GUEST EDITORIAL
On the Way to 100

Maintaining health in mind and body.
By Esther M. Wilkins, RDH, DMD

Within the next several decades many people will live to be 100 years old or older. Life expectancy has been increasing steadily in the United States over the past century. The average life expectancy in 1900 averaged 47 years. By 1996 the average was 76.1 years with women living about 6 years longer than men. Hopefully, the overall health of centenarians will permit a full quality of life so they can enjoy the bonus time they have earned.

We know that oral health along with general physical health is directly related to quality of life. At 93, I am often asked how old I am. When the question is worded "How old are you, really?" it seems to imply that whatever I answer can't be the truth. Sometimes I answer "What is your guess?" or "Unpublished number." In 2008 in Albuquerque at the American Dental Hygien ists' Association Annual Session, I shared the stage with the beautiful, charming, and famous Debbie Reynolds. She said she was 75. Not to be outdone, I said I was older—76. After several public celebrations of my 90th birthday, I decided the whole world seemed to know my age so I could stop being coy.

Advanced Age

Do people even want to reach 100? According to a Boston University centenarian study, the number of Americans reaching 100 has doubled each decade since the 1950s and the United States Census Bureau estimates that by 2040, there will 500,000 American centenarians.

I'm sure most people would love to reach 100 if they have taken good care of themselves and are not afflicted with debilitating health problems. Therein lies the key to a long and happy life—health of mind and body. When asked about how I have maintained my health into advanced age, I explain that I eat right, drink lots of milk, exercise as much as I can, and, of course, maintain excellent oral health.

When pressed with the question of genetics, I love to share about my paternal grandmother who passed quietly away 1 month before her 100th birthday. She was a frail little old lady, but my memories are clear of her busily sewing—by hand primarily—to help her many grandchildren get ready for back–to-school. As for my other grandparents, my maternal grandmother died in childbirth in the late 1800s. Her husband, my grandfather, lived into his late 80s in spite of the daily evening pipe that filled the kitchen with smoke while he read the newspaper after supper.

Promotion of Oral Health for a Lifetime

We are fortunate as members of the dental hygiene profession to understand the significance of oral health in lifelong health. The curricula of our professional schools need to expand to include the research and clinical experience necessary to treat the special needs of our growing aging population. With more knowledge and clinical experience, practitioners can be more motivated to help patients maintain their health and quality of life as they enter their golden years.

Helping people learn the basic health behaviors that will provide a lifetime of oral disease control is a standard objective in dental hygiene practice. When later changes lead to the deterioration of physical and/or mental health, the good health of the teeth and the gingival tissue can continue to provide an ability to chew and give comfort and enjoyment while eating. See the sidebar for the story of Emma, which illustrates the significance of continuing oral health.

The dental profession is responding to the growing aging population and their special oral health care needs with the introduction of the Oral Longevity Initiative created by the American Dental Association (ADA) in collaboration with Glaxo- SmithKline Consumer Healthcare and the ADA Foundation. This outreach to dental educators can contribute to a new generation of dental graduates with more information and clinical experience in the treatment and motivation of older patients.

Meeting the Centenarian Mark

I have never been in favor of complete retirement. When a friend said she could hardly wait to retire, move to Florida, and play golf every day, it sounded quite unappealing to me. My friend Mary Dole, RDH, celebrated her 90th birthday this past year after practicing full time for more 60 years. Mary still keeps a few appointments each month with her favorite patients whom she has served for many years. Most of her patients are also on the way to 100 years.

Full time retirement from active practice of dental hygiene may be necessary for a variety of reasons, but I highly recommend keeping professional contacts when at all possible. Continued membership in dental hygiene organizations and attending meetings can be very rewarding after years of being part of the dental hygiene network. Taking a few continuing education courses as required for continued licensure can help to drive away the lonely feeling that goes with missing practice and the wonderful patients who have their teeth and healthy gingiva because of your devotion to complete dental hygiene care.

It is something of an addiction that I remain on the mailing lists for journals and bulletins that allow continued learning. I have spent many years keeping in contact with the new research; changing viewpoints and terminology for patient instruction; and new products as new scientific information replaces the old. Perhaps my generation of biologic and other scientific terminology has long since been replaced with words and theories I may not recognize, but the challenge to learn what's new is still there.

