Trends Recommendations for Oral Care for Older Adults

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Trends Recommendations for Oral Care for Older Adults

It is now recognized that a healthy mouth is a component of health, and that oral disease can significantly impact quality of life for older adults, including pain, difficulty with mastication affecting the diet, and reduced socialization as a result of an altered appearance. For too long, however, oral health and the burden of oral disease has not been considered in the development of national policies that address healthy aging, and in many countries there are no provisions for the prevention and treatment of oral diseases in older adults. For example, the Medicare program in the United States does not contain any benefits for routine oral healthcare.

Recently, a joint statement from the European College of Gerodontology and the European Geriatric Medicine Society defined three areas of need for action regarding the oral health needs of older adults.1Kossioni AE, Hajto-Bryk J, Maggi S, McKenna G, Petrovic M, Roller-Wirnsberger RE, Schimmel M, Tamulaitienè M, Vanobbergen J, Műller F. An expert opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European policy recommendations on oral health in older adults. J Am Geriatr Soc 2018;66(3):609-13. This statement included learning objectives for non-dental healthcare providers to assess and promote oral health, necessary health policy initiatives, and policy issues for vulnerable older adults (i.e. persons in long-term care facilities, requiring assisted living and rehabilitation centers). For each area, specific suggestions were listed:

  1. Non-oral health care providers should:
    1. understand that oral health is an essential part of healthy aging and good quality of life.
    2. understand how medications can impact oral health.
    3. conduct a simple oral examination and differentiate normal findings from disease.
    4. identify oral diseases and disorders affecting older adults.
    5. demonstrate proper oral hygiene procedures to both older adults and their caregivers; assist in the provision of oral hygiene when needed.
    6. consider barriers to maintenance of oral health in older adults, and how these barriers can be overcome.
    7. understand when a referral to a dentist is needed.
    8. communicate with other health professionals about an older person’s oral health status.
  2. Health policy initiatives:
    1. preventive oral care should be a component of routine medical care.
    2. oral health education should be part of routine medical/geriatric evaluations.
    3. oral health services should be part of public health care coverage.
    4. promote interprofessional health care among those caring for older adults, which should include oral health care providers.
    5. promote oral health prevention to the public.
    6. integrate oral health promotion as part of general health promotion.
    7. provide free oral examinations for vulnerable older adults.
    8. ensure access to dental care to persons in residential care settings.
    9. research new prevention strategies for older adults in community and institutional settings.
    10. define the role for allied health professionals in the evaluation and promotion of oral health.
    11. Advocate for research by companies that manufacture oral health care products to develop new products that improve oral health for older adults.
    12. ensure that oral health is included in health policy initiatives targeting persons in institutional settings (i.e., assisted-living, long-term care).
  3. Policy initiatives for older adults in institutional settings:
    1. oral health should be part of the initial health assessment of new residents.
    2. daily oral hygiene/denture hygiene should be provided.
    3. empower caregivers to provide regular oral hygiene.
    4. train caregivers in how to provide residents with daily oral hygiene.
    5. provide necessary oral hygiene products.
    6. promote a diet that is associated with good oral health (i.e. limit sugar intake, include vegetables and dairy products).
    7. provide routine oral examinations, comprehensive dental care and emergency services.
    8. schedule regular dental screenings for residents using accepted methods.

This policy paper emphasizes a number of key points. These include the important problem of poor oral health of institutionalized individuals, the need to provide care in these settings, the importance of prevention of oral disease for all groups of older adults, the need to understand the linkage between oral health and general health, including quality of life, and the widespread nature of these concerns.

This document adds to earlier publications emphasizing the need for oral health care for older adults across the globe 2Singh A, Purohit BM. Addressing geriatric oral health concerns through national oral health policy in India. Int J Health Policy Manag 2015;4(1):39-42. ,3Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health 2012;102(3):411-8. and aims to help close the artificial separation of dental and medical care, a separation that has existed for too long. These issues take an even greater significance considering the aging of populations across the globe.

The challenge of addressing the health care needs of aging populations will in part define the future of health care, and that is certainly is true for oral health care.4Lamster IB. Invited commentary: The ageing of populations across the globe and implications for the future of the dental profession. Gerodontol 2018;35(1):1-2. Further, as populations in developed countries age, tooth retention is increasing and edentulism is decreasing.5Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, Eke PI, Beltrán-Aguilar ED, Horowitz AM, Li CH. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11 2007;(248):1-92.,6Bernabé E, Sheiham A. Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis. PLoS One 2014;9(8):e104808.,7Wu B, Hybels C, Liang J, Landerman L, Plassman B. Social stratification and tooth loss among middle-aged and older Americans from 1988 to 2004. Community Dent Oral Epidemiol 2014;42(6):495-502. However, as is so often the case, there are social inequities, and lower socioeconomic status is clearly linked to a greater oral disease burden.6Bernabé E, Sheiham A. Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis. PLoS One 2014;9(8):e104808.,7Wu B, Hybels C, Liang J, Landerman L, Plassman B. Social stratification and tooth loss among middle-aged and older Americans from 1988 to 2004. Community Dent Oral Epidemiol 2014;42(6):495-502. In addition, residents of long-term care facilities are at greatest risk for poor oral health.8Yoon MN, Ickert C, Slaughter SE, Lengyel C, Carrier N, Keller H. Oral health status of long-term care residents in Canada: Results of a national cross-sectional study. Gerodontol 2018, Jul 11. [Epub ahead of print] Coupled with the general absence of oral health care services in national health care plans and policy initiatives, a crisis is inevitable.

