The importance of oral health in (frail) elderly people – a review

Abstract

Two important factors contribute to a higher chance of a deterioration of oral health status in frail and disabled elderly people. First, advances in oral health care and treatment have resulted in a reduced number of edentulous individuals and the proportion of adults who retain their teeth until late in life has increased substantially. Second, neglected self-care and/or professional care have led to reduced oral health care utilization. This review reports the consequences of having a poor oral health status and its impact on general health of frail elderly people and gives an overview of the important enabling and disabling factors regarding the provision of oral health care to frail older persons. Impaired cognitive and functional ability, medication-induced hyposalivation, reduced saliva buffer capacity and high saliva acidity, diabetes mellitus, the number of exposed root surfaces due to gingival recession, poor oral hygiene, high frequency of sugar consumption, and poor socio-economic conditions are the major predisposing conditions for the upsurge of caries in older population groups. Poor oral hygiene, tobacco smoking, and excessive alcohol consumption together with some systemic diseases, such as metabolic syndrome, rheumatoid arthritis, diabetes mellitus and post-menopausal osteoporosis are reported to be important risk factors for periodontal disease and later on peri-implantitis. Although during recent years increasing attention has been given to improving oral health care for frail old people, there is ample evidence showing that the oral health of elderly people, in particular of care home residents is (still) poor. The introduction of innovative care pathways to improve oral health care of elderly people by implementing new guidelines or health care models appears to be a complex process. Therefore, a poor oral health status might be regarded as a new geriatric giant in frail elderly people, which deserves urgent attention of scientists, health care providers and policymakers.