#14 - Restoring and Managing Caries

"If we are treating older patients under facing missing teeth, we don't need to just think about what's going on today. We need to think about what's going on five, 10 years from now, how well this patient is going to be able to maintain this going forward. " - Dr. Gerry McKenna 

Hello! Welcome to the Aging Pearls Podcast, where we're dedicated to providing dental pearls for all those concerned with the oral care needs of our aging population. I am Dr. Christie Hogue and today, we sit down with Dr. Gerry McKenna to talk about caries management and restorative treatment and dentistry for older adults.

Dr. Gerry McKenna is a qualified dentist at the University of Newcastle-upon-Tyne, United Kingdom, in 2004. After working in a number of dental hospitals and spending time in dental practice he completed his PhD and higher specialist clinical training in University College Cork, Ireland. He currently works as a Consultant in Prosthodontics and Restorative Dentistry in Queens University Belfast where he provides clinical supervision and teaching for undergraduate and postgraduate dental students. His clinical work is focused on fixed and removable prosthodontics including managing older adults in both hospital and private practice.  

Dr. Gerry McKenna is an active clinical researcher based within the Centre for Public Health in Queens University Belfast where he leads oral health research. He is president elect of the British Society of Gerodontology and a past President of both the Geriatric Oral Research Group of the International Association for Dental Research (IADR) and the European College of Gerodontology (ECG). His research is centered on optimizing treatment options for older adults which positively impact their dental and overall health. This is supported by over £10 million in competitive research funding secured from funders including the National Institute of Healthcare Research (NIHR), Erasmus + and the Dunhill Medical Trust.  

Dr. Gerry McKenna is both a fellow and a King James IV Professor at the Royal College of Surgeons of Edinburgh. Dr. Gerry McKenna is an adjunct Professor in University College Cork.  

He has published over 100 peer reviewed articles and by 2021 published the books "Clinical Cases in Gerodontology" and "Nutrition and Oral Health".  

[00:01 – 08:54] Older Adults Retain Natural Teeth and Improve Oral Health

• How retaining natural teeth is very important for oral function
• The emerging issue of root carries on older adults
• How epidemiology is emerging in lower and middle income countries 

[08:55 – 13:47] Older Adults Face Increased Risk for Root Caries

• The challenge of managing root carries operatively
• Dr. Gerry shares how they're basing their work around the use of atraumatic restorative treatment
• How using the atraumatic restorative treatment is cost effective and patient centric 

[13:48 – 29:25] Using the Fluoride Intervention and Chlorhexidine Interventions

• How caries is a preventable disease, but can be very challenging to implement preventative regime
• The importance of preventive measures for someone who is at high risk of dental caries 
• Why we must consider how well this patient will be able to maintain this in the future, five or ten years from now

[29:26 – 38:40] Final Thoughts

• Dr. Gerry's message to dental students
• Connect with Dr. Gerry McKenna – leave a review and comment (links below)

Key Quotes: 

"Think about how that patient is going to be able to maintain those restorations, those prostheses that you're putting in your patient's mice." - Dr. Gerry McKenna

"So certainly I would be advocating that where possible we think about treatment approaches, which are centered around the shortened dental arch that's healing a functional dentition. Rather than thinking every missing two for this patient must be replaced, particularly if the option is a removable partial denture." - Dr. Gerry McKenna

Resources:

Oral Health and Aging Textbook

Important papers:

An RCT of atraumatic restorative treatment for older adults: 5 year results

C da Mata, G McKenna, L Anweigi, M Hayes, M Cronin, N Woods, D O'Mahony, P F Allen

Risk indicators associated with root caries in independently living older adults

Martina Hayes, Cristiane Da Mata, Margaret Cole, Gerald McKenna, Francis Burke, Patrick Finbarr Allen

Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial

Cristiane da Mata, Patrick F Allen, Michael Cronin, Denis O'Mahony, Gerald McKenna, Noel Woods

Knowledge transfer on the use of Atraumatic Restorative Treatment: A mixed-methods study: Knowledge transfer on the use of ART

Cristiane da Mata, Gerry McKenna, Martina Hayes

Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up

Gerald McKenna, Patrick Finbarr Allen, Martina Hayes, Cristiane DaMata, Ciaran Moore, Michael Cronin

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