Oral Health as You Age

Rev. Beth Long-Higgins 00:07
Hello and welcome to the Art of Aging part of the Abundant Aging podcast series from United Church Homes. I’m Beth Long-Higgins director of the Ruth Frost-Parker Center for Abundant Aging and it is my joy to be able to host this conversation today. On the show we look at what it means to age in America and in other places around the world with empowering conversations that challenge, encourage, and inspire us all to age with abundance. Our guest today is Dr. Leonardo Marchini. Leo is Professor and Chair of preventive and community dentistry at the Iowa College of Dentistry and Dental Clinics. He is also president of the special care dentistry Association. Leo teaches pre doctoral students in the geriatrics and special needs program and treats patients in the faculty general practice. He also acts as a general practitioner with an emphasis in geriatric dentistry. Leo’s current research focus includes geriatric dental and general health epidemiology and satisfaction of press the dawn tick patients do they say that right? You did. Okay. Well, he was also interested in researching the best way to teach dentistry with particular interest again in to geriatric dentistry teaching. Welcome, Leo.

Dr. Leo Marchini 01:29
Thank you very much for this wonderful introduction. I’m not sure if I deserve all that. But I am happy you did it.

Rev. Beth Long-Higgins 01:38
Oh, you deserved all of them. Just look at the certificates behind you on the wall.

Dr. Leo Marchini 01:44
Thank you.

Rev. Beth Long-Higgins 01:45
I want to start here, Leo, by just sharing with us a bit about your background. You’ve chosen to specialize your career in dental dentistry and what you describe as special care dentistry. Older people with disabilities. Why did you choose to focus your talents in this area and this is an area I didn’t even know existed?

Dr. Leo Marchini 02:07
Yeah, it was very interesting because that happened during my journey in dentistry, so once I graduated from dental school, I always thought that I would like to teach. And I start by teaching prosthodontics which is teaching dental students how to fabricate artificial teeth. So they insure either partial or removable or partial or complete dentures, crowns, bridges over implants. And I started teaching, specifically complete dentures, which are, you know, the regular complete dentures that are still used today. And at the time I started doing that 25 years ago, that was primarily done for older adults. So we will have a cohort of older adult patients at the time. And I started gaining more interest in learning how those patients get used to dangers, what were the factors that were dictating their satisfaction to their dangers. So how could we improve the way we fabricate the materials we use and all that to get better patient satisfaction. During that process, I started understanding a lot of the contexts that are around getting old, being old, aging, and how that influences multiple aspects of people’s lives, including those related to oral health. During that process, a new cohort of older adults come into play, adults that would not need complete dentures anymore, they are keeping their teeth for life. And now, we are able. Now we are not only able but we need to understand more complex oral health care needs of those older adults, who at the same time are more medicated than ever, have more chronic diseases and are leaving for longer periods of time. So what was initially something very Nishi very, you know, specific, became much more complex, much more entailing and requiring a much more broad spectrum of health care disciplines to get involved. So interprofessional care came into play, discussing patient medications with pharmacists and other prescribers as well as understanding some specific areas, or have their general health become more important. And as it becomes more complex, I start reading and learning more about it there, and then three students start looking for more information about it. So I started teaching it. And then we started. also noticing that our geriatric and special needs clinic which initially, were predominantly composed by geriatric, or we call geriatric, those frail, older adults, those adults that are Aging Gracefully, they don’t need as much our help, they would be seen by their general practitioners, given that those general practitioners have little knowledge about their medications, possibly impact in their oral health and know a little bit about their chronic diseases. But those more frail, those are our focus. But in our clinic, that cohort started to change to me, too, and we start seeing more patients, more adults, young adults, with special needs, to SOAP adults we fought is with Down syndrome with cerebral palsy that were able to thrive throughout their childhood and adolescence, and now are busy in our clinic. Right? And that, of course, you start seeing that those families have a really hard time, both for frail older adults and adults with special needs to find providers in the community, because the industry was not preparing graduates to care for those populations. While there was in fact, a few decades ago, as we have discussed, the need was not there. But now the need is becoming even more evident. And, therefore, we are offering that learning to our graduates and for post graduate students. And as you know, we start seeing how the feminists are grateful, and how rewarding it is, it becomes a passion, right? It becomes more than just teaching and learning and all that it becomes really something that we do with a lot of love and care.

