Bulletin of the World Health Organization

More oral health care needed for ageing populations

Millions of elderly people across the globe are not getting the oral health care they need because governments are not aware enough of the problem. By 2025, there will about 1200 million people aged 65 years according to UN estimates. Failure to address oral health needs today could develop into a costly problem tomorrow.

IN FOCUS - Feature from the Bulletin
1 September 2005

Many elderly people worldwide do not have a full set of teeth.
PAHO
Many elderly people worldwide do not have a full set of teeth.

Berta Diaz has a wide grin. What she lacks is a toothy smile. Like most elderly adults worldwide, she has lost most of her teeth.

“When they were bad, they just got pulled,” said the 70-year-old patient after getting her new prostheses fitted in Dr Hugo Zamora’s dental practice in Mexico City.

Diaz is one of the 60–70% of Mexicans aged over 65 with few or no teeth. Although the poor are more vulnerable to this and other problems, the oral health problems of the elderly cross class lines. Low awareness, lack of access to oral health services and the misconception that older people will not benefit from health education and preventive measures such as fluoridation, conspire to deprive the elderly of crucial care.

Oral disease is the fourth most expensive ailment to treat in most industrialized countries, according to WHO’s World oral health report 2003. “Unless we take action today, many countries will not be able to pay for treatment programmes,” said Dr Poul Erik Petersen, head of WHO’s Oral Health Programme, with regard to the oral health needs of the elderly.

The burden of oral disease is likely to grow in many developing countries because of unhealthy diets rich in sugars and high consumption of tobacco, Petersen said. Industrialized countries spend 5–10% of their national public health resources on dental care a year, but most developing countries allocate no budget at all to the control of oral disease.

“In many developing countries, the only treatment is tooth extraction in case of pain and problems with teeth,” said Petersen. “Millions of older people ... will suffer tooth loss. Eventually they will be without natural teeth.”

As with other health issues, older people have very different oral health needs to children and younger adults. They are more likely to take medication that causes dry mouth, leading to tooth decay and infections of the mouth. More than 400 commonly used medications — many of them for chronic conditions to which the elderly are susceptible — can dry out the mouth.

Oral cancer is another danger that can strike after years of over-consumption of tobacco and alcohol. The incidence of this cancer is rising in places with growing or high tobacco use, Petersen said, call¬ing the burden of oral cancer a “major challenge to many countries”.

Mexico’s situation is typical of that worldwide. Dr Ernesto Acuña, who specializes in geriatric dentistry in Mexico City, agreed that it is common to yank a tooth that aches or is loose. People start losing teeth as early as their 40s, he told the Bulletin.

The main causes of tooth loss — gum disease and untreated cavities — are rampant in Mexico. Acuña believes that 90% of the Mexican population has untreated cavities, and Mexico’s health ministry says that the country’s six million people over age 65 have on average 18 missing or damaged teeth out of 32.

In many cases, ill-fitting dentures can reduce a person’s quality of life, for example by impeding their ability to chew. This is what happened to Diaz. Diagnosed with diabetes 15 years ago, she eventually got gum disease, a common result. Today she has no natural teeth on top and only four below.

In Mexico, as in the rest of the world, the lower a person’s socioeconomic status the more likely that no preventive measures will be taken. An unfounded belief by families and health-care practitioners that tooth loss is inevitable during ageing, lack of education on the importance of oral health and components of dental care, poor access to services and a low dentist-to-population ratio complete the picture.

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“Unless we take action today, many countries will not be able to pay for treatment programmes.” Dr Poul Erik Petersen, head of WHO’s Oral Health Programme.