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Prevention of oral diseases for the older person (Part 1)

British Dental Journal volume 236, pages 35–41 (2024)Cite this article

Abstract

Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.

Key points

  • Older people are at an increased risk of poor oral health due to changes in medical health, dietary intake, cognition and manual dexterity.

  • All dental care professionals can play a part in delivering and reinforcing prevention with individuals, families and health care and social professionals.

  • Oral health prevention must be included in policy and legislation related to overall health, so it is considered a high priority.

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References

  1. Geddis-Regan A, Walton G. A guide to treatment planning in complex older adults. Br Dent J 2018; 225: 395-399.

  2. Murray C G. Advanced restorative dentistry - a problem for the elderly? An ethical dilemma. Aust Dent J 2015; 60: 106-113.

  3. Slade G D, Akinkugbe A A, Sanders A E. Projections of U.S. Edentulism prevalence following 5 decades of decline. J Dent Res 2014; 93: 959-965.

  4. Watt R G, Steele J G, Treasure E T, White D A, Pitts N B, Murray J J. Adult Dental Health Survey 2009: implications of findings for clinical practice and oral health policy. Br Dent J 2013; 214: 71-75.

  5. Murray Thomson W. Epidemiology of oral health conditions in older people. Gerodontology 2014; 31: 9-16.

  6. Pretty I A, Ellwood R P, Lo E C et al. The Seattle Care Pathway for securing oral health in older patients. Gerodontology 2014; 31: 77-87.

  7. Donnelly L R, MacEntee M I. Social interactions, body image and oral health among institutionalised frail elders: an unexplored relationship: social interactions, body image and oral health among institutionalised frail elders. Gerodontology 2012; 29: 28-33.

  8. Azzolino D, Passarelli P C, De Angelis P, Piccirillo G B, D'Addona A, Cesari M. Poor Oral Health as a Determinant of Malnutrition and Sarcopenia. Nutrients 2019; 11: 2898.

  9. Masood M, Newton T, Bakri N N, Khalid T, Masood Y. The relationship between oral health and oral health related quality of life among elderly people in United Kingdom. J Dent 2017; 56: 78-83.

  10. Zenthöfer A, Rammelsberg P, Cabrera T, Schröder J, Hassel A J. Determinants of oral health-related quality of life of the institutionalized elderly. Psychogeriatrics 2014; 14: 247-254.

  11. Delwel S, Scherder E J, de Baat C et al. Orofacial pain and its potential oral causes in older people with mild cognitive impairment or dementia. J Oral Rehabil 2019; 46: 23-32.

  12. Leavell H D, Clark E G. Preventive Medicine for the Doctor in his Community: An Epidemiologic Approach. 3rd ed. pp 20-21. New York: McGraw-Hill, 1960.

  13. Fernández C E, Maturana C A, Coloma S I, Carrasco-Labra A, Giacaman R A. Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-Analysis. J Dent Res 2021; 100: 914-927.

  14. Jabir E, McGrade C, Quinn G et al. Evaluating the effectiveness of fluoride varnish in preventing caries among Long-Term Care Facility Residents. Gerodontology 2021; 39: 250-256.

  15. León S, González K, Hugo F N, Gambetta-Tessini K, Giacaman R A. High fluoride dentifrice for preventing and arresting root caries in community-dwelling older adults: A randomized controlled clinical trial. J Dent 2019; 86: 110-117.

  16. Hendre A D, Taylor G W, Chávez E M, Hyde S. A systematic review of silver diamine fluoride: Effectiveness and application in older adults. Gerodontology 2017; 34: 411-419.

  17. Slot D E, Vaandrager N C, Van Loveren C, Van Palenstein Helderman W H, Van der Weijden G A. The effect of chlorhexidine varnish on root caries: a systematic review. Caries Res 2011; 45: 162-173.

  18. UK Government. Delivering Better Oral Health. 2021. Available at https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention (accessed January 2021).

  19. Care Quality Commission. Smiling Matters. 2019. Available at https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes (accessed February 2021).

  20. Tsakos G, Demakakos P, Breeze E, Watt R G. Social gradients in oral health in older adults: findings from the English longitudinal survey of aging. Am J Public Health 2011; 101: 1892-1899.

  21. Gale C R, Cooper C, Aihie S A. Prevalence of frailty and disability: findings from the English Longitudinal Study Of Ageing. Age Ageing 2015; 44: 162-165.

  22. Hakeem F F, Bernabé E, Sabbah W. Association between oral health and frailty: A systematic review of longitudinal studies. Gerodontology 2019; 36: 205-215.

