BACKGROUND:Root surface caries is an increasingly important public health concern as populations age and retain more natural teeth. Exposed root surfaces, periodontal attachment loss and social and behavioural factors interact to shape disease patterns. This study investigated root surface caries experience and its associated indicators among community-dwelling adults aged 65-74 years in Ghaziabad District, Uttar Pradesh. METHODS:A community-based cross-sectional study was conducted among 820 dentate participants selected using proportionate stratified random sampling. Data were collected using a pretested structured questionnaire and standardized clinical examinations following World Health Organization criteria. Root surface caries experience was quantified using the Root Caries Index (RCI). Sociodemographic characteristics, oral hygiene practices, tobacco use, and periodontal indicators were recorded. Associations were investigated using descriptive analyses and multivariable logistic regression. FINDINGS:Root surface caries was identified in 37.7% of participants. Prevalence was higher among males and among those aged 70-74 years. The prevalence of root surface caries was higher among participants with gingival recession, fewer remaining teeth, tobacco use, and lower socioeconomic position. In multivariable analysis, gingival recession and selected behavioural factors remained independently associated with root surface caries. CONCLUSIONS:A substantial burden of root surface caries was observed among older adults in this North Indian community. The findings highlight the close relationship between periodontal status, behavioural factors, and root surface caries, underscoring the need for integrated preventive and periodontal care strategies for ageing populations.
BACKGROUND:Preparing future dental professionals to care for an ageing population requires more than knowledge acquisition. While educational interventions may improve attitudes toward older adults, underlying forms of ageism may persist and influence clinical practice. OBJECTIVE:To assess self-reported attitudes and ageism among healthcare students, including dental students, following participation in a multidisciplinary training program focused on older adult care, and to explore the implications for geriatric dentistry education. METHODS:A cross-sectional study was conducted with 259 students (n = 93 students in Dentistry, 52 in Pharmacy, 87 in Nursing Sciences, and 27 in Sports and Physical Activity Sciences) at Université Paris Cité (2024-2025). The program combined theoretical courses, an online serious game, and role-play simulations. Self-reported attitudes toward older adults were assessed using the French version of the UCLA Geriatrics Attitudes Scale (UCLA-GAS-F), and ageism was measured using the Ambivalent Ageism Scale for Health Care (AAShc-F). Comparisons were performed using an ANOVA. RESULTS:The mean UCLA-GAS-F score was 47.6 ± 5.5, with 85.0% of students demonstrating positive attitudes toward older adults (scores higher than 42). The mean AAShc-F score was 52.8 ± 15.7. Notably, 37.5% and 19.7% of students exhibited high levels of benevolent and hostile ageism, respectively. No significant differences were observed according to discipline or exposure to the serious game. CONCLUSIONS:Despite generally positive attitudes toward older adults, substantial levels of benevolent ageism and hostile ageism persisted among health students. These findings suggest that simulation-based geriatric education alone may be insufficient to address implicit biases.
BACKGROUND:Denture stomatitis is a common oral mucosal lesion among older adults wearing removable prostheses. Its prevalence and associated risk factors, however, vary across populations. OBJECTIVE:To describe denture stomatitis and its associations with patient- and prosthesis-related factors among older adults wearing removable dentures in the United Arab Emirates. METHODS:280 patients wearing 492 removable dentures were examined in a specialty dental facility in Ras Al-Khaimah, United Arab Emirates. Clinical assessment of patients and dentures was performed by three prosthodontists. Patient-related variables included years of denture wear, vertical dimension of occlusion, salivary flow, diabetes and hypertension. Prosthetic-related variables included denture integrity, plaque and calculus deposits, use of reline materials or denture adhesives, denture tooth wear, and denture stability and retention. Statistical analysis used SPSS (version 29). RESULTS:Denture stomatitis was diagnosed in 42 participants (15%). Years of denture wear, reduced vertical dimension of occlusion, low salivary flow and all prosthesis-related variables were associated with denture stomatitis. Multivariate Poisson regression showed that longer years of denture wear were associated with a higher risk of denture stomatitis (PR = 1.09; 95% CI: 1.03-1.16), while adequate denture retention was associated with a lower risk (PR = 0.50; 95% CI: 0.25-0.99). CONCLUSION:Denture stomatitis was associated with longer denture wear duration and inadequate denture retention. Regular denture assessment and maintenance may help support oral mucosal health in older adults.
