Integrating Oral Health in General Health National Policy Frameworks for Older Adults: Scoping Review.

Background: Oral health is a critical component of overall health, particularly in older adults who face increased risks of oral and systemic diseases. Despite the preventability of many oral disorders, significant disparities exist, exacerbated by factors such as age, socioeconomic status, and access to care. Smoking and other lifestyle choices further complicate these health challenges. Methods: This review synthesizes current literature on the integration of oral health into general healthcare systems for elderly populations. A comprehensive analysis of studies from databases such as PubMed and Google Scholar was conducted, focusing on the roles of dental and nursing professionals in smoking cessation programs and their impact on oral and systemic health. Results: Findings indicate that incorporating oral health into general healthcare services significantly improves health outcomes for older adults. Dental practitioners are essential in advocating for smoking cessation, which can mitigate risks of periodontal disease and other systemic conditions. The review highlights various strategies for integration, including multidisciplinary cooperation, patient education, and addressing common risk factors. Conclusion: The integration of oral health into overall healthcare is vital for enhancing the health of older individuals. By addressing shared risk factors and fostering collaboration among healthcare providers, it is possible to reduce the prevalence of oral disorders and improve quality of life. Policymakers and health organizations must prioritize these strategies to ensure effective healthcare delivery for aging populations

The prevalence of oral diseases in the older adult population remains high worldwide and is expected to surge in the coming decade. The World Health Organization (WHO) has listed the oral health of older adults as one of its pivotal concerns. Oral health affects general health, and oral diseases increase mortality and morbidity in older adults. Integrating oral health into the general health service with a patient-centred approach can be an effective way to improve oral and systemic health for older adults simultaneously. This integration tackles the shared risk factors of both oral and noncommunicable diseases, aids in the early detection of systemic disease, strengthens health surveillance, enhances efficient data sharing, and allows for the better allocation of resources and the workforce in the healthcare system. However, the oral healthcare sector operates as an isolated field, with an emphasis on intervention rather than prevention, which presents a key challenge to the success of integration. Therefore, refocusing oral healthcare service on prevention is paramount. In addition, approaches taken in clinical practice implementation, interprofessional education and training, technology and innovation, research and evaluation, advocacy by national professional oral healthcare organizations, and policy making will ensure the efficient, effective, and long-term integration of oral and general health services. Integrating these services would foster the accessibility and affordability of oral healthcare services for older adults to improve their oral health and overall well-being in the coming decade. This review aims to discuss the merits and outline the challenges of integrating oral health into general health services for older adults and to propose the approaches that could be taken.

Background: The majority of the cost of oral health care in Australia is borne by individuals, hence many miss out on early, cost-effective care. 63,000 Australians are hospitalised annually for preventable oral conditions. Current approaches separate the provision of oral from general health care. Australia’s National Oral Health Plan recognises oral health as everyone’s business and a role for health care workers and carers to intervene early in oral disease.Objectives: To present an innovative approach to primary oral health care focussed on patient centred care, workforce reorientation, health promotion and prevention and the integration of oral and general health.Methods: North Richmond Community Health (NRCH), an inner urban community health service, in Victoria, Australia, through developing an innovative oral health program, has also developed a conference series Where the Mind Meets the Mouth WMMM (www.wheremindmeetsmouth.com.au) to inform the integration of oral health and general health. In 2015 the inaugural conference explored significant social determinants in oral and general health, such as substance use, mental illness and family violence. In 2016, the second conference, Putting the Mouth back into the Body, examined common risk factors for oral and general diseases, and working with other health professionals (eg. doctors, pharmacists, nurses).Results: WMMM has raised awareness amongst health professionals of the impact of oral health on general health and vice versa. A national research network committed to integration of oral and general health has been established, and a model of diabetes management that includes oral health has been proposed for trial. Conversations about Care, 2018, places the consumer at the centre of informing integrated health care provision.Conclusion: By responding to community needs, encouraging dialogue and sharing between consumers, health professionals and carers, we can truly collaborate in the delivery of primary preventive integrated health care, bringing the mind, body and mouth together.

Older adults with serious illness are particularly vulnerable to oral disease due to worsened overall health, progressive functional loss and polypharmacy. Meanwhile, inability to communicate oral health needs, increased functional disability and psychological distress also hamper timely oral health care and lead to prolonged suffering and compromised quality of life. While many seriously-ill older adults with poor oral health receive no oral health care prior to death, unnecessary treatment is also common. In response to these issues, a new oral health care model is proposed to better address the oral health needs of older adults with serious illness. This model aims to promote comfort, maintain oral function and improve quality of life. End-of-life oral health trajectories and stage-appropriate oral health care strategies are also introduced to guide the care of these vulnerable individuals.