What To Do on the Way

Experts tell us that to "stay with it" we need to plan ahead to maintain our mental and physical health. We all need to include daily physical exercise, a healthy diet without over-eating, restful sleep, and top grade oral hygiene as part of our lifestyle. Avoiding major risk factors is also important, such as traumatic accidents, tobacco use and exposure to second hand smoke, alcohol abuse, lack of physical exercise, risky sexual practices, and a diet that promotes overweight or obesity.

For maintaining mental health, we all need to get out there and participate. Never say "no" to an invitation. The old brain needs daily activity including reading and listening, doing puzzles, and trying new things. Reading the daily newspaper and watching television help us stay in touch with what's happening in the world. Community activities and volunteering help us stay active. Many types of volunteering activities are available in schools, hospitals, nursing homes, and short-term community events, such as sponsored walks and running races to support various causes. Newspapers, senior centers, and the Web are all means to finding volunteer opportunities.

Using email to keep in contact with friends and family is helpful but remember that consistent Internet use has its down side. Dental hygienists already know the physical health problems of repetitive movement and staying in one position too long. Our professional lessons can serve us well during our older years.

And we still have oral health messages to deliver. So as much as the weather and your continued health permit—stay active and walk out into the world every day.

May I Please Have Another Cookie?
By Kenneth E. Myes, DDS

As I walked into the room, the nurse was applying medication to a hand wound my grandmother had received from a fall a week earlier.

"There you are, Emma," she said. " That will be all better soon. Here is company to see you."

My 8-year-old son, Tim, and I had traveled all morning to see my grandmother. Her mind had fallen victim to Alzheimer's disease over the previous several years. I knew she would hardly know who I was, and if she did remember, the memory would be gone moments after I left. But it was especially important to visit regularly so that my son would remember his great-grandmother.

In her wheelchair, she seemed so weak and fragile. I said hello, and she opened her eyes to gaze at me. I held her hand to comfort her, and showed Tim to her as she struggled to smile. Her soft, air-filled voice repeated, "I'm so tired, I'm so tired." Tim gave her a little bag of cinnamon cookies we had brought for her, opened the bag, and offered her one. Her frail hand reached for a cookie and she slowly nibbled on it.

I told her stories about my family, her old neighbors, and the tree we had planted in honor of her husband, my grandfather. As you spend time with with someone who appears to have lost everything, you naturally think about how unimportant much of life can be. I thought about the worldly parts of my life—my beautiful home, my car, our ability to travel. I thought about the simple functions of life: walking, running, dressing, feeding ourselves. We have so much when we are healthy.

Being a dentist, I reflected on how trivial teeth seem at a moment like this. I pondered these thoughts as the first cookie disappeared and then another. My grandmother's exhausted manner seemed to temporarily dissipate. She had found pleasure in nibbling on the cookies. My attention focused on pictures hanging over her bed. Looking down at me was a picture of my grandfather, almost as if he approved I had come. Health for himself and my grandmother had been important, including their teeth. They both had most, if not all, of their teeth to the end.

My grandmother was now working on her fifth cookie. I watched as she gently grasped it, lifted it to her mouth, bit, and sighed with pleasure at its wonderful taste. Suddenly I realized that because she had her own teeth at age 94, she was able to find pleasure in what most would consider a horrible existence. She could still eat and experience the pleasure of taste! What had seemed small in the scale of things a moment ago had renewed importance.

Many patients judge the competence of a dental professional based on whether they are free of pain. However, a dental professional's true competence is measured by whether patients still have the ability to eat at the end of their lives. This can only be achieved with a comprehensive, long-term approach to dentistry and dental hygiene and helping people understand the importance of this type of care. No matter what you do in this world, you need to treat people in a personalized fashion. Now I can look at all of my patients with the hope that when they have lost everything—including their mind and most body functions—they might enjoy the ability to eat and the sense of taste. As we got up to leave, her hand reached out, her fragile voice whispered to me: "May I please have another cookie?"

Reprinted with permission from the Pankey Institute. Adapted from: Myers K. May I please have another cookie? Pankeygram. May 1999.