OBJECTIVE:To examine predisposing characteristics, enabling resources, need-related factors, and health behaviour or service-use indicators associated with unmet dental care needs among Korean adults aged ≥ 65 years, using Andersen's Behavioural Model of Health Services Use as an organizing framework. CURRENT KNOWLEDGE:Previous Korea National Health and Nutrition Examination Survey (KNHANES)-based studies have identified socioeconomic, geographic, and oral health-related correlates of unmet dental care needs among older adults. However, the joint contributions of these factors have received less attention within an explicitly theory-based framework of healthcare access. MATERIALS AND METHODS:This cross-sectional study analysed data from 1737 adults aged ≥ 65 years who participated in the 2023 Korea National Health and Nutrition Examination Survey. Unmet dental care needs were defined as reporting a need for dental care that was not received in the previous year. Weighted descriptive estimates, Rao-Scott adjusted tests, and complex-sample multivariable logistic regression were used. RESULTS:The weighted prevalence of unmet dental care needs was 23.2% (95% CI: 21.0-25.4). Rural residence (aOR = 1.43, 95% CI: 1.06-1.95), no oral examination in the past year (aOR = 2.70, 95% CI: 1.99-3.66), living alone (aOR = 1.54, 95% CI: 1.09-2.17), chewing difficulty (aOR = 2.19, 95% CI: 1.58-3.05), very poor self-rated oral health (aOR = 4.09 vs. very good, 95% CI: 1.47-8.81), and Medical Aid coverage (aOR = 2.80 vs. community-based insurance, 95% CI: 1.40-5.61) were associated with higher odds of unmet dental care needs. CONCLUSION:Unmet dental care needs remain common among Korean older adults and are associated with enabling resources, oral health needs, and preventive service use. Targeted rural outreach, care navigation for socially vulnerable older adults, and stronger linkage between preventive examinations and subsequent dental care may help address these multidimensional access barriers.
INTRODUCTION:Social capital is an important social determinant of health linked to oral health and health-related behaviours. Several studies assessed its association with dental service utilisation; however, findings remain inconsistent. This study aimed to examine the association between individual- and community-level social capital and dental service utilisation within the past 12 months among Japanese older adults. METHODS:This longitudinal study utilised self-report data from the Japan Gerontological Evaluation Study in 2019 and 2022. Individual-level civic participation, social cohesion, and reciprocity were assessed and aggregated to community-level using factor analysis. The outcome was dental service utilisation (preventive, treatment, and overall dental visits). Multilevel Poisson regression analysis was used to examine their associations. RESULTS:The mean age of 11,642 participants from 48 municipalities was 73.8 years (range: 65-95), and 51.4% were female. Participation in three or more civic groups was associated with 22%, 12%, and 16% higher likelihood of preventive (prevalence ratio [PR] = 1.22, 95% confidence interval [CI] = 1.15-1.30), treatment (PR = 1.12, 95% CI = 1.06-1.18), and overall visits (PR = 1.16, 95% CI = 1.10-1.22), respectively. Higher community-level civic participation was positively associated with preventive (PR for the highest tertile group = 1.20, 95% CI = 1.02-1.42), treatment (PR = 1.11, 95% CI = 1.02-1.21), and overall visits (PR = 1.13, 95% CI = 1.03-1.24). CONCLUSION:Individual- and community-level civic participation was positively associated with dental visits. Promoting civic participation could improve utilisation of dental care by older adults.
