Clinical Cases in Gerodontology. Группа авторов
born after World War II have very different attitudes to oral health compared with those born pre‐war.15,16
While increasing tooth retention represents a significant improvement in the oral health of the older population, it also brings with it the emerging challenges of managing chronic dental diseases for a new cohort. Factors including reduced manual dexterity and xerostomia coupled with a cariogenic diet mean that chronic dental diseases can cause considerable pain and suffering among older patients and can impair oral function.17 Dental caries, particularly on root surfaces, remains a challenge for this age group, with high levels found among old‐age populations, especially those living within residential care.18,19
The importance of oral health for older adults: links between oral disease and systemic well‐being
Retention or replacement of missing natural teeth is important for restoration of oral function, aesthetics and quality of life. However, there is an ever‐increasing amount of evidence to suggest that teeth and oral health are also very important for systemic health and well‐being.20 While a number of oral and systemic diseases can be linked by a variety of common risk factors, there is also evidence to suggest that there could be interactions between inflammatory periodontal diseases and conditions such as atherosclerosis, diabetes mellitus and respiratory diseases.21 It has been shown too that as natural teeth are lost, chewing function can be negatively affected. This can have significant negative knock‐on effects on dietary choice and overall nutritional status.22 In older patients in particular, diet plays a very important role in systemic disease prevention, with poor diets implicated in bowel disease, osteoporosis and cardiovascular disease.
Therefore, it is important from both oral well‐being and systemic health perspectives that oral health is maintained for older adults, ideally providing them with a pain‐free, natural and functional dentition for life. In order to help oral health clinicians achieve this, there is a need to develop and provide training focused on gerodontology at undergraduate and postgraduate levels, both as part of formal programmes and through continuing professional development (CPD) opportunities.23 Such opportunities should extend to the entire dental team, since all members have a role to play maintaining and improving oral health for older people.24
References
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13 13 Cronin M, Meaney S, Jepson NJ, Allen PF (2009). A qualitative study of trends in patient preferences for the management of the partially dentate state. Gerodontology 26: 137–142.
14 14 Allen PF (2010). Factors influencing the provision of removable partial dentures by dentists in Ireland. Journal of the Irish Dental Association 56: 224–229.
15 15 Pearce MS, Steele JG, Mason J, et al. (2004). Do circumstances in early life contribute to tooth retention in middle age? Journal of Dental Research 83: 562–566.
16 16 Pearce MS, Thomson WM, Walls AW, Steele JG (2009). Lifecourse socio‐economic mobility and oral health in middle age. Journal of Dental Research 88: 938–941.
17 17 Steele JG, Sheiham A, Marcenes W, et al. (2001). Clinical and behavioural risk indicators for root caries in older people. Gerodontology 18: 95–101.
18 18 Petersen PE, Yamamoto T (2005). Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology 33: 81–92.
19 19 Karki AJ, Monaghan N, Morgan M (2015). Oral health status of older people living in care homes in Wales. British Dental Journal 219: 331–334.
20 20 Seymour RA (2010). Is oral health a risk for malignant disease? Dental Update 37: 279–283.
21 21 Ford PJ, Raphael SL, Cullinan MP, et al. (2010). Why should a doctor be interested in oral disease? Expert Review of Cardiovascular Therapy 8: 1483–1493.
22 22 Moynihan PJ (2007). The relationship between nutrition and systemic and oral well‐being in older people. Journal of the American Dental Association 138: 493–497.
23 23 Kossioni A, McKenna G, Müller F, et al. (2017). Higher education in gerodontology in European universities. BMC Oral Health 17: 71.
24 24 Kossioni A, Hajto‐Bryk J, Maggi S, et al. (2018). An expert opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European policy recommendations on oral health in older adults. Journal of the American Geriatrics Society 66: 609–613.
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