The third act

Jan. 15, 2014
An extra 30 years has been added to our life expectancy over the last century. We are now living, on average, 34 years longer than our great grandparents.
Longer life expectancy doesn't mean older patients are behaving, at least in terms of oral health

by Bridget Conway, BA, RDH

An extra 30 years has been added to our life expectancy over the last century. We are now living, on average, 34 years longer than our great grandparents. As Jane Fonda points out, "That is an entire second adult lifetime!"

Although it is not directly related to the dental world, I encourage everyone reading this article to watch an inspiring and informative TED Talk titled "Our Third Act": http://www.ted.com/talks/jane_fonda_life_s_third_act.html

No longer is it the "old folks." We are them, baby, and we aren't anywhere near finished with life.

This article is an effort to shift the way we think about the aging process as it relates to our patients, many of whom are approaching or in the middle of their third acts, changing careers, children leaving the nest, or a complete geographic change. They are active members of society who are far more conscious of their health and appearance than their parents or grandparents ever were. It touches on a few subjects and gives us a nudge to think about them as we approach patients in this age group within our practices.

This translates to the need for a greater understanding of this demographic in the dental office.

From the business side, this increased patient segment has the potential to account for approximately 32% of the office revenue. If you don't actively recruit this age group, you need to start.


Consider reading


Advancing clinical practices attend to the needs and desires of a generation, many of whom want to maintain their youthful looks through various cosmetic dental procedures, including whitening. In the restorative world, this is where the implant market is exploding. Preventive care is the foundation for these other elective treatments.

The hygienist working clinically now has a greater population of patients over age 50 than ever before. This demographic is aging differently for the most part than their parents and grandparents. Plain and simple, they want to keep their teeth! And they need our help to achieve that goal.

Plaguing the population are the culprits conspiring to demolish our dentition; however, with awareness and attention to proper preventive and restorative care, we can help our patients realize dental health well into the third act.

As far back as 1974, the minister of health in Canada released a report, following an extensive study outlining the four determinants of health. According to Marc LaLonde, The Health Field Concept report, as it is known, emphasized four elements: human biology, lifestyle, environment, and the organization of health care.

Why do I mention this? Well, the majority of effort to improve our collective health has been concentrated on the fourth aspect, the organization of health care, when, in fact, it is the other three elements -- biology, lifestyle, and environment -- that are the main contributors to disease, both oral and systemic.

In our offices, we can assist and contribute to the education of our patients, for example, altering oral biology with the use of a probiotic perhaps or suggesting a lifestyle change, eliminating soda, etc. … changing a stressful environment that is contributing to poor oral health. The dental professional has ample opportunity to make astute observations and constructive suggestions to aid in the oral care of the patient.

As all of us age, there are subtle changes (all right, sometimes not so subtle). For example, you take a medical history and now recognize the patient is taking hormone replacement or a drug for osteoporosis or high blood pressure. These are all indications of shifting biology and its related partners, medications and xerostomia.

We can now engage in some dialogue. Many people are very accepting of any side effects, assuming that is the price to pay for medication use. We can now make suggestions to recommend a mouth rinse, probiotic, and a xylitol-containing product and know where these products are available, making it easy for them to obtain. We can assist in the biological component of creating wellness by altering the oral environment, making it more comfortable for the patient and less susceptible to disease.

Marijuana use

Not everybody age 50 and over is into pot, but this cohort is among the heaviest users of cannabis. That use presents with its own set of oral health implications, and as more states and municipalities legalize the substance, we have to increase and incorporate this fact into our general oral health assessment. Oral health providers should be aware of the diverse effects of cannabis on general health and incorporate questions about patients' patterns of use in the medical history as we would with alcohol consumption. Perhaps a lifestyle alteration?

What do we know about the intraoral effects?

Subtly, a slight green ridge, appearing just at the gingival line, is associated with heavy use and should be addressed as an undesirable side effect.

Heavy use may also cause xerostomia of the oral cavity and throat if the ingestion is by way of smoking. This enhances the environment for caries development.

Thompson et al. (2008) reported a correlation of increased periodontal disease in a study population of 1,015 who were assessed at a younger age; however, if you extrapolate extended use in some, you can make the leap.

Candida has also been reported to be higher in cannabis users compared with tobacco users.

Leukoplakia/erythroplakia and leukoderma are also observed in some users.

Cannabis use represents just one aspect of our changing population, as this was the generation that originally discovered pot, and many are choosing to revisit the experience as they age.

This is relatively new territory for the hygienists in most offices, but it's all part of a shift in population and policy in many places. We need to be aware of this and be able to advise our patients in regard to oral health.


One aspect of aging can sometimes be a sense of loneliness, maybe due to children leaving home or the death or end of a close relationship. Just keeping up with technology in an increasingly digital world can produce feelings of anxiety.

Stress can manifest itself as increased perio or bruxism. The hygienist may be among the first to recognize this in the patient. The opportunity is then ripe for discussion; chances are good the patient had no idea stress could effect their oral health. This has the potential to spur action in relation to their environment, with some incentive to make it less stressful and more engaging. That might sound like Pollyanna hogwash, but let's aim high; it's amazing how we can affect the life of another in a positive manner, and even though our contact is brief, we are uniquely positioned to do so.

In closing, as we go through some of life's changes, there are many oral health products and procedures to help us be the best we can be at every age. As hygienists, we have responsibilities to keep up with the latest advances, products, issues, and resources through available CE and publications, such as this one.

Bridget Conway, BA, RDH, in addition to clinical hygiene, has interests in organizational behavior, dental relationship marketing, and building company culture. Bridget is active in the Maine Dental Hygienists' Association, and she authored a continuing education course on innovative enamel therapies, as well as other subjects, for PennWell. Bridget credits her attendance at the January 2008 Career Fusion as her lift-off point in career development.

More RDH Articles
Past RDH Issues