The recently proposed consensus frameworks for staging and grading in gerodontology represent an important advance toward multidimensional assessment of oral health in older adults. While staging characterises current oral health status by integrating disease burden, oral function, frailty, and care dependency, grading complements this approach by estimating future vulnerability based on oral, systemic, behavioural, and social determinants. Together, these frameworks provide a more comprehensive foundation for personalised, risk-informed geriatric oral healthcare. This correspondence discusses their complementary roles, highlights alignment with contemporary healthy ageing initiatives including the World Health Organisation's Integrated Care for Older People (ICOPE) framework and considers opportunities for integration into comprehensive geriatric assessment. We further discuss key implementation challenges related to clinical feasibility, interdisciplinary collaboration, and adaptation across diverse healthcare systems, particularly in low- and middle-income countries. Finally, we propose pragmatic implementation strategies, including tiered assessment pathways, to facilitate routine clinical adoption. Successful validation and implementation of these complementary frameworks have the potential to strengthen person-centred care, improve interdisciplinary communication, and advance equitable oral healthcare for ageing populations worldwide.
OBJECTIVES:To compare dental utilization and treatment patterns among LTCI recipients and non-recipients over the 5-year period following the expansion of national dental coverage in South Korea. METHODS:Using the National Health Insurance Service-Senior 2.0 database (2015-2019), we performed propensity score matching (1:3) to balance sociodemographic covariates between LTCI recipients (n = 170,407) and non-recipients (n = 486,788). Annual dental utilization rates, frequency of visits, and seven individual dental treatment types were compared using the compound annual growth rate (CAGR). RESULTS:Dental utilization rates increased in both groups, but a persistent gap of 17% remained (LTCI recipients: 29.5% vs. non-recipients: 46.9% in 2019). Both groups exhibited a shift towards more complex, higher-cost prosthetic treatments, as evidenced by a sharp decline in resin-based dentures and a corresponding increase in metal-based complete dentures and dental implants. However, the absolute utilization rate of dental implants in 2019 was 1.7 times higher in non-recipients than in LTCI recipients (14.4% vs. 8.3%, p < 0.001), indicating persistent disparities in access to complex dental care. Meanwhile, partial denture and extraction rates remained stable without significant differences between the groups. Notably, the continuous decline in endodontic treatments despite stable extraction rates among LTCI recipients suggests potential silent unmet needs. CONCLUSIONS:Despite expanded coverage, LTCI recipients face significant, persistent disparities in quantitative and qualitative dental accessibility. The lower utilization of complex care suggests the need for home-visit dental services and prevention-oriented fee structures tailored to the frail older adults within the community integrated care framework.
OBJECTIVE:This narrative review synthesizes current evidence on oral aging in older adults across three clinically relevant domains: mechanisms, assessment and clinical relevance for gerodontology. BACKGROUND:Older adults experience a disproportionate burden of oral disease, tooth loss, oral hypofunction and oral frailty. These conditions are often managed as isolated dental problems despite their interconnections with function, nutrition, quality of life and broader geriatric vulnerability. METHODS:This narrative review synthesizes current evidence on oral aging in older adults across three clinically relevant domains: biological mechanisms, assessment approaches and relevance to gerodontological care. RESULTS:Oral aging reflects interactions among oral dysbiosis, chronic periodontal inflammation, immune dysregulation, cellular senescence, impaired tissue repair and declining oral function. Emerging assessment approaches include salivary biomarkers, oral functional phenotyping, epigenetic clocks and multimodal computational methods; current evidence supports interpreting these measures as tissue-specific and complementary, rather than as direct substitutes for systemic measures. Relevant clinical strategies include periodontal care, prosthetic rehabilitation, oral functional exercise and integrated multidisciplinary care. CONCLUSIONS:Oral aging is a multidimensional construct linking biological change, functional decline and geriatric vulnerability. Future progress requires stronger validation of assessment tools, clinically meaningful functional endpoints and greater integration of oral health within aging care.
