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Recent public declarations by a number of health organizations and institutes that we are experiencing an obesity crisis, and moreover, that obesity is the 'new tobacco' makesBaby Boomer Health Dynamicsboth timely and topical.

Key words: aging, baby boomers, chronic disease knowledge, dental hygiene, oral health, oral health literacy CDHA Research Agenda category: risk assessment and management INTRODUCTION Oral health and its impact on overall health is an important yet regularly overlooked component of healthy aging.1-3 Canada, like many countries, is facing an era of population aging with the number of older adults rapidly increasing due to low fertility rates, longer life expectancy, and the existence of a large baby boom generation.4-6 The large baby boom cohort reaching older adulthood comprises 2 distinct groups referred to as early boomers (those born between 1946 and 1955) and late boomers (those born between 1956 and 1964).1,7,8 Baby boomers grew up in an era that heralded substantial advances in medical care, improvements in public health, higher standards of living, and significant increases in educational attainment.9-11 More than any other cohort before them, baby boomers have had access to oral care, oral health promotion initiatives, and dental insurance throughout their lives and, as a result, they are more likely to retain at least some of their own teeth for their entire lifetime.1,11 As people age, they may develop multiple chronic conditions, which not only cause premature death in some cases, but also place a financial burden on individuals, families, and society in general.12 The 4 main chronic diseases causing death worldwide are cardiovascular disease (CVD), cancer, chronic respiratory disease, and diabetes, and there is evidence demonstrating a link between these conditions and oral diseases.13,14 According to the World Health Organization, oral diseases share common risk factors with all 4 leading chronic diseases.15 Poor oral health affects quality of life across the lifespan, and oral health extends beyond dental disease, with an unhealthy mouth affecting an individual's ability to eat and speak properly, their nutritional status, body mass index, and self-image, as well as increasing the risk for developing chronic diseases.11,16 Oral health and general health are related in that poor oral health causes disability, general health problems may cause or worsen oral health conditions, and oral diseases and chronic diseases share common risk factors.17 The diseases for which an association with periodontal disease has been reported include CVD, stroke, respiratory disease, rheumatoid disease, pancreatic cancer, diabetes mellitus (types 1 and 2), osteoporosis, and osteoarthritis.18-22 Research shows that having periodontal disease can increase the probability that CVD will occur, irrespective of the effect of other causal or risk factors.23-25Aspiration pneumonia is a multifactorial respiratory disease that is influenced by oral-related factors such as difficulty swallowing, dependency on feeding tubes, and presence of cariogenic bacteria and periodontal pathogens.26 People with diabetes, especially poorly controlled and uncontrolled diabetes, have an increased susceptibility to chronic infections and inflammation of oral tissues, including periodontal disease, dental caries, and oral candidiasis.18,25,27,28 The side effects of oral cancer treatment can result in poor oral outcomes such as difficulty swallowing, chewing, and speaking, and can be cosmetically disfiguring resulting in increased depressive symptoms and social isolation.29-31 New research demonstrates that the periodontal pathogen Porphyromas gingivalis infects the epithelium of the esophagus in esophageal squamous cell carcinoma (ESCC) patients, establishing an association between infection with Porphyromas gingivalis and progression of ESCC.32 Individuals with low health literacy skills often have poorer health knowledge and health status, exhibit unhealthy behaviours, are less likely to use preventive services, and have higher rates of hospitalizations, increased health care costs, and ultimately poorer health outcomes than those with higher literacy levels.33 Researchers have proposed a conceptual model of causal pathways between health literacy and health outcomes, in which health literacy is determined by patient literacy level and extrinsic factors grouped as 1) access to and utilization of health care; 2) provider-patient interaction; and 3) self care.34 Oral health literacy (OHL) is the process of acquiring oral health information, appraising concepts, and appropriately applying oral disease prevention and treatment recommendations.35,36 Having low OHL has been shown to contribute to oral health disparities, and those with low OHL are more likely to be poor, not well educated, older, and have limited English language skills.37-39 It has been suggested that those with low OHL may be unable to communicate effectively with health care providers, and this gap in communication may account for poor oral health outcomes.40-41 A growing number of studies has been able to demonstrate that low OHL levels are associated with poor oral health knowledge.42-44 The body of medical literature linking health literacy to health knowledge continues to grow; however, far less is known about the influence of OHL on oral health knowledge. Several studies report that people with low OHL levels have poor dental health knowledge, increased dental visits, and more severe oral disease.56-58 Findings from Valerio and colleagues highlight the role that inadequate OHL plays as a barrier to understanding, processing, and using oral health related information to make informed diabetes management decisions.27 Findings from this study demonstrated a low but positive association between study participants' literacy and knowledge scores, which is similar to findings from other studies that explored the relationship between health literacy and knowledge.43,44 Additionally, Gazmararian et al. explored the relationship between the health literacy and knowledge of disease of Medicare patients ages 65 years and older and demonstrated through multivariate analysis that health literacy was independently related to disease knowledge.12 In the current analysis, cohort predicted low but positive correlations between OHL and oral health knowledge scores. According to Payne and Locker,69 client counselling has been demonstrated as an effective way of increasing knowledge, and providing education allows for the acquisition of non-material resources (such as knowledge) that promote healthy behaviours and better navigation through health resources.70 Not all older adults visit dental professionals on a regular basis. [...]certain segments of the population may not have access to oral health education. Since participants identified dental professionals as their main source for oral health information, dental hygienists can bridge this knowledge gap by educating older adults about the oral-systemic link.