Global oral health of older people--call for public health action.

BACKGROUND: The aim of this report is (1) to provide a global overview of oral health conditions in older people, use of oral health services, and self care practices; (2) to explore what types of oral health services are available to older people, and (3) to identify some major barriers to and opportunities for the establishment of oral health services and health promotion programmes.

METHODS: A postal questionnaire designed by the World Health Organization (WHO) was distributed worldwide to the Chief Dental Officers or country oral health focal points at ministries of health. WHO received 46 questionnaires from countries (39% response rate). In addition, systematic data were collected from the WHO Global Oral Health Data Bank and the World Health Survey in order to include oral health information on the remaining countries. In total, the data base covers 136 out 193 countries, i.e., 71% of all WHO Member States.

RESULTS: Dental caries and periodontal disease comprise a considerable public health problem in the majority of countries. Significant disparities within and between regions are observed in epidemiologic indicators of oral disease. The prevalence rates of tooth loss and experience of oral problems vary substantially by WHO Region and national income. Experience of oral problems among older people is high in low income countries; meanwhile, access to health care is poor, in particular in rural areas. Although tooth brushing is the most popular oral hygiene practice across the world, regular tooth brushing appears less common among older people than the population at large. In particular, this practice is less frequent in low income countries; in contrast, traditional oral self-care is prevalent in several countries of Africa and Asia. While fluoridated toothpaste is widely used in developed countries, it is extremely infrequent in most developing countries. Oral health services are available in developed countries; however, the use of such services is low among the older people. Lack of financial support from government and/or lack of third party payment systems render oral health services unaffordable to them. According to the country reports, health promotion programmes targeting older people are rare and this reflects the lack of oral health policies. Although some countries have introduced oral health promotion initiatives, worldwide there are few population-oriented preventive or curative activities currently implemented that focus specifically on the elderly. Barriers to the organization of such programmes relate to weak national health policy, lack of economic resources, the impact of poor oral health, and lack of tradition in oral health. Opportunities for oral health programmes for old-age people are related to updated information on the burden of oral disease and need for care, fair financing of age-friendly primary health care, integration of oral health into national health programmes, availability of oral health services, and ancillary personnel.

CONCLUSION: It is highly recommended that countries establish oral health programmes to meet the needs of the elderly. Relevant and measurable goals must be defined to direct the selection of suitable interventions to improve their oral health. The common risk factors approach must be applied in public health interventions for disease prevention. The integration of oral health into national general health programmes may be effective to improve the oral health status and quality of life of this population group.