  23. Yoshida M, Suzuki R, Kikutani T. Nutrition and oral status in elderly people. Jpn Dent Sci Rev 2014; 50: 9-14.

  24. Peters R, Ee N, Peters J et al. Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction. Ther Adv Chronic Dis 2019; DOI: 10.1177/2040622319880392.

  25. Jordan H, Hidajat M, Payne N, Adams J, White M, Ben-Shlomo Y. What are older smokers' attitudes to quitting and how are they managed in primary care? An analysis of the cross-sectional English Smoking Toolkit Study. BMJ Open 2017; DOI: 10.1136/bmjopen-2017-018150.

  26. Taylor D H Jr, Hasselblad V, Henley S J, Thun M J, Sloan F A. Benefits of smoking cessation for longevity. Am J Public Health 2002; 92: 990-996.

  27. Lubin J H, Muscat J, Gaudet M M et al. An examination of male and female odds ratios by BMI, cigarette smoking, and alcohol consumption for cancers of the oral cavity, pharynx, and larynx in pooled data from 15 case-control studies. Cancer Causes Control 2011; 22: 1217-1231.

  28. Gupta B, Johnson N W. Systematic review and meta-analysis of association of smokeless tobacco and of betel quid without tobacco with incidence of oral cancer in South Asia and the Pacific. PLoS One 2014; 9: 113385.

  29. NHS. NHS Long Term Plan. 2019. Available at https://www.longtermplan.nhs.uk/ (accessed 2021).

  30. Gell L, Meier P S, Goyder E. Alcohol consumption among the over 50s: international comparisons. Alcohol Alcohol 2015; 50: 1-10.

  31. Lubin J H, Purdue M, Kelsey K et al. Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies. Am J Epidemiol 2009; 170: 937-947.

  32. Foley N C, Affoo R H, Siqueira W L, Martin R E. A Systematic Review Examining the Oral Health Status of Persons with Dementia. JDR Clin Transl Res 2017; 2: 330-342.

  33. Brennan L J, Strauss J. Cognitive impairment in older adults and oral health considerations. Dent Clin North Am 2014; 58: 815-828.

  34. Delwel S, Binnekade T T, Perez R S, Hertogh C M, Scherder E J, Lobbezoo F. Oral health and orofacial pain in older people with dementia: a systematic review with focus on dental hard tissues. Clin Oral Investig 2017; 21: 17-32.

  35. Hunter R V, Clarkson J E, Fraser H W, MacWalter R S. A preliminary investigation into tooth care, dental attendance and oral health related quality of life in adult stroke survivors in Tayside, Scotland. Gerodontology 2006; 23: 140-148.

  36. Ajwani S, Ferguson C, Kong A C, Villarosa A R, George A. Patient perceptions of oral health care following stroke: a qualitative study. BMC Oral Health 2021; 21: 127.

  37. Nederfors T. Xerostomia and hyposalivation. Adv Dent Res 2000; 14: 48-56.

  38. Gerdin E W, Einarson S, Jonsson M, Aronsson K, Johansson I. Impact of dry mouth conditions on oral health-related quality of life in older people. Gerodontology 2005; 22: 219-226.

  39. Ikebe K, Nokubi T, Sajima H et al. Perception of dry mouth in a sample of community-dwelling older adults in Japan. Spec Care Dentist 2001; 21: 52-59.

  40. Turner M D, Ship J A. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc 2007; 138: 15-20.

  41. Sreebny L M, Schwartz S S. A reference guide to drugs and dry mouth - second edition. Gerodontology 1997; 14: 33-47.

  42. Smithard D G. Dysphagia: A Geriatric Giant? Med Clin Rev 2016; DOI: 10.21767/2471-299X.1000014.

  43. Poisson P, Laffond T, Campos S, Dupuis V, Bourdel-Marchasson I. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology 2016; 33: 161-168.

  44. El-Yousfi S, Jones K, White S, Marshman Z. A rapid review of barriers to oral healthcare for vulnerable people. Br Dent J 2019; 227: 143-151.

  45. The Faculty of Dental Surgery of The Royal College of Surgeons of England. Improving Older People's Oral Health. 2017.

  46. Prasad M, Manjunath C, Murthy A K, Sampath A, Jaiswal S, Mohapatra A. Integration of oral health into primary health care: A systematic review. J Family Med Prim Care 2019; 8: 1838.

  47. NHS England and NHS Improvement. The Framework for Enhanced Health in Care Homes. 2020. Available at https://www.england.nhs.uk/wp-content/uploads/2020/03/the-framework-for-enhanced-health-in-care-homes-v2-0.pdf (accessed 2021).

