Geriatric dentistry and prevention: research and public policy (reaction paper)

The population of older adults is heterogeneous and can be divided into many subgroups: the young-old, the old-old, the healthy, the sick, the frail, the mentally and physically handicapped, the ambulatory, the chair-bound, house-bound or institution-bound, and the economically advantaged and disadvantaged. This diversity is extremely important to the discussion of the oral health needs, preventive health strategies, and research agenda for the elderly. As life expectancy increases, more attention is being paid to disease prevention so that the quality of life in old age can be improved. However, the link among oral health, systemic disease, and quality of life in the elderly needs to be better-defined. There is some evidence in the literature that indicates that coronal and root caries appear to be major health problems for the elderly. This needs to be corroborated in longitudinal studies. Although periodontal disease prevalence and severity are high in some subgroups of the elderly, these appear to be in decline in the general population. Dental health-care workers must be cognizant of the oral conditions associated with systemic disease and the use of medication, a major concern in older adults. Prevention of oral disease in the elderly requires early intervention, education of the dental health team, and innovative uses of well-established preventive agents such as fluoride. An extensive research effort is needed to answer basic and applied questions regarding the oral health needs of the elderly. Federal and private funding will be necessary. The dental profession will have to demonstrate and be persuasive that money spent on research and care for the elderly is money well spent.