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Original Article

Oral care needs, barriers and challenges among elderly in

India
Ramesh Bharti, Anil Chandra, Aseem Prakash Tikku, Deeksha Arya1, Richa Gupta
Departments of Conservative Dentistry and Endodontics and 1Prosthodontics and Dental Material Sciences, Faculty of Dental Sciences,
King George’s Medical University, Lucknow, Uttar Pradesh, India

Objective: This paper presents an approach to the assessment of oral health needs of elderly and barriers
Abstract to receive oral care in the life course.
Background: The dental needs of the elderly are changing and growing day by day. The management of older
patients requires not only an understanding of the medical and dental aspects of ageing but also provide them
good oral health service. In the life course of elderly there are many hurdles to receive proper oral care. The
use of an assessment of oral health need will be essential in the development of care pathways to the elderly.
Methods: The proportion of older people is growing faster than that of any other age group. There is no
sound database regarding the oral disease burden and treatment needs of the elderly in India. Physical and
biological barriers with age can also affect oral health care either directly or indirectly.
Conclusion: Oral care guidelines designed to assist elderly should consider not only prevention and
treatment modalities but also the means of implementing such therapies in varying settings and utilizing
the whole dental team.

Key Words: Barrier in care of elderly, elderly patients, geriatric patients, oral health needs

Address for correspondence:

Dr. Deeksha Arya, Flat No. 805, Doctor’s Flat, T.G. Hostel Campus, Khadra, Sitapur Road, Lucknow ‑ 226 003, Uttar Pradesh, India.
E‑mail: [email protected]
Received: 23rd March, 2015, Accepted: 24th March, 2015

INTRODUCTION around 100 million elderly at present, and the number is

expected to increase to 323 million, constituting 20% of the
India occupies 2.4% of the world’s land area and supports total population, by 2050.[2]
over 17.5% of the world’s population. The demographics of
India are inclusive of the second most populous country in the The rapid greying of the population comes with a number of
world, with over 1.21 billion people (2011 census), more than difficulties in terms of general and oral health.[3,4] A continuing
a sixth of the world’s population.[1] progress in the medical field has raised the longevity of life. This
changing face of population offers the oral professionals to
With the population growth rate at 1.58%, India is predicted observe unique challenges to treat the rapidly growing segment
to have >1.53 billion people by the end of 2030. India has of the elderly and the dependent overage population – the
homebound residents and the nursing homebound residents.
Access this article online
The old age of the residents is compounded with chronic
Quick Response Code:
Website: medical problems they are suffering from and the medications
www.j-ips.org they are taking.[5]

DOI: The dental needs of the elderly are changing and growing.
10.4103/0972-4052.155044 The management of older patients requires not only an
understanding of the medical and dental aspects of ageing,

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Bharti, et al.: Oral care needs, barriers and challenges

