Bulletin of the World Health Organization

More oral health care needed for ageing populations

Millions of elderly people across the globe are not getting the oral health care they need because governments are not aware enough of the problem. By 2025, there will about 1200 million people aged 65 years according to UN estimates. Failure to address oral health needs today could develop into a costly problem tomorrow.

Even in developed countries such as the United States older people face a host of impediments to continuing dental care even if they used to go to the dentist regularly, said Dr Barbara Gooch, an oral health expert from the US Centers for Disease Control and Prevention (CDC). After retirement they may be unable to afford dental care. If they become less mobile, they may not be able to get to the dentist.

The results of oral health problems reverberate throughout the body. Nutritional problems are the immediate result of problems with chewing, which can start long before tooth loss. “I was chewing badly and I got stomach problems,” Diaz said.

“The mouth is the gateway to the digestive system,” Acuña said, adding that caregivers tend to think that if an older person is eating, then he or she is fine.

But chewing difficulty makes people shun foods that they can’t swallow easily, and those are often ones with fibre and essential nutrients, such as fruit and vegetables. Sometimes people gravitate toward softer, processed foods which are often laden with sugar. On the flipside, some people stop eating enough and lose weight.

“The point in public health is that if oral health promotion and disease prevention are integrated with noncommunicable and chronic disease prevention, we can make progress for better oral health and prevention of oral diseases worldwide,” Petersen said.

Even farther under the health-systems radar are the psychological problems associated with having discoloured, diseased or missing teeth. The person becomes uncomfortable socializing, loses self-esteem and begins a spiral of decline.

The good news is that much of the damage is preventable.

“Some people tend to think that if you’re old, there is little chance that you will change your lifestyle in terms of tooth cleaning or dietary habits to be healthy, or other behaviour modifications,” Petersen said. “But the experiences gained in some countries have shown that you can also at old age achieve healthy lifestyles and have positive outcomes as an effect of health-education intervention programmes.”

Starting people on dental care programmes and exposing them to flouridated water and toothpaste improves dental health regardless of a person’s age. Increasing the ratio of dentists to population, especially in poorer areas, is essential, as is educating caregivers such as workers in homes for the elderly. Alerting general medical practitioners on what to look for is also necessary.

In the United States in the 1950s — as was the case with most industrialized countries — more than half of the people aged 65 and over had lost all their teeth, the CDC’s Gooch said. Now it is less than 30%. In addition to educating health professionals, CDC emphasizes the role patients can play in maintaining and monitoring their own oral health.

Theresa Braine.