Rev. Beth Long-Higgins 07:39
Yeah, that’s fantastic. I was just as you were talking, thinking of a dear friend of ours who lived with Down syndrome, and he lived well into his 60s. And I realized, you know, through his family, that that was an extraordinary long longevity for him. And that folks are living longer with these previous conditions, which usually resulted in shorter lives. So yeah, very interesting. Very interesting.

Dr. Leo Marchini 08:11
Correct. And you know, Beth, what’s nice is that this is an achievement of humankind, right? It’s the apex of our civilization, we are able to care and provide a meaningful life for those individuals for a longer period of time. And for that to happen, we need a lot of care coordination, we need a lot of people involved and don’t have spurts of that team.

Rev. Beth Long-Higgins 08:43
Yeah, absolutely. So let’s just take a step back for just a second. And would you explain to us I found this really fascinating. We were talking, what is the state of oral or dental care for older adults today? And for instance, why does Medicare not cover dental?

Dr. Leo Marchini 09:03
That’s a wonderful question and thank you for asking that. Well, let’s start with the first part of the question. Right, which is the state of oral health for frail older adults? Now, when you look at any report, almost anywhere in the world, about oral health for frail older adults, especially those more vulnerable by vulnerable usually we’re talking about those who are living in long term care institutions, or are leaving history in the community but homebound. So for those two groups, oral health is always poorer. Compared to their counterparts, we’ve seen an age range for free will that adults, especially those who really require a lot of help that we call the functionally dependent, frail older adults. Those are the ones who usually have poorer oral health. Well, Lel, what’s poor oral health, poor oral health means more cavities, more gum disease, more oral lesions of different kinds, including oral, non-diagnosed, more advanced oral cancer lesions, that’s what it means. Or fortunately, that population many times can’t seek care for. They’re on, right? I mean, they can’t express pain or discomfort, because of their cognitive abilities. And many times, even if they can do that, they don’t have the mobility, because they have these physical disabilities to seek care on their own. So as they are dependent on that, they become more exposed to, you know, not having a dental home or, you know, not having regular care. So, the oral health among these groups, usually poor. Well, there are many reasons for that. Some are, as we said, related to the person, right, related to the fact that the person has a disability, that can can impair cognition that can impair mobility that can impair access to care, that are barriers that are related to the profession, to us dentists, that we don’t have enough dentists that have the knowledge to care for that population, because there are few dentists who had advanced training in that area. Some others are related to the social context, right, which is the family being able to provide care, is the institution providing the care, the oral health care among are there the necessary points of care? Is there transportation for that? To bring them to the dental office? And finally, the finances? As we know, those families are usually under extenuating finances, conditions, and the right financial conditions. Why is that? Well, because they need to provide all the other general care, they need to provide nursing care, they need to provide medications they need to provide the home institution. And as we know, in our health system model, dental care and dental insurance is related to employment. So for both our focus, population of groups, I mean, frail older adults and adults who have special needs, employment usually is not part of the picture. So they don’t have insurance, meaning that they would need to pay out of pocket for dental care. That’s a huge barrier. Some states do provide Medicaid coverage for adults, and frail older adults, for adults with special needs and frail older adults. However, that coverage changes through state lines and changes also with the political winds. Right. So that’s another piece of the puzzle where you can start seeing a more important influence of the political landscape of this social landscape into this specific type of care. So here in i We are very fortunate to have a Medicaid program that covers adults with special needs and covert frail older adults and provides comprehensive dental care to those groups so we and we are a large Medicaid provider. So this is a very fortunate circumstance. However, in a state that has this fortunate circumstance, reimbursement might also play a role. So, you know, some providers in the community may not take Medicaid patients, because of the level of reimbursement rates, which is unfortunate and then have more multifactorial origin. But fortunately, here in the college, we are able to accept and provide comprehensive care for those patients. Now, why Medicare doesn’t have dental coverage has also historical roots. Right? When Medicare was established for people who would get to 65. First, not a lot of people will get just 65. At that time. So, you know, when the calculation was done, the budget would be for a small fraction of the population that we’ll get to that. Well, currently, that trend has reversed. So putting the budget under more pressure, then of course, adding anything to that already pressured budget is complicated. So I think that’s the root cause of it. But of course, you know, there are where, how do people say, when there is a wheel? What is the way? Right. So, yeah, it all depends on our society, right?