  48. Personal Social Services Research Unit. Projections of Demand and Expenditure on Adult Social Care 2015 to 2040. 2018. Available at https://www.pssru.ac.uk/pub/5421.pdf (accessed January 2021).

  49. UK Government. What is Known about the Oral Health of Older People in England and Wales: A review of oral health surveys of older people. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/489756/What_is_known_about_the_oral_health_of_older_people.pdf (accessed December 2021).

  50. Weening-Verbree L F, Schuller A A, Cheung S-L, Zuidema S U, Van Der Schans C P, Hobbelen J S. Barriers and facilitators of oral health care experienced by nursing home staff. Geriatr Nurs 2021; 42: 799-805.

  51. Skills for Health. The Care Certificate Standards. 2015. Available at https://www.skillsforhealth.org.uk/images/projects/care_certificate/Care%20Certificate%20Standards.pdf (accessed 2021).

  52. National Institute for Health and Care Excellence. Oral Health for Adults in Care Homes. NICE guideline [NG48]. 2016.

  53. Welsh S. Caring for smiles: improving the oral health of residents. Dent Nurs 2014; 10: 224-228.

  54. Howells E P, Davies R, Jones V, Morgan M Z. Gwên am Byth: a programme introduced to improve the oral health of older people living in care homes in Wales - from anecdote, through policy into action. Br Dent J 2020; 229: 793-799.

  55. Residential Oral Care Sheffield. Domiciliary Dental Care Scheme to Improve Oral Healthcare for Patients in Care Homes. 2016. Available at https://www.nice.org.uk/sharedlearning/residential-oral-care-sheffield-rocs-domiciliary-dental-care-scheme-to-improve-oral-healthcare-for-patients-in-care-homes (accessed December 2021).

  56. Van Noort H H, Witteman B J, den Hertog-Voortman R, Everaars B, Vermeulen H, Huisman-de Waal G. A context analysis on how oral care is delivered in hospitalised patients: a mixed-methods study. J Clin Nurs 2020; 29: 1991-2003.

  57. Hua F, Xie H, Worthington H V, Furness S, Zhang Q, Li C. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2016; DOI: 10.1002/14651858.CD008367.pub3.

  58. Scannapieco F A. Pneumonia in nonambulatory patients. The role of oral bacteria and oral hygiene. J Am Dent Assoc 2006; 137: 21-25.

  59. Salamone K, Yacoub E, Mahoney A-M, Edward K-L. Oral care of hospitalised older patients in the acute medical setting. Nurs Res Pract 2013; 2013: 827670.

  60. Doshi M, Mann J, Quentin L, Morton-Holtham L, Eaton K A. Mouth care training and practice: a survey of nursing staff working in National Health Service hospitals in England. J Res Nurs 2021; 26: 574-690.

  61. Stout M, Goulding O, Powell A. Developing and implementing an oral care policy and assessment tool. Nurs Stand 2009; 23: 42-48.

  62. NHS England. Mouth Care Matters. 2023. Available at https://www.e-lfh.org.uk/programmes/mouth-care-matters/ (accessed 2021).

  63. NHS Wales 1000 Lives. Improving Mouth Care for Adult Patients in Hospital. 2021. Available at http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/MAH%20Resource%20%20vers%205%20July%20%202013%20%201000%20lives.pdf (accessed May 2021).

  64. Patel R, Robertson C, Gallagher J E. Collaborating for oral health in support of vulnerable older people: co-production of oral health training in care homes. J Public Health (Oxf) 2019; 41: 164-169.

  65. Mann J, Doshi M, Quentin L, Eaton K, Morton-Holtham L. Cost Benefit Analysis of Two Oral Health Improvement Programmes. Community Dent Health 2021; 38: 26-32.

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Acknowledgements

The BDJ Editorial Team would like to thank the authors of this chapter for granting us permission to republish their chapter within our journal. This chapter was first originally published in Rosalyn Davies and Mili Doshi, Oral Health and Dental Care in the Ageing Population, BDJ Clinician's Guides, https://doi.org/10.1007/978-3-031-10224-0_5, ©Springer Nature Switzerland AG 2022. The second half of this chapter will be republished in an upcoming issue of the BDJ.

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  1. Public Health Wales, Cardiff, United Kingdom

    Rosalyn Davies

  2. Dental and Maxillofacial, Surrey and Sussex Healthcare NHS Trust, Surrey, United Kingdom

    Mili Doshi

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Correspondence to Mili Doshi.

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Davies, R., Doshi, M. Prevention of oral diseases for the older person (Part 1). Br Dent J 236, 35–41 (2024). https://doi.org/10.1038/s41415-023-6610-2

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