BACKGROUND:Periodontitis is a prevalent chronic inflammatory condition that frequently co-occurs with systemic chronic diseases. Although older adults experience a high burden of both periodontitis and chronic conditions, the extent to which age-specific evidence has been synthesised remains unclear. OBJECTIVES:To map and synthesise existing systematic reviews and meta-analyses examining associations between periodontitis and chronic conditions relevant to older adults and to identify evidence gaps related to age-specific analyses. METHOD:A scoping review and evidence gap map were conducted in accordance with Joanna Briggs Institute guidance and the PRISMA-ScR checklist. Seven electronic databases were searched, published between 2010 and 2024. Reviews examining associations between periodontitis and chronic conditions prevalent in older adults were included. Age focus and age-stratified analyses were extracted and mapped. RESULTS:Twenty-four studies were included. Across the studies included, periodontitis was generally reported to be associated with chronic conditions. Evidence specific to older adults was limited and mainly concentrated on cognitive impairment and dementia. Most systematic reviews included pooled general adult data without age stratification. Age-specific synthesis was largely absent for several chronic conditions and heterogeneity in disease definitions and sensitivity to confounding was common. CONCLUSION:Despite evidence suggesting associations between periodontitis and chronic conditions, age-specific evidence particularly for older adults remains limited.
BACKGROUND:Poor subjective masticatory function (SMF) and abnormal body mass index (BMI) have been shown to be associated with functional decline in later life. Oral dysfunction can precede weight loss and frailty, and BMI often shows a U-shaped association with disability. However, whether BMI is on the pathway from SMF to disability remains unclear. OBJECTIVES:To examine whether BMI mediates the association between poor SMF and incident functional disability. METHODS:We conducted a retrospective cohort study using the Shizuoka Kokuho Database of health checkups, medical claims and long-term care insurance data in Shizuoka Prefecture, Japan. Residents aged ≥ 65 years who attended health checkups, excluding those with prior long-term care certification, were eligible. SMF was assessed at the baseline checkup, BMI at the subsequent checkup and the outcome was new long-term care certification. Time-to-event mediation models estimated total, natural direct and natural indirect effects. Sensitivity analyses used BMI category transition as the mediator. RESULTS:Among 169,319 participants, 22.1% reported poor SMF. Poor SMF was associated with a higher risk of disability (hazard ratio [HR] 1.07; 95% confidence interval [CI] 1.03, 1.11). Low and high BMI were each associated with disability; only the low-BMI pathway contributed to mediation. The proportion mediated was 11.1% (95% CI 4.6, 46.4). Findings were consistent in sensitivity analyses using BMI transition. CONCLUSIONS:Poor SMF was associated with a higher risk of functional disability, partly accounted for by low BMI. Preventing low BMI among older adults with impaired mastication-together with oral-function care-may help to preserve independence.
OBJECTIVE:To explore how edentulous older adults and their family members experienced the use of complete removable dentures and to examine the meanings they attributed to this rehabilitation in relation to daily life, social participation and perceived quality of life. BACKGROUND:Complete removable dentures remain the most common treatment for complete edentulism in public services. Although previous research has extensively documented clinical performance and patient-reported outcomes, less is known about how older adults and their families experience denture use in everyday life. Understanding these experiential and relational dimensions is important for informing more patient-centred prosthetic care. METHODS:This interpretive qualitative study was conducted in a public primary healthcare centre in Santiago, Chile. Semi-structured interviews were undertaken with 50 edentulous adults aged 60 years or older who had received complete removable dentures, and with 36 family members involved in their everyday support. In addition, one focus group was conducted with a purposive subset of older adults to deepen themes identified in the interviews. Audio-recorded data were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS:Four interpretive themes were developed. Complete removable dentures were often experienced as a form of visible recovery, restoring appearance, confidence and ease of communication. At the same time, this recovery remained fragile when denture instability, particularly in the mandible, affected eating, speaking and social interaction. Many participants described daily adaptation through dietary restriction, vigilance and avoidance of potentially embarrassing situations. Family members played an important role by providing practical assistance, emotional support and help in managing meals, routines, and follow-up needs. CONCLUSIONS:For edentulous older adults, complete removable dentures were experienced as more than a technical replacement for missing teeth. While they often improved self-presentation and confidence, their functional limitations frequently sustained social and emotional burden. These findings support prosthetic care models that incorporate follow-up, family involvement and attention to psychosocial adaptation.
