Ageing is Good

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Ageing is Good!
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Ageing

• Chronological

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Ageing

• Attitudinal

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Ageing

• Medical

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Ageing

• Dental

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Ireland Population ()

• Year 0-14 65
• 1961 30.6 11.8
• 1971 30.7 12.1
• 1981 29.7 11.9
• 1991 25.8 12.9
• 2001 21.2 11.1
• CSO 2002

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Ireland 65
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Ireland Population Projection () Dependency
Ratio

• 0-14 65
• 2001 21.5 11.2
• 32.0 16.6
• 2006 20.8 11.2
• 2011 21.0 11.8
• 2021 20.0 14.6
• 30.7 22.4
• CSO 2006

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EU 65 ()
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Ireland 65
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Dublin 65 yrs ()

• Dublin 14.7
• Ayrfield 1.7
• Priorswood 1.7
• Tallaght 2.0
• Grange 2.3
• Kinsaley 2.7
• Firhouse 2.7
• CSO 1991

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Dublin 65 yrs ()

• Dublin 14.7
• Inchicore 19.0
• Drumcondra 19.8
• Walkinstown 20.9
• Clontarf 21.8
• Chapelizod 22.1
• Phoenix Park 24.7
• CSO 1991

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Dentate ()

• Age 1979 1989/90
• All 70 81
• 55-64 43 59
• 65 28 52
• OMullane and Whelton 1992

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Teeth Present

• Age Number
• 16-24 27.2
• 25-34 25.4
• 35-44 21.9
• 45-54 17.5
• 55-64 15.4
• 65 14.1
• OMullane and Whelton 1992

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Dentate 65

• Area ()
• Ireland 52.0
• O.H.B. 46.9
• E.H.B. 64.6
• OMullane and Whelton 1992

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WHO Proposals 2010

• 65-74 year olds
• lt5 edentulous
• 75 minimum 20 teeth
• lt0.5 sextants have CPITN of 4

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65 Regular Dental Visit

• Group ()
• All 11.0
• Edentulous 2.0
• Dentate 26.0
• OMullane and Whelton 1992

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Visit Dentist Previous Year ()

• Age Edentulous Dentate
• 65 -74 13 68
• 75 7 60
• All 14 59
• ADH1998

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Oral Conditions

• Oral pathology
• Xerostomia
• Periodontal diseases
• Caries
• Endodontics
• Toothwear
• Aesthetics
• Tooth Loss

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Management of the Dentate Elderly

• Epidemiology
• Planning of care
• Prevention
• Periodontal diseases
• Toothwear
• Endodontics
• Caries
• Choice of material
• Tooth loss
• Prognosis
• Aesthetics

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Dublin G.A. Treatment
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Planning of Care

• Systemic factors
• Attitude
• Patient
• Carer
• Dental team

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Barriers to the Provision of Complex Dental
Treatment for Dentate Older People A Comparison
of Dentists and Patients Views

• Wilson M.C., Holloway P.J. and Sarll D.W.
• British Dental Journal 1994

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...dentists overestimated their older patients
reluctance to receive dental treatment. It is
likely that dentists....are likely to offer them
only the simplest treatment in the mistaken
belief that anything more complex is likely to be
refused.

• Wilson et al. 1994

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Planning of Care

• Systemic factors
• Social
• Finance
• Support
• Time
• Access

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Planning of Care

• Systemic factors
• Physical
• Communication
• General health
• Mobility

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Planning of Care

• Local factors
• Soft tissues
• Occlusion
• Hard tissues
• Iatrogenic factors

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Planning of Care

• Systemic management
• Consult
• Patient
• Carer
• Physician

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Planning of Care

• Systemic management
• Appointment
• Logistics
• Length
• Medication

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Planning of Care

• Local management
• Treatment plans
• Emergency
• Primary
• Finite
• Maintenance

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Planning of Care

• Local management
• Treatment plans
• Emergency
• Primary
• Finite
• Maintenance

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Prognosis

• Why bother?
• Little research

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Retention of Restorations

• Class V cervical lesions (n178)
• internal walls roughened with coarse diamond
• bevelled enamel
• etched enamel
• incremental placement
• 24 month evaluation
• Heymann et al. 1991

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Retention of Restorations

• Composite
• Prisma-Fil Prisma Micro-fine Silux
• Bonding agent
• Prisma Universal Bond Scotchbond
• Application technique
• regular - one coat regular - two coats
• bond - etch - rebond - two coats
• Heymann et al. 1991

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Retention of Restorations

• 167 restorations at recall
• maxillary restorations 54
• 21 molar 93 premolar 64 anterior
• no statistical difference between groups with
  regard to colour, marginal discolouration ,
  marginal integrity, wear or caries
• Heymann et al. 1991

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Retention of Restorations

• 22.9 of restorations lost
• no significant difference between bonding agent
  or method of application
• significant association between composite resin,
  occlusal stress, tooth location and patient age
  and loss of retention
• Heymann et al. 1991

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Retention of Class V by Age
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Patient Age and Bridge Survival

• 150 patients
• 150 practitioners
• 15 year follow-up
• 64 patients
• mean units/patient 6.9
• pontic abutment 0.47
• Glantz and Nilner 1993

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Patient Mortality

• age
• lt37 8.8
• lt65 10.5
• gt65 35.2
• Glantz and Nilner 1993

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Bridge Survival

• age
• lt37 58
• lt65 64
• gt65 60
• Glantz and Nilner 1993

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Prognosis

• Success one year after RCT
• Age
• All 91
• 65 96
• Ingle et al. (1985)

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ART

• Atraumatic
• Restorative
• Treatment

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ART

• ..excavation of caries by means only of hand
  instruments and tooth restoration by means of
  glass-ionomer cement
• Ewoldsen et al. 1997

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Oral Care for the Older Patient

• 25 - 26 October 2007
• www.fodasmrcsi.ie

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Questions?