1. Santa Fe Group TACKLING DENTURE DISABILITY Oral Health For the Elderly: Challenges and Opportunities 28 June 2007 Santa Fe, NM Jocelyne Feine McGill University

2. Percent Edentulous Among U.S. Adults, by Age Group: 1960-2002 NCHS, National Health and Nutrition Examination Surveys

3. The Impact of Edentulism General Health and Quality of Life • Comfort • Nutrition • Ability to chew • Food choice • Ability to socialize • Intimate activities

4. Edentulism and General Health • Edentulous individuals have poorer nutrition than those who are dentate(Lee at al, 2004; Sheiham et al, 2001; Joshipura et al, 1996; Krall et al, 1998; Fontijn-Tekamp et al, 1996; Papas et al, 1998; Greksa et al 19995; Mojon et al; 1999). • Edentulous elders have an increased risk of systemic diseases(Johansson et al, 1994; Joshipura et al, 1996; Hamasha et al, 1998; Elter et al, 2003; Morais et al, In preparation). • Edentulous elders have significantly greater morbidity and earlier mortality than dentate elders(Shimakazi et al, 2001; Hamasha et al, 1998; Joshipura et al, 1996).

5. Edentulous Denture-Wearing Elders are at Risk for Disease • Prevention of tooth loss • Therapy to improve chewing ability and nutrition.

6. OSSEOINTEGRATED INTRAORAL IMPLANTS

7. From Health Technology Assessment to Health Policy

8. Healthcare Professional Reducing Cost of Care • Complex traditional prosthetic techniques are no better than simplified techniques to fabricate high quality conventional dentures (Kawai et al, 2005; Carlsson, In Press). • Inexperienced new dentists are able to provide equally effective and satisfactory simple mandibular implant overdentures than experienced prosthodontists (Esfandiari et al, 2007).

9. Cost-Effectiveness Assessments • Mandibular 2-implant overdentures opposing maxillary conventional dentures are more cost-effective (OHQoL) on the long term than are complete conventional dentures(Heydecke et al, 2005).

10. TECHNOLOGY Healthcare Professional Technology TransferMicro Level Peer-reviewed journals Clinical practice guidelines Professional schools Peer practice Continuing education / courses Dissemination of knowledge Health supply company Legal precedent Advertisements Hospital policies

11. “I got a bone to pick with you, girlie!” McGill Consensus Conference: Mandibular Overdentures on 2 Implants: Minimal Standard of Care for Edentulous Patients

12. At what point does our canine colleague have an obligation:1) To inform his patients of new effective therapies?2) To provide such therapies to his patients?

13. Economic factors Duty of care Treatment Plan (alternative therapies) Standard of care Patient Legal and professional issues Ethical and moral issues Social factors Informed consent Access to care Treatment of choice Technology Transfer Health Care Professional Negligence Malpractice

14. You may stop the postman from delivering the message, but, at some point, ignorance of the evidence is no defense!

15. How to Convince Policy Makers and 3rd Party Payers ? Meso and Macro Levels Demonstrate improved health and QoL Demonstrate cost-effectiveness Apply political and social pressure

16. WHO WILL SPEAK FOR ME?