A few thoughts on oral health and aging (mostly aging)

1. A few thoughts on oral health and aging (mostly aging) Edward L. Schneider, MD Dean Emeritus USC

2. Demography 101 Note: The Census Bureau has consistently underestimated the growth of the older population

4. Once again, these figures are probably underestimates

6. Again, Census is probably way off the mark, by 2050, the number will be closer to 30 million

9. A couple of findings from the 2006 Census report • The health of older Americans is improving. The proportion with a disability fell significantly from 26.2 percent in 1982 to 19.7 percent in 1999. • The financial circumstances of older people have improved dramatically. The proportion of people aged 65 and older in poverty decreased from 35 percent in 1959 to 10 percent in 2003.

10. Some Additional Interesting Data • The quality of health in later life may be determined more by your perinatal and prenatal environment than by your health habits (What about oral health?) • Socioeconomic status is a better predictor of poor health in old age than exercise or nutrition • Oral health may be a predictor of Alzheimer Disease and other conditions related to chronic inflammation • Transportation which equates with independence will be a major issue for tomorrow's seniors

11. Political Issues • Social Security will need only minor adjustments to survive • Medicare will need major attention and will probably not survive in its current state • Medicaid will need radical surgery to survive as long term care costs soar • But remember, all the political decisions will be made by a Congress and a President elected largely by older voters

12. The future of Aging: Your Replacement Part Store is Open • All joints: wrists, ankles, shoulders, elbows, hands, jaws? • Most organs: heart, liver, kidney, pancreas, lungs • Stem cells will be available to make bone marrow, immune cells, brain cells, artificial bladders, skin, teeth?

13. The future of Aging: Current causes of disability and death will be eliminated • The focus of prevention will shift to perinatal and prenatal care • Prenatal genetic screening will pinpoint specific lifetime preventive strategies • Arteriosclerotic Cardiovascular Disease will be treated with periodic mechanical (nanorobotic) and chemical cleansings • Cancers will have specific molecular targeted therapies • Satiety pills will be used to treat the metabolic syndrome • Drinking water will contain chemicals that prevent cognitive impairment and other conditions that affect the majority of the population • Smokers will be forced to pay exorbitant health insurance rates (wishful thinking?)

14. The future of Aging • Life expectancy at birth will reach 100 • People will take mid-life sabbaticals • Social Security retirement ages will be a sliding scale of benefits from 65 to 85 • 80 will be the new 60, 60 will be the new 40 • The main causes of death will be accidents, homicides and suicides • Twinkies will probably not be the new health food (sorry, Woody Allen)

16. What this means for Dentists More Older People + Less Edentulism = More Teeth

17. Consequence of the Aging of America on Dentistry • Unless you are a Pediatric Dentist or an Orthodontist, you will be a Geriatric Dentist • Not unique to Dentisty, all Physicians except Obstetricians and Pediatricians with be Geriatricians

18. Things you should know as a Geriatric Dentists • Additional care is needed with medications due to polypharmacy, adverse drug responses • Incidence of oral cancers increase with aging • Cutbacks of Medicare and Medicaid will lead to poorer seniors who may skimp on their dental care • Dentists are the health care provider seen most often by many seniors and therefore can play a key role in health promotion and disease prevention

19. Now that you feel comfortable about being a Geriatric Dentist, lets look at Nutrition and Aging Most of what you learned about Nutrition in Dental School is wrong: • Department of Agriculture Food Pyramid • Multivitamins • Supplements

21. Multivitamins for All Ages

22. Mini to Maxi

23. Various Multivitamin Products

24. Multivitamins for Our Faithful Companions

25. The Case Against Vitamins Recent studies show that many vitamins not only don't help. They may actually cause harm. By TARA PARKER-POPEWall StreetJournal, March 20, 2006; Page R1

26. Multivitamins • Contain 100% RDAs of many vitamins, some minerals and today’s hot supplement • Contain Iron, Copper, and Vitamin A in the form of Retinol • Contain very small amounts of needed vitamin D or enough Vitamin B12 for those who need it

27. Popular Supplements • Beta Carotene • Vitamin C • Vitamin E • Vitamin A • Selenium • Calcium • Folic Acid • Resveratrol

28. What is left? • Vitamin D (1000 IU) to prevent fractures, reduce your risk of arthritis and certain cancers • Vitamin B12 (1 mg) for many seniors who are achlorhydric

29. I can’t take all this bad news, what can we eat to age well! • lots of fruits and veggies • nuts • 1 to 2 servings of fatty fish each week • lots of fiber • monounsaturated fats (olive oil) • Cabernet Sauvignon • Chocolate

30. Benefits of Chocolate Decreases Blood Clotting Relaxes and Dilates Blood Vessels Fat in Chocolate, Stearic Acid does not elevated cholesterol levels 1/3 of Fat is monounsaturated Flavonoids prevent LDL oxidation

31. If you invite me back, I will tell you that most of what you learned about the following is wrong • Hormone replacement • Insomnia • Prevention of hip fractures • Alternative medicine