but also many other factors such as ambulation, independent Americans who would have liked to visit a dentist during the
living, socialization, and sensory function.[6] previous year, almost 50% gave their age as a reason but the
inference was that decreased mobility was a factor influencing
Recent surveys[7] indicate that older dentate people utilize many although only 20% identified transport problems as a
dental services less than any other dentate age group. Patient barrier to receipt of care. Similar values were reported by Kail
utilization of dental services is predominantly a consequence and Silver.[19]
of patient‑perceived need for such treatment and therefore
perceived need has been considered to be an accurate predictor Fear
of utilization of dental services.[8‑10] According to Todd and Ladder[7] most people experience some
apprehension at the prospect of a dental visit, and others have
Although there is evidence to suggest that attitudes toward identified fear as a real barrier to the receipt of care in older
and perception of dental care are influenced by former dental people.[13,20] Further, Locker et al.[21] stated that the greater the
experiences,[11] this factor is unlikely to be the sole cause for level of anxiety, the lower the rate of utilization of services.
the large difference between perceived and normative needs The basis of such fear is difficult to quantify and a qualitative
for dental care.[12,13] study of adults between 16 and 59 years demonstrated that
some had an indefinable generalized fear of things, some
Age had specific fear to, for example “the drill” or “needles” or
Ettinger and Beck undertook an impressive study of 2000 fear of a repeat of a painful visit or of reprimand from the
subjects, who were living independently and identified four age dentist. Locker et al.[21] demonstrated that significantly more
groups; 18–60 years, 60–64 years (the new elderly), 65–74 edentulous patients identified fear as a barrier than did their
(the transition group) and >75 age group (the old elderly). It dentate counterparts. This may have been the consequence
was reported that the two younger groups had similar attitudes of considerably more exposure to exodontias and its inherent
toward dentistry and that the new elderly had significantly more implications, or it may point to an underlying fear of dentistry
favorable attitudes toward dental care than the old elderly.[11] which precluded regular (restorative) dental care.
Socioeconomic status CARER RELATED BARRIERS
Townsend et al.[14] demonstrated that utilization of preventive
health care is highest among higher social classes. A facile If holistic care of older patients is to be practiced, then
explanation might be that more affluent patients are able awareness of dental care must be present among careers of our
to overcome any financial barrier to dental care.[15] Kiyak[16] elderly population. The onus of providing dental education
has suggested that the higher social classes tend to be better for careers is they medical practitioners, registered nurses or
educated and are potentially more likely to be familiar with well‑meaning relatives rests on the dental profession. Studies
and to adopt favorable attitudes toward the maintenance of in England have highlighted deficiencies in knowledge of basic
oral health. oral hygiene among all of these careers.[22]

OTHER BARRIERS TO RECEIPT OF CARE DENTIST RELATED BARRIERS

Patient related barriers Age

Cost has been stated to be a barrier in some studies of the Patient age has been demonstrated to affect treatment planning
receipt of care by older people who were functionally disabled in that although missing teeth were scheduled to be restored,
or attended with a functionally‑disabled partner. Most of these 42% of younger age groups were prescribed fixed prosthesis,
elderly people, it was reported, existed on lowly pensions. Studies while only 17% of older age groups were prescribed this option,
have identified variability between different groups with some the majority being recommended removable prosthesis.[23]
researchers reporting only 1.5–3% of subjects in the community
identifying cost as a barrier. In contrast Hoad‑Reddick et al. The determinant toward treatment is the attitude of a
reported cost as a barrier in 29% of those elderly living alone in dentist;[16] some dentists who hold a negative stereotype of
the community, and approximately 10% for those living in the the elderly are more likely to provide rudimentary treatment
community (but with assistance) or those in residential homes.[13] options than dentists with positive stereotypes, although the
nature of stereotype is complex.[24] Previous dental attendance
Access to dental services may present a barrier as a result patterns have been reported to influence treatment options[25,26]
of physical incapacity or disability, travel problems, lack of although it is uncertain if objectivity is possible or desirable
knowledge of dental services or lack of dental services in for many irregularly‑attending patients who wish merely to be
given area.[17] Anzack and Branch[18] reported that among older relieved of pain.

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Bharti, et al.: Oral care needs, barriers and challenges

