Oral health for an ageing population: the importance of a natural dentition in older adults

Abstract

Despite progress in dentistry, tooth loss in old age is still a reality, even more so in long-term-care residents. However, recent trends indicate that natural teeth are lost later in life. Functional decline and age-related pathologies have to be considered in oral health care for this vulnerable population. Retaining and restoring teeth and oral function in elders is important. Tooth loss significantly impairs masticatory performance, which cannot be fully restored by prosthodontic means. Hence an unconscious change in food intake occurs, often involving malnutrition and withdrawal from common meals. Poor oral appearance and bad breath may further impede social activities. Although a chewing activity may be beneficial for cognitive function, natural teeth can present a considerable risk for fragile elders, in whom aspiration of biofilm can lead to pneumonia and death. The presence of natural teeth is also correlated with higher life expectancy, but socio-economic confounding factors have to be considered. When evaluating oral health in the elderly population, standards and priorities for reporting oral health outcome measures have to be defined. Anatomical indicators such as the number of natural teeth or the presence of prostheses might be one option for reporting. However, functional indicators such as masticatory performance and patient-centred outcome measures may be more relevant. In conclusion, there is an overwhelming body of evidence that maintaining a healthy natural dentition in old age is beneficial from a structural, functional and psycho-social point of view.

Keywords: Tooth loss; ageing; gerodontology; oral health; public health.

Figure 1.

Prevalence of edentulism in the WHO regions according to ‘The global burden of oral disease and risks to oral health‘ data by Petersen et al. (2005).

Figure 2.

Epidemiological studies from the Survey of Health, Ageing and Retirement in Europe (SHARE) in Europe and Israel evince that tooth loss is occurring later in life. Number of natural teeth by country and age. The grey areas represent 95% confidence regions for the estimated outcome. Reprint permission from Stock et al. (2016).