Solace Blog

Why we must support vulnerable older people to maintain good oral health

By Dr Sandra White, National lead for Dental Public Health, at Public Health England.

Poor oral health can impact on vulnerable older people in a number of ways. Painful teeth, missing teeth, sore gums or an inability to wear dentures can comprimise eating, sleeping and socialising. Commissioners, service providers and care givers can play an important role in helping the most vulnerable older people lead healthier and more satisfactory lives. This may involve something as simple as integrating mouth care and oral health improvement into existing commissioned services.

Public Health England (PHE) has published Commissioning better oral health for vulnerable older people, to support commissioners to improve the oral health of vulnerable older people in all settings. It explains the impact of oral diseases, the evidence on what works to improve their oral health and advice on how to commission appropriate services.

With people living for longer, it is important  to maintain good oral health into older age.

What do we mean by vulnerable older adults?

‘Vulnerable’ older  people are defined as those requiring special care support or protection due to age, disability, or risk of abuse or neglect.

People over 65  may have physical or mental impairment or illness which means maintaining oral and general health is difficult to achieve without support from carers.

Our toolkit focuses on groups for whom Adult Social Care departments in local authorities commission services. These include: 

•         residential and nursing home residents;

•         older people living with dementia;

•         frail older people; and

•         older people living with learning disabilities.

What are the challenges facing older people’s oral health?

We live in an increasingly ageing population with 11 million people aged over 65 in the UK, expected to rise to 14 million by 2032.

Although oral health in England has improved since the late 1960s, many older people  have many restorations such as fillings, crowns and dental implants – this is why they are sometimes referred to as the ‘heavy metal generation’.

A significant proportion of older adults are therefore likely to have complex dental treatment needs, which will increase over time. This creates challenges, such as a need to access appropriate dental care. This may include domiciliary care, or the need to be seen by specialist in special care dentistry.

Treating the mouth and the body

Research has shown a relationship between general health and oral health. There is evidence to show associations between oral health and diabetes, cardiovascular disease, respiratory disease and dementia.

For example, having good gum health may improve glycaemic control in people with type 2 diabetes. There are also studies suggesting a greater risk of developing tooth decay one year after being diagnosed with dementia.

Understanding these links between general and oral health, and providing the necessary support to maintain good oral health, are positive  steps towards supporting vulnerable older people.

What can we do to meet these challenges head on?

Local authorities are responsible for health and care following the introduction of the Health and Social Care Act 2012 and the Care Act 2014. This includes oral health.

As well as looking after the oral health of the general population, for example by introducing community water fluoridation, local authorities should target improving the oral health of vulnerable older adults.

Commissioning better oral health for vulnerable older people is supported by a rapid review of the evidence of what works. It suggests a number of interventions Adult Social Care departments can consider, such as higher fluoride toothpastes, oral hygiene regimes, and training programmes for staff and carers.

Alongside these, we have published a resource compendium for commissioners, providing links to useful resources such as the ten key questions to ask when assessing local oral health improvement for vulnerable older people. 

Dental public health consultants based at local PHE centres can provide local authorities with further advice and support where needed.

Our ambition

Our ambition is for vulnerable older people to be supported to maintain good oral health throughout life. With the right support, they have the opportunity to live fulfilling lives without experiencing the pain and health impacts associated with poor oral health.