Poor confidence ‑ Several studies have demonstrated that a In addition to self‑care and professional care, environmental
significant number of dentists feel some diffidence in the factors also have an impact on the prevention of oral disease in
treatment of older patients, for a variety of reasons including elders. Recent studies have shown that root caries and coronal
lack of knowledge about gerontology, including drug caries rates are lower for life‑long residents of fluoridated
interactions.[27‑29] communities as compared with nonfluoridated communities;
there is also benefit for older adults who began exposure to
Access and venues ‑ Are also perceived to be determinants fluoridated water in adulthood.[38,39]
toward provision of care for elderly. Patients with problems
of mobility, for example, are less likely to visit dental clinics RESTORATIVE MANAGEMENT FOR ELDERLY
where stairs have to be climbed.
The selection of restorative techniques in older adults is
Financial ‑ An additional dental‑related factor relates to more or less similar to that in younger population. However,
remuneration and the consensus view of several studies permissible direct plastic restorative materials are preferred in
suggests that fees for treatment on a domiciliary basis are the former as these restorations can be readily and inexpensively
insufficient to encourage dentists to perform more domiciliary repaired or replaced. Owing to the presence of several risk
treatment.[20,27,30] factors, caries activity is quite high and, therefore, requires
frequent maintenance which might not be easily done in an
The World Health Organization discussion paper on health and indirect restoration.[40,41]
aging indicated, “we can afford to get old if countries, regions
and international organizations enact “active ageing” policies “Smile has no age bar.” Most of the elderly lead an independent
and programmers that enhance the health, independence, and social life and are, therefore, conscious about their appearance.
productivity of older women and men.” The time to plan and The esthetic treatment for elderly could range from simple
to act is now.[31‑33] recontouring procedures to bleaching, laminates and crowns.
Any major esthetic rehabilitation should be undertaken only
COMMON ORAL PROBLEMS IN THE ELDERLY after proper occlusal and esthetic analysis to achieve predictable
results.
Preventive dentistry must be concerned with the three
levels of prevention in the adults, which are not fully Successful endodontic can be achieved for the elderly, if
edentulous: proper attention is given to the diagnosis, good quality
• Prevent the initiation of disease radiographs and adapting techniques that overcome the
• Prevent progression and recurrence[34] challenges posed by calcification of the root canal system.
• Prevent loss of function and loss of life.[35] As long as the tooth has a strategically important role to
play, endodontic therapy is indicated and justified in any
Recommended oral self‑care consists of tooth‑brushing twice patient.
daily, use of fluoride toothpaste, daily interdental cleaning,
and avoidance of sugar.[6] Regardless of dentate status, it is PERIODONTAL TREATMENT FOR ELDERLY
recommended that the elderly make dental visits at least every
6 months for clinical reevaluation, depending upon their ability Conservative, nonsurgical treatment may be the best therapeutic
to perform oral hygiene.[36] option for the major portion of older adults who require
periodontal therapy.
Many older adults have difficulty achieving effective daily
plaque control. Various bristle and handle designs are available In those individuals for whom initial therapy alone is inadequate
in either manual or powered (electric or sonic) brushes for such to resolve the periodontal problem, surgical intervention is
patients. For patients with difficulty holding a toothbrush indicated. This decision should be made only after considering
because of arthritis or stroke, devices are available to facilitate the many circumstances that may override the decision to
brushing. Wider floss, Teflon‑coated floss, floss holders, intervene surgically. Surgical treatment may consist of simple
proximal brushes and even electric flosses are available. gingivectomy where there is ample attached gingiva or may
involve a flap procedure such as modified Widman or apical
Those with reduced ability to perform oral self‑care should repositioning.[42]
be seen more frequently for prophylaxis. Since denture‑related
and other oral mucosa lesions are common in the elderly, Surgical techniques are also performed to achieve crown
edentulous patients should be periodically evaluated by dental lengthening, which may be necessary in the elderly patient
professionals.[37] who is prone to root caries and fractured teeth at or below the

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Bharti, et al.: Oral care needs, barriers and challenges