Rev. Beth Long-Higgins 16:43
Yeah, absolutely. It’s, you know, this is just a perfect example, to be able to talk about how we age within systems and the policies, and the legal structures around us affect how we age. This is just a perfect illustration of that. So as you know, we’ve been talking about increased lifespan for many of us. So what do you see for those folks who are living into their late 80s 90s or centurions? What changes happen within our mouths?

Dr. Leo Marchini 17:22
Very good question, Beth. Very good question. Because that has, at least we can answer this question in two main layers. Let’s talk about the changes that happen without disease. And let’s keep in mind that this is very rare, right 90% of adults across the globe will experience cavities, right cavities sometime in their lives. 90%. Right. So it’s the most prevalent chronic disease in the world, the most prevalent chronic disease in the world, and I would add the most prevalent, chronic, but preventable disease in the world, but we’ll get there. So that’s, let’s take that out of the picture and say that the person was able to prevent caries and periodontal disease, then is Aging Gracefully, systemic health wise, same thing, they are being able to stay healthy and active, and a good diet and all that what would happen is the teeth get more yellow, which, right So currently, there is frenzy around whitening and doing all that, which, you know, we understand that that’s depicted this way in the media and all that older adults who usually have naturally, you know, with good aging, yellowish teeth, as compared to themselves when they are when they were younger, right? Because that way it becomes more yellow. Also during our lives, we chew and we also grind our teeth. Every now and then during our lifespan more, some people do it more, some people do it more. Don’t do it as much and we will have some degree of attrition. So you’re gonna see a little bit of leveling of the teeth, right and some, when that’s a little bit more pronounced, you can also see kind of is more lines in people’s teeth, right? We call those crazy lines, right? They don’t necessarily need treatment. They should be inspected by a dentist regularly but most of the time They don’t require any treatment. Right? The gums can present with a little recession, meaning that a little bit of the root of the tooth can become visible, right. So that would also be seen as a normal result of aging. An hour’s mouth is keen, and will get a little bit more set tissue. So we’re going to see a little bit more yellowish points in the mouth scheme to write. But that’s totally normal and doesn’t bring any trouble and all that. So that’s normal aging, right? Without disease. But what really happens is that people get cavities, and then they need to stretch teeth, and then there is also periodontal disease, our diet is rich in sugar, sugar is the food for the bacteria that would destroy the teeth. So what happens is people would, as they age, they are more exposed to those factors. And therefore, they start losing their teeth with losing their teeth, their bite starts to collapse, you’re gonna see, you know, the chin getting closer to the nose, and reducing the, the height of this lower third of the face. So when you look at people’s profile, you’re gonna see that chin getting close to the nose, which in old times would be called it, you know? Well, in our jargon, we call it reduced vertical dimension. And that means that people will start to get more wrinkles around the lips, especially these wrinkles here. And there is that really stereotypical old face rain when that happens, and why it’s more common to have that type of visual appearance when we age well, because it’s more common to age with some oral health disease. Okay, right. This cohort is changing it. Baby Boomers are getting in droves at retirement age, and baby boomers will change that paradigm, because what will happen is they will have most if not all of their teeth.