Oral health is essential for the overall well-being of aging adults, yet significant disparities persist in the United States, contributing to malnutrition, reduced quality of life, and social isolation. Despite advancements in preventive dentistry, older adults continue to face substantial oral health challenges. This study reviewed the current state of oral health among aging adults in the United States, analyzing national health surveys and existing preventive dentistry protocols to assess their effectiveness. National data indicated that a high percentage of older adults experience tooth loss, periodontal disease, and root caries. Results indicated that almost 40% of adults aged 65 and older have lost a significant number of teeth, and a large proportion of the aging adult population has suffered from high rates of caries and periodontal disease. Socioeconomic factors were found to significantly influence access to dental care. Key barriers included low income, inadequate insurance, and low oral health literacy exacerbating disparities. The study proposes a multifaceted approach to improve oral health equity, including policy changes, community-based preventive programs, enhanced geriatric dentistry education, and the integration of oral health into primary care. Addressing these disparities is needed to improve both oral and overall health outcomes for the growing elderly population in the United States.

The high oral disease burden among children in South Africa, specifically early childhood caries, has received scant attention despite the fact that it is a public health concern that negatively impacts the overall well-being and quality of life of the child. While South Africa has a number of well documented policies that focus on oral health in general and maternal and prenatal health, none specifically addresses the oral health of children under the age of six years. The integration of oral health in maternal and child health care in South Africa could lead to an improved oral health quality of life and better oral health outcomes for mothers and children to address the high prevalence of childhood caries and unmet treatment needs for this population. While the integration of oral health care into primary healthcare is recognised as crucial and affordable, it however continues to be neglected. In South Africa, oral health disparities are attributed to the unequal distribution of oral health services, and policies that govern oral, maternal and child health seem to work in parallel with one another. Integrating oral health into interventions for primary health care delivery is a cost-effective way to improve the health of disadvantaged groups. Considering that maternal oral health predicts children's oral health and primary health care teams regularly see under-6-year-olds, this primary care setting is ideal for integration of these services. Despite growing interest in an integrated oral health and primary care system, there is little literature on oral health integration models. Improving the oral health of vulnerable populations requires integrating oral health into primary care and implementing interdisciplinary public health programs. The development of an Integrated Maternal and Child Oral Health policy would play a critical role in advancing integration; however, such a policy should be designed with both implementation and translation in mind for it to be successfully followed through. Such a policy should be comprehensive and contextual, aimed at increasing access to oral health services for women and children and reduce the oral disease burden. This paper proposes and describes the possible content and objectives of such a policy that will enhance effective leadership and accountability and strengthen health system delivery platforms for quality maternal and child oral health services along the continuum of healthcare. Furthermore, it will illustrate the importance of a policy that aims to promote coordinated, relevant, trans-multi-disciplinary and inter-sectoral community engagement to improve pregnancy and oral health outcomes, and importantly, establish a sustainable and contextual surveillance system for maternal and child oral health.

BackgroundThe siloed delivery of oral and medical health care in the United States has contributed to a lack of awareness of the consequences of poor oral health and has hampered effective interprofessional education and collaboration. The aim of this study was to assess the knowledge and practice behaviors of primary care medical providers in an urban safety-net hospital regarding collaboration with dentists and integration of oral health into overall health-care delivery.MethodsA 36-item survey was designed in a web-based platform (Survey Monkey®) and electronically distributed in September 2020 to 181 primary care medical providers (physicians, nurses, physician assistants) within a municipal hospital in the Bronx, New York. The questionnaire included sections on demographics, current practices, oral health knowledge, and opinions regarding interprofessional collaboration. Descriptive statistics and bivariate analyses using the chi-square and Fisher’s exact test were performed with a significance level of 0.05.ResultsThe response rate was 66% (119 respondents). The vast majority (80%) reported little or no training in oral health and 85% reported no team experience with oral health professionals. Medical providers’ confidence in examining the oral cavity was positively associated with previous additional training (p = 0.001) and with team experience (p = 0.005). The two most commonly reported barriers to willingness to collaborate were lack of formal relationships with dental providers (74%) and competing priorities (69%).ConclusionOverall, there is very limited awareness and integration of oral health into the clinical practice of medical providers at this safety-net hospital. However, those providers with previous training and team experience had greater oral health confidence. Given the critical importance of oral health to overall health, increased efforts should be directed to further educate and train medical providers and address barriers to interprofessional care.

Improving oral health of older adults for healthy ageing

ObjectiveThis scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care.MethodsGrounded in...