gingiva. Dental implants may be a viable option for restoring • Ability to diagnose treatment needs of aging patients
the debilitated dentition in certain elderly individuals. • Ability to perform specialized procedures (especially
prosthodontic treatment)
PROSTHODONTIC MANAGEMENT OF ELDERLY • Management of the elderly.
PATIENTS
Attitudes
The main aim of success of prosthodontic treatment is to • Empathy/understanding
maintain the teeth. If the remaining teeth have a poor prognosis, • Caring/compassion
then they can be planned for overdenture abutment. Where • Positive attitude toward, and enjoyment of, older patients
complete dentures are provided, these can be retained using • Respect for the elderly patient
dental implants to overcome many of the problems associated • Flexibility in treatment planning (keeping planning
with conventional replacement dentures. realistic).
HOW CAN WE EFFECTIVELY APPROACH
GERIATRIC POPULATION? Geriatric dental education programs must address each of
these categories and must be made available to all professionals
Enhancing the dental office environment for the elderly and paraprofessionals providing oral health services directly or
Delivery of health care services to the elderly in a community indirectly. Programs developed to prepare dental professionals
setting requires accessible buildings and an environment that to treat the geriatric patient must address the entire spectrum
can be negotiated with safety. Dental office reception room of “health and well‑being.”
is intended to be comfortable and inviting space for geriatric
patients. In order to allow individuals with walkers or canes MEDIA
to negotiate in safety, there must be a clear path of at least
28 inches wide in the room and through doorways. Tiles or Educational newsletters and material should be circulated.
wood floors should have a nonskid surface and be free of A number of business and appointment cards and brochures
scatter rugs.[43] Firm, standard height chairs with arms should could be printed in extra‑large type. Large‑print leisure and
be used for support. Adequate lighting should be provided in educational material should be available in the reception
each room to minimize any visual disorientation or mental room. Articles on geriatric dentistry could be placed in seniors’
confusion.[44] A portable audio amplifier with headset can magazines and newspapers, and informative talks given to
help the dental professional communicate with the very hard community groups to demonstrate a willingness and ability
of hearing patients. Large type magazines, newspapers, health to treat medically compromised clients.[46]
education brochures and patient information sheets will be COMMUNICATION
appreciated by the older patients.[43]
An important element in effectively developing an awareness
Geriatric dental education
of oral prevention is communication skills. Communication
It is of utmost importance for dental surgeons to be well
with the older adult can be a rewarding, enriching experience
trained, understanding and compassionate, and to be aware of
especially when certain principles of adult learning are
the special needs of the elderly population. Kress and Vidmar
used. Communication is a two‑way process. Many times
surveyed 50 experts in geriatric dentistry to determine the
questions of a patient’s history, family, or likes/dislikes
30 major areas of competence for a geriatric dentist. The top
are appreciated. Being a patient listener is a critical skill to
five categories in each domain were listed.[45]
develop for communicating with any individual regardless
Knowledge of age‑and can be particularly important in dealing with
• Psychology and sociology of aging the oral adult.
• Disease of aging
• Pharmacology and drug interaction Remember the patient is a person first and a patient second.
• Biology and physiology of aging Individuality should be explored and nurtured. In that
• General medicine/systemic diseases. way, treatment can be more easily customized. Inquiring
about past hobbies or areas of interest can open the door
Skills for the older adult to share part of his or her life. Though
• Ability to communicate with elderly patients and other difficult to always remember, effort must be made to
providers realize‑especially with the frail‑they have not always been
• Ability to adapt treatment plans for the elderly as they appear now.[34]

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Bharti, et al.: Oral care needs, barriers and challenges

EQUIPMENT Gerodontology 2012;29:e1‑5.

