The paradox of better subjective oral health in older age

We analyzed data from the 2004-06 Australian National Survey of Adult Oral Health to investigate the paradoxical relationship of better subjective oral health in older adults compared with young or middle-aged adults. In interviews with 14,092 adults, prevalence of problems with eating or appearance was not significantly associated with age among dentate people with no denture(s). In contrast, among dentate denture-wearers, prevalence ranged from 18.7% in ≥ 65-year-olds to 46.7% in 25- to 34-year-olds (p < 0.01). Dentate interviewees (n = 3,724) underwent oral epidemiological examinations and completed the 14-item Oral Health Impact Profile (OHIP-14) questionnaire, evaluating adverse impacts of oral conditions. In multivariable analysis, mean OHIP-14 scores were only weakly associated with age among people who had none of 5 clinical conditions [≥ 5 missing teeth, denture(s), untreated decay, moderate/severe periodontitis, toothache]. However, for people with ≥ 2 clinical conditions, there was a three-fold, inverse association between age and mean OHIP-14 scores (p < 0.01). The findings show that experience of oral disease is more deleterious to subjective oral health when it occurs early in adulthood than when it occurs in old age, a pattern that likely reflects high expectations of young generations and, conversely, great resilience in Australia's oldest generation.