Jay S. Luxenberg, MD

I don't usually write book reviews for the Wave, but this book sent to me by the author, a friend, surprised me so much by how it changed my thinking about an under-addressed aspect of long-term care that I want to share it with our readers. It is called "Poor oral health, a potential new geriatric giant" and it is subtitled "Significant oral health (care) issues in frail older people." It was a result of the PhD thesis work of its author, Gert-Jan van der Putten, an Elderly Care Physician (what we would call a geriatrician) and researcher at Radboud University Nijmegen Medical Centre in the Netherlands. Gert-Jan's book reports many studies that he has done in care homes and nursing homes in the Netherlands, looking at the provision of oral health care and the correlates of poor oral health. In particular, he looks at screening tools for xerostomia and hyposalivation. He reports on how frequently nursing home residents are on medications that diminish salivation. He found lower rates of resting, chewing stimulated and acid stimulated saliva secretion in women in nursing homes compared to men, and found that polypharmacy correlated with a very acidic saliva production.

Most importantly, he reviews published guidelines for oral health care provision in residential care for the elderly, with a wonderful emphasis on the strength of the data in support of each of the recommendations. He then reports on several clinical trials looking at implementation strategies for these guidelines – not surprisingly, nursing aid and facility staff compliance with the guidelines benefited from supervision. In great detail, he lays out recommendations for best practices in the provision of oral health care, avoidance of periodontal disease, xerostomia and hyposalivation. In general, reading this book made me rethink the way I look at the component of holistic healthcare that is oral health. Poor oral health has been linked to aspiration pneumonia, diabetes, stroke and myocardial infarction. Of course, poor oral health is associated with chronic mouth pain and poor appetite. I know that prevention is the best medicine, and rather than dealing with severe oral diseases I'd rather help the facilities that I work with provide excellent daily oral care that will help us avoid many problems. I know that for many of us, oral health and dentistry were woefully underemphasized in medical school. Given the frequency we deal with poor appetite, weight loss, and chewing problems I think a periodic knowledge refresher such as provided by this book is very helpful.

Comment from Kristin Outlan, DMD

Happy to see this! My dental practice (Florida & California) provides on-site care to nursing facilities and private homes. For the past 12 years, this has been an issue I deal with on a daily basis. Looking forward to reading this book. How can I get a copy?