7. Todd JE, Lader DA. Adult Dental Health 1988. United Kingdom, London:
HMSO; 1991.
Portable dental equipment can be used to service the
8. Branch LG, Antczak AA, Stason WB. Toward understanding the use of
functionally dependent elderly at home or in nursing homes. dental services by the elderly. Spec Care Dentist 1986;6:38‑41.
This equipment varies from a domiciliary valise to a portable 9. Brodeur JM, Demers M, Simard P, Kandelman D. Need perception as
dental office, neither housed in a van nor set up in an available a major determinant of dental health care utilization among the elderly.
Gerodontics 1988;4:259‑64.
room in a nursing home.[46] 10. Evashwick C, Conrad D, Lee F. Factors related to utilization of dental
services by the elderly. Am J Public Health 1982;72:1129‑35.
GOVERNMENT POLICIES 11. Ettinger RL, Beck JD. The new elderly: What can the dental profession
expect? Spec Care Dentist 1982;2:62‑9.
It is obvious that oral health care is not a priority in our 12. Kay DW. Ageing of the population: Measuring the need for care. Age Ageing
health care system. Governments are struggling to keep up 1989;18:73‑6.
13. Hoad‑Reddick G, Grant AA, Griffiths CS. The dental health of an elderly
with spiraling health costs and growing demand.[47] Public population in North‑west England: Results of a survey undertaken in the
policy options to support geriatric oral health care, and Halton Health Authority. J Dent 1987;15:139‑46.
research are limited by the government’s preoccupation 14. Townsend P, Davidson N, Whitehead M. Inequalities in Health. London:
Penguin Books; 1990.
with cost containment and the lack of visibility for dental
15. Kandelman D, Lepage Y. Demographic, social and cultural factors
programs.[48] influencing the elderly to seek dental treatment. Int Dent J 1982;32:360‑70.
16. Kiyak H A. Impact of patients and dentists attitudes on older persons use
It is, therefore, incumbent on us, as dental health care of dental services. Gerodontics 1988;4:331-5.
professionals, to deal with this need and provide access to care 17. McCord JF, Wilson MC. Social problems in geriatric dentistry: An overview.
Gerodontology 1994;11:63‑6.
for elderly patients.[47] 18. Antczak AA, Branch LG. Perceived barriers to the use of dental services
by the elderly. Gerodontics 1985;1:194‑8.
The dental management of geriatric population is an 19. Kail BI, Silver MM. Dental demands of elderly people living at home in
increasingly important aspect of dental practice because these Hertfordshire. Br Dent J 1984;157:94‑7.
20. Fiske J, Gelbier S, Watson RM. Barriers to dental care in an elderly
patients have high incidence of medical problem, the dentist population resident in an inner city area. J Dent 1990;18:236‑42.
must be capable of detecting these diseases and understanding 21. Locker D, Liddell A, Burman D. Dental fear and anxiety in an older adult
their relationship to dental treatment. population. Community Dent Oral Epidemiol 1991;19:120‑4.
22. McCord JF, Connolly M, Whittle G, Wilson MA. Determination of dental
education experienced by medical students and general medical
Risk factors for oral diseases in the elderly can be reduced practitioners. J Inst Health Educ 1993;31:149‑57.
by personal home‑care regimens, professionally provided 23. Braun RJ, Marcus M. Comparing treatment decisions for elderly and young
preventive, diagnostic, and therapeutic care, changes in high‑risk dental patients. Gerodontics 1985;1:138‑42.
behavior, and a supportive environment.[48] 24. Hamilton FA, Sarll DW, Grant AA, Worthington HV. Dental care for elderly
people by general dental practitioners. Br Dent J 1990;168:108‑12.
25. Tuominen R, Ranta K, Paunio I. Items of dental care received by adult
Apart from a good oral physician, this age group requires a good dentate and edentulous populations. Community Dent Health 1988;5:39‑47.
human being and a trustworthy friend, and we should play the 26. Kay EJ, Blinkhorn AS. Some factors related to dentists’ decisions to extract
dual role of both a doctor and a friend. The easiest and the teeth. Community Dent Health 1987;4:3‑9.
27. MacEntee MI, Dowell TB, Scully C. Oral health concerns of an elderly
most effective way of treating the geriatric population is when population in England. Community Dent Oral Epidemiol 1988;16:72‑4.
we can mix professional treatment with the human touch.[37] 28. Niessen LC, Gibson G. The geriatric patient. In: Stefanac SJ, Nesbit SP,
editors. Treatment planning in Dentistry. St Louis: Mosby; 2001. p. 223–44.
REFERENCES 29. Pemer A, Landt H. Evaluation of the need, perceived by general practitioners,
for further education in geriatric dentistry. Gerodontics 1988;4:18‑22.
1. India’s population to be biggest’ in the planet. BBC News. 18 August, 2004. 30. Berkey DB, Call RL, Gordon SR, Berkey KG. Barriers influencing dental
PubMed US Census Bureau, Demographic Internet Staff. “United States care in long‑term care facilities. Gerodontics 1988;4:315‑9.
Census Bureau‑International Data Base (IDB)”. Available from: http://www. 31. Niessen LC, Gibson G. The geriatric patient. In: Stefanac SJ, Nesbit SP,
Census.gov. [Last retrieved on 2011 Sep 24]. editors. Treatment Planning in Dentistry. St. Louis: Mosby; 2001. p. 223‑44.
2. India’s Elderly Population: Some Fundamentals, General Knowledge 32. Johnson CS. Ageing and healthy life expectancy: Will the extended years
Today; March, 8th 2013. Available from: http://www.gktoday.in/indias-elderly- be spent in good or poor health? J Indian Acad Geriatr 2008;4:64‑7.
populationsome-fundamentals/. 33. Pyle MA, Terezhalmy GT. Oral disease in the geriatric patient: The
3. Robert GH, Barry C. Practical Consideration in special patient care, physician’s role. Clin J Med 1995;62:218‑26.
delivering dental care to nursing home and homebound patients. Dent Clin 34. Oral health and the older adult: Kenneth Shay: Crest ®Oral‑B ®
North Am 1994;38:537‑51. at dentalcare.com continuing education course. [Last revised on
4. Chandra S, Chandra S. Geriatric dental health care. Text Book of Community 2012 June 13].
Dentistry. 1st ed. New Delhi, India: Jaypee Brothers Medical Publishers (P) 35. Mandel ID. Preventive dentistry for the elderly. Spec Care Dentist
Ltd.; 2004. p. 239‑51. 1983;3:157‑63.
5. Panchbhai AS. Oral health care needs in the dependant elderly in India. 36. Yeh CK, Katz MS, Saunders MJ. Geriatric dentistry: Integral component to
Indian J Palliat Care 2012;18:19‑26. geriatric patient care. Taiwan Geriatr Gerontol 2008;3:182‑92.
6. Issrani R, Ammanagi R, Keluskar V. Geriatric dentistry – Meet the need. 37. Rai S, Kaur M, Goel S, Bhatnagar P. Moral and professional responsibility of

