Important target groups
Improving oral health among older people
The loss of teeth is preventable and risk factors intervention is effective when incorporated into NCD intervention. The evidence on oral health interventions is strong and prevention is easily applicable to countries. Public health experience from countries with established prevention programmes show significant improvements in dentate status.
Complete loss of natural teeth is a severe global public health problem, which has great bearing to countries as the economic burden to society and individuals are high. Tobacco use, unhealthy diet, and excessive consumption of alcohol, are the leading causes of complete loss of teeth. Tooth loss is the ultimate consequence of tooth decay and severe gum disease (periodontitis) which are conditions caused by lifelong exposure to risk factors common to other non-communicable chronic diseases (NCDs).
According to the global World Health Survey, complete tooth loss affects approximately 30% of old-age people 65-74 years, however, prevalence rates are increasing dramatically in low- and middle-income countries, especially among poor and disadvantaged population groups. In addition to the huge inter-country variations, the striking intra-country inequalities in complete tooth loss are universal.
The oral disease burden among older people
Oral diseases are usually progressive and cumulative. The process of ageing may directly or indirectly increase the risk of oral disease, compounded by poor general health, illnesses or chronic diseases. At old age, high prevalence of co-morbidities and barriers to care are observed, together with oral health care challenges in relation to major disease conditions such as:
- changing dentition status
- caries prevalence with unmet need for care
- periodontal pocketing/loss of attachment and poor oral hygiene
- tooth loss and limited oral functioning
- denture related conditions, ill fitting removable dentures
- oral cancer and oral mucosal lesions
- Xerostomia ("dry mouth")
- craniofacial pain and discomfort.
Interrelationship between oral health and general health
The interrelationship between oral health and general health is particularly pronounced among older people. Poor oral health can increase the risks to general health and, with compromised chewing and eating abilities, affects nutritional intake. Insufficient nutrition may ultimately lead to low immune response. Severe periodontal disease is associated to diabetes and HIV infection. Similarly, other systemic diseases and/or the adverse side effects of their treatments can lead to an increased risk of oral diseases, reduced salivary flow ("dry mouth"), altered senses of taste and smell, oro-facial pain, gingival overgrowth, alveolar bone resorption and mobility of teeth. The high prevalence of multi-medication therapies in this age group may further complicate the impact on oral health.
Important risk factors
Oral health of older people is strongly affected by social determinants such as low educational background, poor personal income, deprived living conditions, and poor housing. Additional risk factors include unhealthy lifestyles, high sugar content diets, inadequate oral hygiene due to poor dexterity, tobacco use and excessive consumption of alcohol.
Barriers to oral health care
Barriers to oral health care among older people are considerable. Impaired mobility impedes access to oral health care, particularly for those who reside in rural areas with poor public transport. The situation is worsened in developing countries when oral health services and domiciliary care are not available. Given that some older people may experience financial hardship following retirement, the cost or perceived cost of dental treatment, together with poor attitudes to oral health, may deter them from visiting a dentist. The fear of violence may make them apprehensive of strangers, hindering good communications with oral health services providers.
In some countries, older people tend to live alone, away from friends and family. The lack of social support and feelings of loneliness and isolation may affect their mental health and well being. Clearly, there is unmet need among this group. It is important that health care service providers recognise these important psychosocial factors that underpin the health and well being of older people. There is a need to provide sensitive oral health services that are accessible, appropriate and acceptable to them. Their general health must be taken into account when planning complex treatment that may involve surgical procedures. Special needs diagnosis and advanced treatment planning are crucial. Finally, the implications for research and training are considerable.
The WHO Oral Health Programme
The WHO Oral Health Programme has developed strategies for improved oral health of older people. Based on experiences from demonstration programmes in countries, national oral health planners are encouraged to integrate systematic oral health activities towards improved quality of life. The programme effectuates these strategies in collaboration with the WHO Kobe Centre in Japan, the Regional Offices, WHO Collaborating Centres on Oral Health and NGOs.