Rev. Beth Long-Higgins 22:47
Yeah. So as I’m aging I shared with you that I had my first cavity at the age of 59, I almost slipped and joined the 90%. And that was it. So some things I’ve learned along the way, it was really shocking to me at the age of 26, to be in the dentist chair and for her to say, the hygienist to say Beth just so you know, when the dentist comes in, they’re going to probably talk about you having braces. And I almost started to cry. So they had braces twice already. And that was a planned two phase thing. And she said, Well, you, your jaw starts to shrink in your 20s. So I did braces again for the third time. And so I’m a baby boomer who is aging, and I wear a retainer. Not every night but most nights, you know. So you’re pretty sure previous generations as we age didn’t come to the dentist’s and say, Can you clean this for me?

Dr. Leo Marchini 23:49
Right, this is an awesome example of access to care. Right now. It improved in a generation. Right? Yeah. I mean, you were able to assess, yeah, to access really, you know, specialized care and let alone having those frequent recall appointments with the dental hygienist. We have an exempt front of dentists every six months or every year, right, that we’re able to keep your dentition for the whole life. Of course you did your part of it too, right? Controlling the diet, brushing your teeth, flossing, and all that. But a lot of it has to do with fluoridation of the water lately, right? So we have that as a benefit to almost, you know, the entire population. And in the end you just highlighted how important it is to have access to care right to have access to care. dentist you have access to regular care, you had a dental home, where you were regular, the dentists know, you know, the dentists, you know the dental hygienist, the dental hygienist know, you know your habits know how to talk to you about, you know, changing habits to improve outcomes and all that. Unfortunately, you know, that’s not evenly distributed in our society yet as we were discussing. So, you know, many times what happens is that the pool right will not have that same level of access. So, there is a trade where he, you can see that the people that now are getting old, losing their teeth are only those who will reduce it. Economic means, right. I mean, it Dental is more, which is why losing all the teeth has become restricted to some geographic areas where poverty is more ingrained. Right. Yeah. So, you know, its density is rare among middle class and wealthy families. But is this two thing among the poorest

Rev. Beth Long-Higgins 26:31
and not even an economic factor? But is there a relation? You know, I know that there are many parts of the country, you said, Iowa is one of these, where there are counties that don’t have dentists and so where if people do receive dental care, they have to travel long distances? How does that affect the longevity and the health of those individuals who just don’t even have access to dental care?

Dr. Leo Marchini 26:57
Right, you know, that you are absolutely right, that is another important factor. And this important factor is intact tween it with the other one, right, because usually, the more affluent, as soon as you know, families get more fluent, they will leave those areas where there is no care where there is no access to cultural, you know, things where there is no access to the goods and services that they are looking for. So, you know, they are intertwined. But of course, they are intertwined in a bad way, they are integrated in a good way, if we can provide those services, then it will be a Dr. Draghi factor for people to populate those areas. And, you know, so we, you know, many times it can be a vicious cycle. And if we take the right measures, it can become a positive cycle. And, you know, and then we can have that, but auto health, the private areas, right areas where we don’t have enough practice, practitioners to provide care for the population are a real issue. You know, those are dental deserts, if you will, right, where people don’t have a dentist, they need to drive one hour, maybe two, to get to a dentist. And when you look at frail, older adults, those are more, those are even larger areas, because you know, to obtain the care that is age appropriate for them, they, their local dentists may not be able to do that. So they will need to travel even further to get that age appropriate care.

Rev. Beth Long-Higgins 28:55
So let’s talk about some practical tips that you might have. Yes, our listeners, what things should we be looking for, that support us as we age in terms of our own? Our own oral health so for instance, should I be looking for different things in my toothpaste?