The Journal of Indian Prosthodontic Society | Jan-Mar 2015 | Vol 15 | Issue 1 21

[Downloaded free from http://www.j-ips.org on Saturday, February 9, 2019, IP: 103.255.4.18]

Bharti, et al.: Oral care needs, barriers and challenges

oral physician toward geriatric patient with interdisciplinary management‑The 1994;84:27‑30, 2.

time to act is now! J Midlife Health 2011;2:18‑24. 45. Kress GC Jr, Vidmar GC. Critical skills assessment for the treatment of
38. Stamm JW, Banting DW, Imrey PB. Adult root caries survey of two similar geriatric patients. Spec Care Dentist 1985;5:127‑9.
communities with contrasting natural water fluoride levels. J Am Dent Assoc 46. Antczak A, Branch LG, Perceived barriers to the use of dental services by
1990;120:143‑9. the elderly. Gerodontics 1985;1:194-8
39. Hunt RJ, Levy SM, Beck JD. The prevalence of periodontal attachment loss 47. Morreale J. In support of geriatric dentistry at the undergraduate level.
in an Iowa population aged 70 and older. J Public Health Dent 1990;50:251‑6. J Can Dent Assoc 2007;73:149‑50.
40. Saunders RH Jr, Meyerowitz C. Dental caries in older adults. Dent Clin 48. Gershen JA. Geriatric dentistry and prevention: Research and public policy.
North Am 2005;49:293‑308. Adv Dent Res 1991;5:69‑73.
41. Atkinson JC, Grisius M, Massey W. Salivary hypofunction and xerostomia:
Diagnosis and treatment. Dent Clin North Am 2005;49:309‑26.
How to cite this article: Bharti R, Chandra A, Tikku AP, Arya D, Gupta R.
42. Steinberg BJ, Brown SS, Rose LF, Cohen DW. Successful periodontal Oral care needs, barriers and challenges among elderly in India. J Indian
treatment for the elderly. Dent Clin North Am 1989;33:101‑8. Prosthodont Soc 2015;15:17-22.
43. Epstein CF. Geriatric dentistry. Dent Clin North Am 1989;33:43‑50.
Source of Support: Nil, Conflict of Interest: None.
44. Otsuni E, Mohl GR. Communicating with elderly patients. Dent Econ

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