Oral healthcare continues to be a challenge for senior citizens in the United Kingdom. At least 1.8 million people age 65 years and older in England, Wales, and Northern Ireland have an urgent dental condition such as dental pain, oral sepsis, or extensive decay in untreated teeth, according to the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons. Also, the FDS reports, this total could rise by more than 50% by 2040.
“Many of us know what it’s like to have excruciating tooth or gum pain. It puts you off your food and makes it difficult to do daily tasks. For older people, the effects are even worse. It can be very isolating, making people reluctant to socialize with friends and family and will have a significant impact on their quality of life,” said Michael Escudier, MD, dean of the FDS.
“As well as causing pain and making it difficult to speak, eat, and take medication, poor oral health is linked to conditions in older people such as malnutrition and aspiration pneumonia,” said Escudier. “We need to work together to ensure improvements in oral healthcare for older people. Dental health needs to be viewed as part of older people’s overall health, with health professionals and social care providers being trained to recognize and deal with problems.”
Over the last 40 years, standards of adult oral health have improved dramatically in the United Kingdom, the FDS says. While just 22% of people in England age 65 years and older retained some of their natural teeth in 1979, 85% of 65- to 74-year-olds and 67% of those age 75 years and older had some of their teeth in 2009. This creates new challenges for dentists, though, as these often heavily restored teeth require ongoing maintenance.
The FDS offers several recommendations for improving oral healthcare among senior citizens in England, with some suggestions relevant for Scotland, Wales, and Northern Ireland as well:
- Government, health services, local authorities, care providers, regulators, and the oral health profession should work together to develop a strategy for improving access to dental services for older people.
- Key health professionals in acute and community care settings, such as nurses, junior doctors, pharmacists, and geriatricians, should be trained in oral health.
- Social care providers should provide their staff with appropriate training about oral health and care, as well as ensure that all services have an oral care policy and cover oral health as part of initial health assessments.
- Preventive advice on maintaining good oral health should be easily available for older people themselves, their families, and their caregivers.
- Health and social care regulators should ensure that standards of oral care are assessed during their inspections or care homes and hospitals.
- All hospitals and care homes should have policies in place to minimize denture loss, such as checking whether a patient has dentures on admission and ensuring that staff always check for dentures when disposing of food trays and changing bed linen.
- More data on the oral health of senior citizens is needed. NHS Digital’s quarterly dental statistics, which only give figures on access to dental services for the overall adult population, should provide a breakdown for people age 65-74 years, 75-84 years, and 85 years and older. The Adult Dental Health Survey also should continue to monitor older people’s oral health.
Meanwhile, the British Dental Association (BDA) notes that it has been a longtime advocate of collaborative strategies for ensuring oral healthcare for the senior citizen population. In 2003, it outlined 21 recommendations to improve oral healthcare for older adults, but only 7 of these recommendations have been met in full so far.
“Senior citizens, whether they are residents in care homes or living at home independently or with support, all face significant barriers to accessing quality dental care,” said Mick Armstrong, BDA chair. “The complex and diverse needs of a growing group of vulnerable patients are going unmet. We urgently require a strategy that ensures oral health for the over-65s is no longer treated as an optional extra.
Recently, the National Institute for Health and Care Excellence released guidelines and a Quality Standard on oral health for adults in care homes. While this guidance specifically concerns oral health for those in residential care, the FDS believes it should be used as a benchmark for all types of care provision.
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