
560 Harrison Avenue, Room 301
Boston, MA 02118, USA
E-mail addresses:
[email protected] (J.M. Calabrese)
[email protected] (M.M. Henshaw)
This page intentionally left blank