BACKGROUND:With the global rise in ageing populations, dental education must prepare students to care for older adults with empathy and competence. Ageism, defined as negative bias towards older individuals, can hinder quality care and meaningful dentist-patient relationships. OBJECTIVE:This study aimed to explore whether documenting and narrating oral health-related life experiences of older adults could promote positive intergenerational attitudes and enhance empathy among dental students. METHODS:A reflective qualitative study was conducted among 3rd-year dental students enrolled in a Social and Behavioural Sciences module. A subgroup of students participated in an enhanced learning session that involved biographical interviews with older adults, focusing on their oral health journeys and related life stories. Students documented these narratives and produced reflective essays. Thematic analysis of the essays was performed to identify key domains of learning and professional development. RESULTS:Engagement with older adults' life stories fostered greater understanding of the psychosocial dimensions of ageing and oral health. Thematic analysis revealed enhanced empathy, improved communication skills and increased cultural sensitivity. Students recognized the importance of preparation, clear communication and digital tools for engagement. They also identified barriers such as financial constraints and access inequalities, demonstrating growing social awareness for older patients. CONCLUSION:Documenting and reflecting on oral health-related life experiences provided dental students with meaningful intergenerational learning opportunities that strengthened empathy, cultural sensitivity and readiness for geriatric dental care. Narrative-based reflection represents a valuable pedagogical tool to reduce ageist perceptions and promote inclusive care within dental education.
BACKGROUND:Population ageing has increased the number of frail older adults living independently and retaining their natural dentition. To support oral healthcare professionals in caring for this patient group, the Royal Dutch Dental Association published the practice guideline Care for Frail Older Adults in the Dental Practice. However, little is known about how oral healthcare is currently provided in daily practice. OBJECTIVE:To explore general dental practitioners' (GDPs) experiences in providing oral healthcare to community-dwelling frail older adults, and to examine whether they were familiar with the practice guideline. METHODS:A qualitative study was conducted using semi-structured interviews with 11 GDPs between June and November 2024. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS:Oral healthcare for frail older adults required additional attention, effort and coordination from GDPs and the entire dental team. GDPs emphasised the importance of long-term patient relationships, continuity of care, and the role of the dental team in prevention and early detection of decline. Barriers included time constraints, limited opportunities for referral and limited collaboration within primary care. Few GDPs provided home visits due to time or logistical constraints. Most GDPs were unfamiliar with the guideline. CONCLUSION:Providing oral healthcare to frail older adults requires additional effort and coordination within the dental team, and attention to interprofessional collaboration. While GDPs strive to deliver patient-centred and preventive care, practical, organisational and guideline-related barriers remain. These findings underscore opportunities for professional bodies and policymakers to support guideline dissemination, facilitate interprofessional collaboration, and ensure care for this vulnerable patient group.
OBJECTIVE:To explore community-dwelling older adults' expectations and perceptions of future needs and requests concerning assisted oral care from healthcare professionals in event of greater need for care. BACKGROUND:Older adults with care needs often require support with oral care from care professionals, yet cognitive impairments may hinder their ability to express needs and preferences. MATERIALS AND METHODS:A qualitative study with an inductive approach and purposive sample was conducted. Eighteen community-dwelling older adults (≥ 65 years) receiving municipal home healthcare or home help services in southwest Sweden were interviewed individually. Information on oral health, oral care and anticipated future need for assisted oral care was gathered. Interviews were audio-recorded, transcribed verbatim, and analysed using qualitative content analysis. Ethical approval was obtained, and the study adhered to the COREQ checklist. RESULTS:The analysis generated an overall theme: 'Tensions between thoughts, envisioned standards and anticipated practicalities in future assisted oral care' and three subthemes 'Oral self-care is the last stronghold of independence, with staff support considered under specific conditions', 'Sensitive dialogue enables access to assisted oral care' and 'Tough but necessary to accept assisted oral care'. CONCLUSION:There are tensions in community-dwelling older adults' expectations of assisted oral care. A desire for independence and delayed assistance contrasts with the need for early communication before health decline impairs decision-making to ensure autonomy and person-centred care.