The challenge of addressing the health care needs of aging populations will in part define the future of health care, and that is certainly is true for oral health care.

Another important consideration in this equation is the increased global prevalence of non-communicable chronic diseases (NCDs).9Balakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res 2016;113(Pt A):600-9. NCDs disproportionately affect older adults, and a number of these disorders have been linked to oral diseases. The two best examples are cardiovascular diseases and diabetes mellitus.10Almeida APCPSC, Fagundes NCF, Maia LC, Lima RR. Is there an association between periodontitis and atherosclerosis in adults? A systematic review. Curr Vasc Pharmacol 2017, Aug 30. [Epub ahead of print],11Teshome A, Yitayeh A. The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis. BMC Oral Health 2016;17(1):31.,12Nascimento GG, Leite FRM, Vestergaard P, Scheutz F, López R. Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies. Acta Diabetol 2018;55(7):653-77.

These facts emphasize the need for collaborative care between medical and dental providers.13Jones JA, Snyder JJ, Gesko DS, Helgeson MJ. Integrated medical-dental delivery systems: Models in a changing environment and their implications for dental education. J Dent Educ 2017;81(9):eS21-9. Assessment of the risk for NCDs in the dental office is one aspect of this interprofessional model of care, and common risk factor messaging is another.14Lamster IB, Myers-Wright N. Oral health care in the future: Expansion of the scope of dental practice to improve health. J Dent Educ 2017;81(9):eS83-90.,15Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 2000;28(6):399-406. This shift can have many benefits for patients and providers, including better outcomes, and cross-referral of patients with identified medical or dental needs.

References

  • 1.Kossioni AE, Hajto-Bryk J, Maggi S, McKenna G, Petrovic M, Roller-Wirnsberger RE, Schimmel M, Tamulaitienè M, Vanobbergen J, Műller F. An expert opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European policy recommendations on oral health in older adults. J Am Geriatr Soc 2018;66(3):609-13.
  • 2.Singh A, Purohit BM. Addressing geriatric oral health concerns through national oral health policy in India. Int J Health Policy Manag 2015;4(1):39-42.
  • 3.Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health 2012;102(3):411-8.
  • 4.Lamster IB. Invited commentary: The ageing of populations across the globe and implications for the future of the dental profession. Gerodontol 2018;35(1):1-2.
  • 5.Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, Eke PI, Beltrán-Aguilar ED, Horowitz AM, Li CH. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11 2007;(248):1-92.
  • 6.Bernabé E, Sheiham A. Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis. PLoS One 2014;9(8):e104808.
  • 7.Wu B, Hybels C, Liang J, Landerman L, Plassman B. Social stratification and tooth loss among middle-aged and older Americans from 1988 to 2004. Community Dent Oral Epidemiol 2014;42(6):495-502.
  • 8.Yoon MN, Ickert C, Slaughter SE, Lengyel C, Carrier N, Keller H. Oral health status of long-term care residents in Canada: Results of a national cross-sectional study. Gerodontol 2018, Jul 11. [Epub ahead of print]
  • 9.Balakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res 2016;113(Pt A):600-9.
  • 10.Almeida APCPSC, Fagundes NCF, Maia LC, Lima RR. Is there an association between periodontitis and atherosclerosis in adults? A systematic review. Curr Vasc Pharmacol 2017, Aug 30. [Epub ahead of print]
  • 11.Teshome A, Yitayeh A. The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis. BMC Oral Health 2016;17(1):31.
  • 12.Nascimento GG, Leite FRM, Vestergaard P, Scheutz F, López R. Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies. Acta Diabetol 2018;55(7):653-77.
  • 13.Jones JA, Snyder JJ, Gesko DS, Helgeson MJ. Integrated medical-dental delivery systems: Models in a changing environment and their implications for dental education. J Dent Educ 2017;81(9):eS21-9.
  • 14.Lamster IB, Myers-Wright N. Oral health care in the future: Expansion of the scope of dental practice to improve health. J Dent Educ 2017;81(9):eS83-90.
  • 15.Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 2000;28(6):399-406.