Oral Healthcare and the Frail Elder, 2nd Edition

Fully updated reference to clinical knowledge and strategies for effective oral healthcare in frail older adults

Taking an evidence-based approach, with theoretical and clinical knowledge underpinned by the literature, Oral Healthcare and the Frail Elder provides a comprehensive reference to management strategies for dental diseases as noncommunicable diseases in older populations. The book presents a global perspective with current guidance for clinicians, addressing the particular challenges of providing dental care for people who are confronting frailty in old age. Reflecting the numerous developments in the discipline since the previous edition was published, this Second Edition has been thoroughly updated throughout with 15 new chapters.

The first section covers background information, including demographics, social considerations, and factors affecting oral health in this population. The second half of the book is devoted to clinical management strategies.

Some of the new topics discussed in this edition of Oral Healthcare and the Frail Elder include:

• Theories and significance of oral health in frailty and oral health-related quality of life, and the influence of the life-course on oral health
• How sugar, tobacco, and alcohol initiate and sustain oral diseases, as with other noncommunicable diseases, into old age
• Mitigation of dental caries, periodontitis, gingivitis, mucositis, and other non-communicable diseases of the mouth
• Infection control, communications and tele-dentistry, mobile dental services, and strategies to appraise the usefulness of community-based oral healthcare programs

With an emphasis on population and public health in the context of non-communicable disease, the Second Edition of Oral Healthcare and the Frail Elder is an important resource for clinicians dealing with the geriatric population, including dentists, dental hygienists, dental therapists, denturists and dental technicians, nurses, and geriatricians.

CONTENTS

Foreword xv

Preface xvi

List of Contributors xix

1 Demography of Aging and Frailty, and the Epidemiology of Oral Conditions 1
W. Murray Thomson, Moira B. Smith, Fernando Neves Hugo, and Philippe Mojon 

Demography of Aging and Frailty 1

The Aging Population 1

Conceptualizing Aging 1

Multimorbidity 2

Frailty 3

Oral Frailty 4

Importance of the Life-Course 4

Epidemiology of Oral Conditions in Older People 5

Edentulism and Incremental Tooth Loss 5

Dental Caries 7

Periodontitis 7

Oral Mucosal Lesions 7

Dry Mouth 9

Muscular and Joint Disorders 9

Conclusion 10

References 10

2 Challenges with Noncommunicable Diseases and Frailty 16
Michael I. MacEntee, Paul Allison, Denise Laronde, and Bruce Wallace 

Noncommunicable Disease 16

Frailty 18

Noncommunicable Diseases of the Mouth 19

Dental Caries 19

Periodontal Disease 21

Tooth Loss 23

Oral Cancers 24

Risks for Noncommunicable Diseases of the Mouth 25

Sugar 25

Tobacco 25

Alcohol 26

Aging 26

Immune System and Oxidative Stress 26

Other Risks 27

Social Determinants 27

Conclusion 28

References 28

3 Theoretical Perspectives on Frailty, Oral Health- Related Quality of Life, and Well- Being in Old Age 37
Michael I. MacEntee, Dominique Niesten, Mario A. Brondani, and Maha M. Al-Sahan 

Health 38

International Classification of Functioning 39

Oral Health 40

Comfort, Well-Being, and Quality of Life 42

The Myth of Measurement 42

Frailty 43

Oral Frailty 44

Managing Ill-Health and Frailty 45

A Metatheory 45

A Clinical Scenario 46

Conclusion 47

References 47

4 Communities and Frail Elders 54
C. Peter Owen, Michael I. MacEntee, Rodrigo Marino, Victor Minichiello, and Gladys Meriting Thokoane 

What Is a Community? 54

Culture and Ethnicity 55

Culture and Acculturation 55

Ethnicity 56

Communities of Elders 56

Barriers to Equitable Healthcare 57

Agism 57

Racism 58

Migration 59

Equitable Healthcare and Cultural Competence 60

Health Advocacy 61

Conclusion 63

References 63

5 Oral Healthcare Policy, Equity, Economics, and Political Action for Aging Populations 68
F.A. Clive Wright, Michael I. MacEntee, Joke Duyck, Moira B. Smith, Bruce Wallace, and C. Peter Owen 

Purpose of Policy 68

Categories of Public Health Policy 69

Uniqueness of Health Policy 70

Forming Health Policy 70

Equality and Equity 71

Agism 71

Adopting Health Policy 72

Financial Policies 73

Analyzing and Assessing Health Policy 73

Global Strategy on Oral Health 76

The Challenge 76

Promoting Oral Healthcare Policies 76

Oral Healthcare Workforce 78

Pyramid of Primary Oral Healthcare 78

Conclusion 79

References 80

6 The Influence of the Mouth and Mouthcare on the Body-Image and Social Interactions of Frail Elders 87
Leeann Donnelly, Laura Hurd, Alison Phinney, and Michael I. MacEntee 

Body-Image and Oral Health 87

Social Isolation, Loneliness, and Depression 88

Clinical Implications 89

Oral Health and Social Interactions 90

Clinical Script 90

Conclusion 92

References 92

7 Ethical and Moral Considerations for Oral Healthcare of Frail Elders 96
Michael I. MacEntee, Mario A. Brondani, Nico Creugers, Shafik Dharamsi, and Mary E. McNally 

Healthcare Ethics 96

Frailty 97

Ethical Theory and Principles in Healthcare 97

Patient-Centered Care, Care Ethics, Narrative Ethics, and Feminism 98

Moral Distress 99

Moral Injury 100

Surrogate Decision-Makers 100

Ethical Dilemmas 101

Socially Responsible Care 101

Universal Health Coverage 101

Professional Responsibilities 102

Elder Abuse 102

Reporting Abuse 103

Identifying and Managing Elder Abuse 103

An Ethical Framework 104

Clinical Context 105

Clinical Scripts 106

Complexities 106

References 109

8 Educating a Workforce for Dental Geriatrics 115
Matana Kettratad-Pruksapong, Shiva Khatami, Linda Slack-Smith, Jirakate Madiloggovit-Lower, Leonardo Marchini, C. Peter Owen, and Michael I. MacEntee 

Teaching and Learning Dental Geriatrics 115

Exposure to Frailty 116

Postgraduate Education 116

Cultivating Clinical Reasoning 116

Promoting Compassion 118

Healthcare-Teams 119

Conclusion 120

References 120

9 Chronic Orofacial Pain and Movement Disorders in Old Age and Frailty 125
Pierre J. Blanchet, Limor Avivi-Arber, Barry J. Sessle, and Gilles J. Lavigne 

Assessing Pain 125

Age-Related Changes in Processing Pain 126

Mechanisms of Processing and Modulating Pain 126

Afferent Nerve Fibers 127

Pain Processing and Modulation 127

Pain-Related Sensorimotor and Other Functions of the CNS 127

Orofacial Pain 128

Temporomandibular Disorder (TMD) Pain 128

Management of TMD Pain 128

Lesion or Disease of the Cranial Nerves 128

Trigeminal Neuralgia 128

Other Trigeminal Neuropathic Pain 129

Postherpetic Neuralgia 129

Idiopathic Orofacial Pain Conditions 130

Burning Mouth Syndrome 130

Persistent Idiopathic (Atypical) Facial Pain 131

Persistent Idiopathic Dentoalveolar Pain (Atypical Odontalgia) 131

Movement Disorders and Orofacial Pain 132

Oromandibular Dystonia 132

Management of Oromandibular Dystonia 132

Oral Dyskinesia 132

Management of Oral Dyskinesia 133

Stereotypies 133

Management of Stereotypies 133

Bruxism 133

Management of Bruxism 134