INTRODUCTION:Implementation of oral health assessment tools in residential care for older adults remains challenging. We aimed to establish the content validity and practice relevance of the Mouth-related Risk Assessment for Professional Nursing (Mu-RAP), a nursing-applied instrument designed to identify oral health risks in care-dependent older adults. METHODS:This sequential, two-panel Delphi study (with two rounds per panel) was conducted between May 2025 and February 2026. In Phase 1, a dentist panel of gerodontology experts (Round 1: n = 26; Round 2: n = 27) evaluated conceptual completeness and item relevance (numeric rating scales, qualitative feedback). In Phase 2, a heterogeneous nursing panel (Round 1: n = 66; Round 2: n = 35) assessed item relevance, clarity and feasibility for routine care (Likert-type scales, structured comments). Consensus thresholds were predefined (dentist panel ≥ 60% agreement; nursing panel ≥ 75%). RESULTS:Agreement for the refined 13-item instrument was high across both panels. In the first nursing round, 12 of 13 items reached the predefined relevance threshold. Two items were rephrased and achieved strong agreement in Round 2 (91.4% and 85.7%). Feasibility was rated as high (median usability rating 9/10) and 93.9% of participants would integrate Mu-RAP into routine care. CONCLUSION:The Mu-RAP achieved strong interprofessional consensus on its content validity, clarity and practical applicability. It may provide a framework for early identification of oral health risks in care-dependent older adults.
Introduction Comprehensively, systematically and reproducibly assessing and describing the (oral) health status and care needs of older adults is challenging. We aimed to provide a framework for evaluating and reporting older adults' oral health, capturing general and oral function and disease, as well as oral, systemic and socio-economic/social risk factors determining oral care complexity and capability, care needs and levels, and clinical management, including prevention, active and supportive therapy, as well as informing education, research, surveillance and health services. The present paper describes the first aspect, staging of oral health in this population.Methods Eight reviews were conducted to identify risk factors for deterioration of oral health in older adults; existing systematic reviews were further considered during the framework development. A 2.5-day workshop with 31 international researchers and stakeholders was held and a structured consensus process implemented to come to an agreed, internationally applicable framework. A 75% level of agreement was achieved after two rounds of voting.Results A case definition based on staging and grading, reflecting the current general and oral health and function, care complexity, and the risk of deterioration of oral health due to local, systemic, and socio-economic and social factors, was developed. Staging includes person-level (based on clinical frailty), function-level (based on clinical and subjective evaluations reflecting oral function, such as tooth loss and oral impacts), and disease-level (including caries, periodontal disease, and oral mucosa assessments) domains.Conclusion Oral health staging in older adults can allow clinicians, carers, and policymakers to systematically and comprehensively define and classify patient cases in order to derive appropriate and adequate care. Staging should be used in combination with grading, and both may allow capturing the overall health status and care needs of older patients for health surveillance, research, and education purposes. Next steps will include validation, dissemination, and implementation of the framework.
BACKGROUND:Older adults in nursing homes experience complex oral health needs, yet oral care is often under-prioritised in long-term care settings. In Malaysia, evidence examining oral health practices within nursing homes remains limited, particularly in relation to daily oral care and service delivery. OBJECTIVE:To explore oral health challenges and coping strategies among older residents and caregivers in Malaysian nursing homes and to identify system-level factors influencing daily oral care. METHODS:A qualitative study was conducted using in-depth interviews with 10 residents and five focus group discussions, together with one individual interview, involving a total of 21 caregivers across six nursing homes (five private and one government) in Selangor. Data were analysed using reflexive thematic analysis following Braun and Clarke's approach. Trustworthiness was enhanced through triangulation of resident and caregiver data, peer debriefing and cross-checking transcripts against field notes. RESULTS:Five themes described oral health experiences in nursing homes. Residents reported challenges related to functional decline, denture discomfort and mild cognitive limitations. Structural and institutional barriers constrained access to oral care and dental services. Caregivers played a critical role in maintaining daily oral care but encountered challenges related to limited training, workload pressures and behavioural resistance, which may compromise residents' quality of life. Both residents and caregivers adopted adaptive coping strategies, while support from families, facilities and structured training acted as key facilitators. CONCLUSION:Oral health in Malaysian nursing homes is shaped by the interaction of resident capacity, caregiver preparedness and institutional context. Strengthening caregiver training, ensuring consistent oral care resources and integrating routine dental services into long-term care are critical to improving oral health outcomes for residents.