Dr. Leo Marchini 29:15
Yes, you should. You should always be looking if your toothpaste has fluoride in it. That’s by far enlarge the most important piece so every need

Rev. Beth Long-Higgins 29:28
that fluoridation our entire lives. It’s not just one word kids

Dr. Leo Marchini 29:33
all know, Beth, I’m so glad you said that because that’s some very important misconception. Now that topical fluoride that we applied topically to our teeth, like the fluoride on the toothpaste that fluoride on a rinse, even the fluoride that is in the water fluoridation It is very important to have that throughout the lifespan because this is a dynamic process, okay, our teeth will lose minerals and gain minerals from the saliva all the time. So fluid it is there, they will gain fluoride from the saliva fluoride and will strain your teeth throughout your lifespan. And then that fluoride that strangely now, maybe last tomorrow, but then you have exposure to fluoride again, you regain it. So you know, you need to keep that exposure all the time for ever. So, good question. Excellent point. So the first and most important thing in a toothpaste is does it contain fluoride, okay. Everything else is less important than that. But of course, if you have sensitive teeth, and would like to use a toothpaste that is desensitizing for you, like, you know, some people need Well, that’s totally fine as far as its desensitizing but does have fluoride fluoride is the key ingredient there for us. And I would always say, you know, find a toothpaste that you like the taste of, or fluoridated toothpaste that you like, because then you are more likely to use it. Another important piece is a pea sized amount. That’s all we need. Throughout our lives a pea sized amount, we don’t need that he you know, don’t have to face in our toothbrush, P sighs that world. Okay.

Rev. Beth Long-Higgins 31:56
Now the practical tip from you, what would you suggest? How do I establish a better relationship with my dentist so that I can better support my future self? So I will be going to the dentist in two weeks. For the last time, I will be telling them goodbye because they’re no longer supported by my dental plan. So I’m going to be looking for a new dentist, I’m now over 60, or there’s some particular things I should be thinking about in as I’m looking for a new dentist in this period of life,

Dr. Leo Marchini 32:26
You are an adult that is aging very gracefully, especially in regards to your health. Thanks, God, right and your care. And also, you know, your oral health, as you have pointed out earlier, so and general dentists in the community that you know, a friend, and the community regard as a good dentist will be a great fit for you, they will be taking good care of you, they would be able to do exams, every I would say ideally, every six months have a cleaning and an exam and every year, get a few set of x rays, just to keep things on check. It’s all that you need. What we need to be very attentive is not as much as two persons with your characteristics, because I’ll do your part of the majority. The real problems happen to people who were doing what exactly what you are doing, and and having the care that you’re receiving, but then all of the sudden they get a stroke or they are diagnosed with Alzheimer’s or they have a diagnosis of Parkinson’s or they or they start having really real issues with their hands because of arthritis. Well, of course people that would have to correct those problems, they will not go to a dentist, they are gonna go to the provider that will care for those issues. Right so especially let’s say stroke, they go to the emergency room, and then they will see a group of people but usually led by a neurologist right and they will get all that care and all that. And there are a lot of things going on: housing, finances, how they’re going to dress, how they’re going to do it. Bathe in how they’re going to Do you know all how they are going to take care of their daily lives? Well, and of course, one thing that fell through the cracks is the dentist, the dental appointments. Understandably, you know, they have a lot on their plates, they’re doing a lot. But it would be awesome. If the provider who, you know, is taking care of them, of course, there is a lot on their plates too. But they have a protocol, they are going to say you need, you know, a week here in the hospital, then two, then two months in the rehab center, then you’re going to need physical therapy, occupational therapy, i.e. at home, you need to have these adaptations. But among these laundry lists, there are no dental appointments there, most of the time. And that’s a problem. Because it would be awesome. If there is one line there saying, you know, as soon as possible, contact the dentist to see if a special oral health care prevention routine needs to be established. Because that person, of course, if the person is not able to take a shower, they probably are not also able to brush their teeth. But see, when you are in your routine, you may be like myself, you know, before I take a shower, I will brush my teeth, that’s a daily routine, you know, I do that every day. So one thing triggered the other. Well, the person who had the stroke, will not be able to have a say on that. And the person who is helping the person who had a stroke will not remember that it’s not, you know, they’re busy enough trying to give them a shower, let alone you know, be reminded that they need us to breastfeed you. But if they go to the dentist it will help them establish a routine for that. And it’s a similar thing, when they get a diagnosis of Zappos either, they will get a lot of tips about different things, especially, you know, ways to avoid them wandering around and all that that can put their lives at risk and all that. But maybe if there is one line on that bliss shoe saying it would be great to contact the dentist to establish, you know, an auto hygiene routine for our loved one, great, they are going to do that right. So the you’re gonna go to the dentist, the dentist will be able to check out what the patient can do cannot do who can help who cannot will figure that out among you know, with the family, with their caregivers and come up with a plan, a plan that may include, you know, instead of six months or six months recalls, maybe three months recall or maybe four, or maybe even the six, but they will be able to say well now instead of using any toothpaste that’s fluoridated, you’re gonna use a high fluoride toothpaste that’s a prescription one that we are going to prescribe for you once a day or once every other day, whatever you know, the need is please check on mum to see if she is brushing at the time. She’s supposed to be doing it, please check the amount of toothpaste that has been used after a week. Right? Or please remind mum in the evenings to brush her teeth, you know, and then when you start the dentist will be able to provide a nice straightforward way to keep track of it. That can be, you know, night and day as having no problems with affordable health or more on top of all the other issues or having auto health as you know, a big problem on top of all the other problems. So the key in our profession is prevention. All the most important dental diseases by far which is Keras first periodontal disease second, their pre van double, they can be presented.

