Published on March 16, 2016
3. 3 DEALing with the TSUNAMI of DISINTEGRATING Dentistry in the coming DECADES? Dr. Jon Strom, DDS, FACD RETENTION! RETENTION! RETENTION!
4. 4 RETENTION 1 Transition from Edentulous to Dentate Seniors 1800’s to 1st half of 1900’s Surgical Extraction Dentures for Young Adults (Wales, Que.) Post WW II . Preventative Dentistry Prevails Baby Boomers :Schools 1950’s- Health 2020’s
5. 5 Geriatrics and FRAIL ELDERLY! Over 65’s outnumber Children and Young Adults as of 2016! Chronic Disease Polypharmacy and Xerostomia impact Oral Hygiene Status Lack of mobility of Frail Elders inhibits Dental Visits
6. 7 BABY BOOMERS Dental History: Edentulous 1st 50 years of 20th Century Antibiotics changes the next 50 years Dentists acquire hi-speed rotor, flourides and hygienists. Population becomes more Dentulous. Peripheral Seal on Full Dentures loses importance. Implants lock Dentures in place. Increased Dentate Population needs extra care
7. 8 SILVER TSUNAMI Numbers of Frail Elderly about 22 per Dentist 3,000 Dentists in BC, so 66,000 patients need more oversight to maintain good oral health! Many are not accessing Dental Care. Need for education and special protocol. Average patient over 65 visits Dentist every Two Years. Inadequate supervision if General Health is compromised.
8. 9 Not FRAIL ELDERS
9. 10 Restorations Retain Teeth
10. 11 Dentition Retained for a lifetime Adults are retaining Natural Dentition longer and Living Longer. Good Oral Hygiene is of greater significance as Chronic Health Problems appear!
11. 12 Who is A FRAIL ELDER? Slow Walkers:10 Seconds to walk 3 Meters! Unable to Stand from Seated Position with Arms crossed over Chest! Hard of Hearing Comprehension and Memory Difficulty Bette Davis said OLD AGE IS NOT FOR SISSIES! THE GOOD NEWS IS: IT DOESN’T LAST THAT LONG!
12. Poor oral hygiene & Elders RETENTION #2
13. 14 MEDICAL / DENTAL DISCONNECT MEDICARE and Dental Care disconnect MEDICARE :Coverage from Tonsils on Down POLYPHARMACY : Oral Side Effects ignored DENTISTRY: Out of Pocket Expense. Value? LONG TERM CARE: Not Cognizant of Problem
14. 15 Dental Health and Aging No relationship with age and Oral Health Relationship between Chronic Diseases and Hygiene Dissociation of Medical Profession from implications of Oral Health and Medical Prognosis. Dental Care restricted to Dental Clinics. Need for Outreach Protocol becomes obvious!
15. 16 Oral Hygiene
16. Gingival Sulcus infection source of Bacteremia Pneumonia if inspiration occurs!
17. 18 Alzheimers Affects 4% of 75 Year Olds, 16% over 75, and 32% over 95 years of Age This still means over 70% of over 90’s are mentally sharp! Need some autonomy in Oral Hygiene Care In Future Robotics may assist!
18. 19 Parkinson’s and Chronic Disease Parkinson’s. Xerostomia Polypharmacy. Overuse of Drug Therapy Lack of Information about side effects of drugs Xerostomia (Dry Mouth). Saliva production and pH not often Considered.
19. 20 The Players Involved A frail ELDER with Cognitive Problems may have Decision makers involved Such as: Trustee, Spouse,Family Facilitator, Doctor, Nursing Aide,Assigned Caretaker, Long Term Care Facility Protocol must be considered Privacy Laws and Security Regs add Red Tape and Complicate Treatment decisions
20. 21 RETENTION #3 26 % of Elders access Dental Office every Two Years Only 50% see value in maintaining Oral Health Perception is: will lose teeth anyway Do not perceive General Health Status and Healthy Mouth are related Family, caregiver and Trustees not engaged Can this destructive perception be overcome? BY WHOM? -----PRACTICING DENTIST!
21. 22 Inform, Inform, Inform Modern Information SYSTEMS WEBSITE SMARTPHONES IntraOral cameras-3D E-mail: Text & Photos Office Ambassador for Frail Elders Office Protocol Oral Science -Courses& Products
22. 23 PHOTO, SHARE, INTERNET Oral Condition emailed for analysis A picture is worth 1,000 words
23. 24 PROTOCOL SUGGESTED Early Education on Importance of Oral Health if General Health is Compromised Present implications to patient before health is compromised. Age 60 is suggested Provide healthy Patient with information in an Introductory Brochure. Provide Website Links. Assure him that your Dental Clinic wishes to provide him appropriate care for his Lifetime Have a Staff Member trained to so instruct on your office protocol
24. 25 Areas of Special Concern Diet changes needed of special significance List of drugs being used.Need for Hydration and Oral rinses to mitigate Xerostomia. Effective Tooth Brushes and Toothpastes for each stage of inhibited physical ability. Use of Xylitol Lozenges to inhibit Caries. Proper use of Chlorihexidrine Gels and Flouride applications. Pilocarpine Lollipops to stimulate Saliva Production.
25. 26 Other Oral Hygiene Aids WaterPik Chewbrush Potential Chewstick Irony of toothbrush technology! Sanitation Issues.Bacterial exposure.Ultraviolet,etc. Spending on Pets in US.$61 Billion.$6.5 in Canada 55-64 Year Olds spent most of any Age Group.
26. 27 BLIZZIDENT
27. 28 Prototype MOUTH BRUSH
28. 29 Need to ENROLL ALL PLAYERS Need to Co Ordinate Health Care protocol for the Frail Elder All need to be on Same Song Sheet Provide as much Autonomy as possible for Patient Special needs in Nutrition, Drug Side effects,Oral Hygiene instruments and Oral Hygiene Aids. Regular supervision and Updates for all Players Who will oversee this Co-ordinated Care?
29. 30 DIET & NUTRITION Affects Oral Environment: pH of saliva, amount of saliva, Oral Flora, Calculus deposits, Bacterial constituents. Hydration Refined Carbohydrates detrimental. WHO position. Sweden has AdoptedNew Nutritional Guidelines (FAT GOOD_REFINED CARBS BAD) Instruction and inception of a strict protocol needed
30. 31 DEAD FILES Patient Retention skills listed in Courses for Dentist Keeping an on-file Patient beats enrolling a new one! Enroll all 65+ Patients into Lifetime Program Prepare them for Special Needs Your clinic Provides! 3,000 Dentists in BC. Each G.P. has 22 Frail Elders. They often disappear from the Practice. Be prepared for Aging Dental Special needs Inform them beforehand that Your office has a Retention Protocol for FUTURE NEEDS!
31. 32 ONLINE RESOURCES USERS are Patients, Dental Staff, Family, MD, Pharmacist ACCESS LEVELS to Info and Protocols: Dentist,Staff, (Office Ambassador) Patients, Ambassador, Family Support, Caretakers
32. 33 RETENTION, RETENTION, RETENTION THE MESSAGE IS THIS: The DENTIST is the SOURCE to RETAIN PATIENTS FOR A LIFETIME SO the PATIENT is ENABLED to RETAIN THEIR TEETH AND DENTAL HEALTH FOR THEIR LIFETIME. HOW: BY USING NEW TECHNOLOGY TO REACH OUT AND KEEP THE PATIENT INFORMED FOR THEIR LIFETIME.
33. 34 Who’ll care for the rapidly aging?
34. 35 Dr. Jon Strom, DDS, FACD RETENTION! RETENTION! RETENTION! /JONSTROMDDS
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