Valuing oral health: Accomplishments and challenges

Good oral health during the prenatal period translates into better oral and overall health for women and their infants. Although the importance of oral health during pregnancy is well established, oral health assessments are not routinely included in prenatal care visits. The purpose of this study was to explore prenatal care providers' practices regarding oral health assessments and identify reasons for the gap in oral health integration in prenatal care. Data were gathered from midwives in Virginia, United States. Information on midwives' knowledge about oral health, education, practices, and awareness of oral health guidelines and the pregnancy-related Medicaid dental benefit policy in Virginia was collected. An online survey was distributed to midwives practicing in Virginia through their state-level professional organization. The data were collected online, and descriptive data analyses were conducted. A total of 30 midwives (mean age 51.9 years) participated in the survey for an overall response rate of 13.6%. Among survey participants, knowledge of oral health was high (score of 4.69 out of 5). Nearly 20% of participants reported receiving no education about oral health during professional training, and 72.4% reported no receipt of continuing education about oral health in the past year. Although 86% of the participants reported discussing oral health in clinical practice, only 10.3% reported conducting oral health assessments. Awareness of Virginia's Medicaid dental benefit policy was high (75.9%), but less than half of the participants were aware of oral health guidelines (44.1%). Although many midwives did not conduct oral health assessments, 79.3% reported that they provided oral health referrals to pregnant patients. Enhancing and integrating education about oral health in the academic curriculum for midwives and providing them with opportunities for continuing education about oral health can improve their engagement with oral health. Sharing of evidence-based guidelines through organizational newsletters, meetings, and other venues can be ways to increase awareness of new guidelines and health coverage benefits among midwives.

BackgroundGood oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.MethodsA systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O’Malley’s scoping review framework.ResultsThe findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.ConclusionThere is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, White) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do White older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, whereas the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian, and White elders. More research on the ways oral health affects the lives of older adults is warranted.

BackgroundOral health conditions are common among people living with HIV, yet many have unmet needs for oral health care. In most low-income countries like Uganda, oral health is not yet integrated in the HIV care settings. We aimed to explore the stakeholder’s perspectives on oral health care integration in HIV care and research settings.MethodsWe conducted focused group discussions (FGDs) among people living with HIV (PLHIV) and semi-structured interviews among other key stakeholders that included policy makers, educators and practitioners in fields of HIV and oral health. The participants for both interviews and FGDs were selected purposively. The interviews and FGDs were audio-recorded, transcribed verbatim and analyzed using inductive thematic analysis approach in OpenCode software version 4.03.ResultsFour FGDs were conducted among 31 PLHIV, and interviews were conducted among 18 key stakeholders. The PLHIV acknowledged that oral manifestations are common and were associated with physical, psychological and social consequences which greatly affect their quality of life. They also reported facing stigma and discrimination in non-HIV settings where they seek oral care and advocated for the integration of oral health services in HIV care settings. The barriers to integration of oral health in HIV care identified by the key stakeholders included limited local research to inform policy, lack of clear policy on integration of oral health, inadequate trained health workers and limited resources to support research and integration of oral health services.ConclusionThe findings highlight the urgent need to integrate oral health services into HIV care settings in Uganda. Addressing policy gaps, stigma, inadequate training, and limited research through stakeholder collaboration and capacity building could enhance access to oral care and strengthen the overall quality of life for people living with HIV.

Oral diseases constitute a major public health burden globally and disproportionately affect rural populations due to socioeconomic deprivation, limited access to care, and inadequate integration of oral health within primary healthcare systems. Despite strong evidence linking oral health with systemic diseases and overall well-being, rural oral health remains marginalized in health policy and service delivery frameworks, particularly in low- and middle-income countries such as India. This review aims to comprehensively synthesize existing evidence on the burden, determinants, consequences, and health system challenges related to oral health in rural populations, while identifying research gaps and proposing evidence-based, policy-relevant strategies to reduce rural–urban oral health disparities. A narrative review was conducted using PubMed, Scopus, Web of Science, Google Scholar, and official databases of the World Health Organization and the Ministry of Health and Family Welfare, Government of India. Peer-reviewed articles, national surveys, and policy documents published between 2000 and 2024 were included. Study selection followed PRISMA guidelines, and findings were thematically synthesized. The literature consistently demonstrates a higher prevalence of untreated dental caries, periodontal disease, tooth loss, and oral cancer among rural populations compared to urban counterparts. Key determinants include poverty, low health literacy, workforce maldistribution, infrastructural deficits, cultural practices, and inadequate policy prioritization. Preventive services are limited, and oral healthcare utilization remains largely symptom driven. Rural oral health inequities reflect broader systemic failures in healthcare delivery. Addressing these challenges requires integration of oral health into primary healthcare, redistribution of the dental workforce, community-based prevention strategies, and sustained policy commitment to achieve universal health coverage and improved population health outcomes.