Keynotes

Dr. J. Frencken

DDS, emm. Associate professor, Department Oral function and prosthetics, Radboudumc, Nijmegen, The Netherlands

The ART approach improves oral care for older people: myth or reality? 
At the recently held congress of the World Dentist Organization (FDI), international speakers praised the ART approach to provide care to older people as well in intra- as in intramural settings. This lecture will give an overview of the state of affairs regarding the ART approach and discusses the results of studies conducted with the ART approach among older people.

Prof. Dr. A. Maier

Professor of General Medicine and Aged Care | @AgeMelbourne | The University of Melbourne, Australia
Divisional Director of Medicine and Community Care | The Royal Melbourne Hospital
Professor of Ageing | @AgeAmsterdam | Vrije Universiteit, Amsterdam, The Netherlands

How your (oral) health impacts longevity
During the last decades life span increased significantly, which is a great success of modern healthcare. However, the healthspan - the time without diseases - decreases and, as a consequence old age is accompanied by multimorbidity and polypharmacy. Ageing is the most important risk factor for multimorbidity and death, which is likely to be preventable or at least slowed down by interventions targeting ageing processes either by repurposing existing drugs, new compounds or lifestyle interventions.

Prof. Dr. B. Leplow

Senior professor at the Dept. for Psychology, Martin-Luther-Unviersity Halle-Wittenberg and Chair of strategic planning of the "International Society of Behavioral Medicine (ISBM")

Behavioural Medicine and Oral Health

"From biology via behaviour to public health" is a phrase which well describes the scope of Behavioural Medicine. For Oral Health that means (i) that oral pathology which contributes to the development of various somatic diseases including neurodegenerative disorders has to be investigated, (ii) behavioural techniques have to be established by which oral health can be improved and (iii) translational research has to identify means by which public health can be enhanced in order to control oral inflammation. With respect to neurodegenerative disorders it has been frequently shown that periodontitis is associated with the onset of Alzheimer's disease and Parkinson's disease, respectively and that the course of these disorders is influenced by inflammatory load. Mild Cognitive Impairment and selected cognitive parameters could also be related to oral bacteria. In many cases, halitosis and bacteria screenings indicate poor oral state and the question arises whether or not these measures can function as valid markers for behavioral change. Moreover, chewing has been related to metabolic alterations within both the prefrontal cortices and the hippocampi. Since diminished chewing therefore not only impairs memory functions and spatial abilities but also alters the activity of the HPA-stress axis, a direct link to inflammation can be postulated. Therefore, in this talk the state of our knowledge about behavioural factors, inflammation and the emergence of neurodegenerative disorders will be outlined. It will also be clarified, to which extent self-regulation techniques and oral health behaviour may dampen the course of these disorders and their respective consequences for patients and their caregivers.

Prof. Dr. J. Schols

Aging in place, frailty detection and the route towards a supportive and sustainable elderly care in the future?

In the presentation, attention will be paid to the current EU policy of aging in place which requires empowerment of older people but also a trajectory towards a more proactive elderly care instead of today’s reactive elderly care. What does this trend mean? How to come to a proactive approach of community dwelling older people? What is the meaning of the concept of frailty in this and what does it require from health care professionals?

Prof. Dr. M. Olde Rikkert

Chair Dept Geriatrics Radboudumc/ Radboudumc Alzheimer Center

Dementia and Oral Health: A multiple interactions tale.
Dementia incidence is declining in Western societies per age group, but prevalence is globally still increasing as our societies are rapidly aging. Consequently, oral health professionals more and more have to care for older people, and dementia becomes a primary comorbid condition to take into account in your clinical practice and research. This lecture will give an update on the primary causes of dementia, the state of affairs on Alzheimer’s disease diagnosis and treatment, and on what dementia means in the interaction with other health care problems. More specifically, current dementia care developments, specifically the network care for dementia will be highlighted as this is also highly relevant for oral health care professionals for adherence to preventive and therapeutic management plans. Most Alzheimer’s disease (AD) trials focuses on lowering the beta-amyloid and tau-protein aggregate burden, but so far all were unsuccessful in disease modification. However, using both insights from our extensive research on dementia’s heterogeneity and multicausality, and summarizing recent treatment successes with multifaceted interventions, there appear new horizons for effective and efficient dementia care. I will show examples of how we to improve successful personalisation of and collaboration in the treatment of patients with Alzheimer’s disease, which may also benefit oral health care in frail older people.

Prof. Dr. P. Assendelft

General practitioner and professor Department of Primary and community care Radboud University Medical Center

Collaboration in oral health care; what’s the role of the General Practioner?
For many elder people the general practitioner (GP) is the first point of contact in healthcare. More than medical specialists the GP deals with multimorbidity and takes care of home dwelling frail elderly. More and more the connection between oral health and general health is emphasized. This provokes new questions. How should the communication between dentist and GP be organized? For what relations between oral and general health is there sufficient evidence? And what do the dentist and GP expect from each other regarding prevention? An established partnership between dentist and GP requires specific attention and a joint plan.

Prof. Dr. P. Brocklehurst

Professor of Health Services Research, Deputy Head of School (Research), Director of NWORTH Clinical Trials Unit, Honorary Consultant in Dental Public Health Y Wern The Normal Site Bangor University

Co-production and co-design: working with older people rather than to, about or for them!

Older people's own thoughts on the challenges to health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of both research and service provision. Co-production and co-design methodologies challenge the traditional ‘top-down’ medical model. They promote an inductive paradigm of partnership working and shared leadership, helping to improve the translational gap between research, health policy and health-service provision.

Prof. Dr. R.A. Jablonski

CRNP, FAAN, FGSA  
Nurse Practitioner, Department of Neurology
Division of Memory Disorders & Behavioral Neurology UAB | The University of Alabama at Birmingham, USA

Using the Neurobiology of Threat Perception to Provide Mouth Care to People with Moderate to Severe Dementia: Tested and Effective Strategies.

Persons living with dementia undergo neurodegenerative changes that causes them to perceive intimate caregiving activities, such as mouth care, as physical assaults. My team has developed and tested specific behavioral techniques that reduce threat perception. This presentation will describe the strategies and discuss our current mouth care implementation project, where we are evaluating the quantity and quality of mouth care delivered by nursing home staff, using an intraoral camera.

 

Prof. F. Lobbezoo

DDS, PhD,  Dept. Of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands

Orofacial pain and dysfunction in older people with impaired cognition, especially dementia

Oral health in older people with mild cognitive impairment (MCI) and dementia is poor. In association therewith, orofacial pain is a prevalent condition in this vulnerable population. In this lecture, an overview will be provided of the current knowledge on the prevalence of orofacial pain in MCI and dementia. Tools for the assessment of orofacial pain in non-verbal individuals will be described, with special focus on the Orofacial Pain Scale for Non-Verbal Individuals (OPS-NVI). This tool, that is still under construction, is based on observations of facial activities, body movements, vocalizations, and some specific orofacial behaviors that have been suggested in the literature as being associated with (orofacial) pain. The OPS-NVI has been applied in large-scale studies on the prevalence of orofacial pain and dysfunction in older people with MCI and dementia, the results of which will be presented. The most important take-home message will be that a regular oral examination by healthcare providers in people with MCI and dementia remains imperative, even if no pain is reported.