Rev. Beth Long-Higgins 39:58
So what do we need to think about out then in terms of when a loved one has to go into a nursing home for long term care. Come to the skilled community.

Dr. Leo Marchini 40:12
Oh, Beth, now you touch the nerve. This is a really good question: bad quit? The answer for that is yes and no. Meaning that some dentists in the community will come to nursing homes and we’ll do some care. Some other dentists will have an arrangement with the nursing home and the nursing home will transport people to their facilities. But most common, then not the nursing homes, we will have a dentist on file because that’s mandatory. Okay, but they will not have a regular procedure, they will not have a regular routine. For two things, they will not have a regular routine for dental care. Many times, nursing homes don’t have a regular routine for oral hygiene. And they also don’t have a regular routine for auto healthcare, meaning, you know, bringing residents to the dentist regularly for regular checkups. So when you are looking at a nursing home for a mum or dad to reside, it would be really good if you can ask what the dental plan is? What is the usual regular routine? Mum has Alzheimer’s, she will not be able to brush on heroin. Would the nurses help have then been trained? Right? Mom who needs to see the dentist more often than another person than a person that doesn’t have Alzheimer’s? Right? A person that doesn’t have dementia? So would you guys be able to bring mum every four months to the dentist? He does this and then contacts mom’s dentists to say, hey, who does that? Beth? Who does that? Does that not happen? Right? Contact mom’s dentists and say, Hey, doctor, you have been mom’s doctor for many years. Now Mom’s going to a nursing home, I want to tell you that. How can we keep her dental care for you and me to bring her Gee, do you have an arrangement with a nursing home? Or do you wanna refer me to someone who does? You know, ask the question and be the advocate for your loved one. Right. Ideally, you should not have to because, you know, ideally, the systems should be such that they provide the the medical provider will give you the guidance. Right, the nursing home will give you the guidance, but realities. It usually doesn’t happen. So then also, and Mayor culpa, mea maxima culpa, right, I mean, he also did dances should be well, you know, Mr. has not been here for an appointment in a near he was a regular, let’s call him. And if he doesn’t answer the phone, let’s talk to his wife or his daughter, or you know, because many times they are all patients. Okay, of course, you should not break HIPAA concerns there. But you might be able to ask, you know, is there something going on? And most of the times people will be upfront will say, Oh, yeah, I know. Mr. So and so has had a stroke. Oh my gosh, would it be wonderful if he come for a visit because it’s really important to prevent oral health issues from happening, you know? So, the dentists also play a role in not establishing routine care.

Rev. Beth Long-Higgins 44:29
This has just been a great conversation and we are going to continue on another podcast so I’m going to bring this one to a close. Thank you so much. Okay, do you know I before we had our conversation I had never even thought about how I’m sorry about dentistry in terms of how it affects longevity. And there are just so many other questions I could ask . We could talk for a very long time. But as we bring this to a close there are a couple questions that we ask our podcast guests So, I’m going to ask you a couple of them now. Are you ready?

Dr. Leo Marchini 45:04
Yes, I am, hopefully. Okay.

Rev. Beth Long-Higgins 45:07
When you think about how you have aged, what do you think has changed about you or grown with you that you really like about yourself?

Dr. Leo Marchini 45:15
Oh, gosh, it’s hard to tell Bob to talk about ourselves is that it, but let’s try. I think the thing that I like most about aging is that as we age, we can accumulate experience. And there are certain things, there are certain topics and certain matters, certain themes that you can only really learn about and understand fully with experience by, by having that experience by passing through that circumstance, by being there in that moment. Even if you read a lot, if anything is funny, even if you stand a lot and are chilled, nothing will replace that experience learning that, you know, that only happens with aging. So I hope that I was able to get as much as possible from all those experiences. And I know, then I now know better how to deal with those sets of circumstances. So I think maturing in that regard, is a very good thing that comes with aging.

Rev. Beth Long-Higgins 46:46
Nice. Okay, here’s the last question for you. What has surprised you the most, as you have aged about yourself?

Dr. Leo Marchini 46:55
Oh, my gosh, what? Well, it really struck me that there were some changes in my body in my physical form. Some, you know, conditions that are due to repetitive movements, and so are related with time, right, that will not be a thing for a 25 year old. But a common thing for a 15 year old. Those are the things that we don’t think about when we are 2530. But now they can impact my routines. And when that happens, that’s trucks that really gets me, you know, and I would love to have been more thoughtful about them. When I was younger, to either, you know, postpone the consequences of it, or avoid entirely the consequences of it. And then now I need to deal with them medically. And thanks, God, medicine has evolved. And we have wonderful physicians that can help us. But yeah, that is the part that I think, to some extent, could have been prevented, or at least as I said, could have been postponed, but are not as pleasant. I would say,

Rev. Beth Long-Higgins 48:36
Well, as we say aging is cumulative. And so right. And back to your first answer, there are just some things we don’t know until we are older. And

Dr. Leo Marchini 48:48
right. Yeah. But for sure, aging is better than the alternatives that I can tell for sure.

Rev. Beth Long-Higgins 48:54
Exactly. Exactly. Well, thank you, Leo. Thank you to our listeners too, for listening to this episode of The Art of aging part of the blended aging podcast series with United Church homes. And we want to hear from you what’s changed about you as you’ve aged? What’s changed about you that you love what surprised you the most, invite you to visit us at www DOT abundant aging podcast.com to share your ideas. You can also give us feedback when you visit the Ruth frost Parker Center website at WWW DOT United Church homes all one word.org backslash Parker, dash center backslash and when you check out that website, if you’re still listening to this in the month of September, check out our symposium which will be happening on October 6, where we will be talking about how to how to dismantle ageism. And Leo Tell us again where can people find you. And tell us about the organization, the special special care dentistry

Dr. Leo Marchini 50:00
Yes, well first of all, I want to express my gratitude to you for the wonderful questions for welcoming me to the podcasts and to your wonderful team that are behind the scenes making this happen. So thank you a lot for that. Thank you for our listeners, right we you the listeners, you are the reason for us to be here. So thank you for listening. Anyone can find me at the University of Iowa College of Dentistry and Dental Clinics. I am the chair of the Department of Preventive and community dentistry. My name is Leonardo. Please, if you have any questions or concerns, you can direct the questions to me. And if they cannot, that can be cut later. I want to make a really quick pitch. We are fundraising for the geriatric and special needs clinic here at the University of Iowa College of Dentistry and Dental Clinics, we have a very lofty goal of raising money to improve even further our operations and being able to perennially forever take care of the population that we that we care for. So if you are inclined to donate to this cause please do not hesitate to contact me and I will connect you with the University of Iowa Center of advancement who would be collecting donations of any size. So thank you very much.

Rev. Beth Long-Higgins 51:53
Thank you. Thank you very much, Leo. Blessings!