When we think about well-being among older adults, how often do we think about their oral health as being an important component? In reviews of risk factors for low well-being among older adults, oral health is never explicitly mentioned, although other health conditions and disease states are often discussed. This is despite untreated caries (dental decay) being the most prevalent of all health conditions in global burden of disease estimates.
General health and functioning are important components of well-being, especially among older adults. Even though oral health is an integral part of general health, it is often neglected in gerontological research. For example, in all the research papers published in The Journals of Gerontology, Series A and B, the term ‘oral health’ is mentioned in the titles only five times.
Even when well-being research takes disability among older adults into account, common measures of disability such as limiting health problems or Activities of Daily Living (ADL) do not explicitly refer to disabling conditions related to oral health. For example, one of the ADL questions is about problems people have with cutting their food. This is different from a common problem that most older adults face which are problems with chewing food due to missing teeth. Another common oral health problem among older adults is the pain and discomfort associated with ill-fitting dentures, which can also decrease well-being.
In previous research, a paradoxical association between older age and better oral health related quality of life has been found, even though older adults are more likely to be edentate (no natural teeth). Historically, tooth loss was considered a normal part of the ageing process. However, expectations have changed and most people now assume that they will maintain most of their teeth over their lifetime, and take active measures to do so.
Becoming edentate can have a negative impact on a person’s social life and daily activities. For example, people who are edentate may avoid participation in social activities because they are embarrassed to speak, smile, or eat in the company of other people. Difficulty eating, avoiding smiling, and difficulty cleaning teeth are the daily life functions most commonly affected by oral conditions. Becoming edentate could have an immediate impact on a person’s mood and subjective well-being. Tooth loss is a traumatic experience and a serious disabling life event resulting in feelings of bereavement, lowered self-confidence, and altered social behaviours.
Although oral health is not the most important factor for subjective well-being among older adults, our research suggests that it is an independent risk factor for changes in well-being among a national sample of older adults living in England. We found that a worsening in oral health-related quality of life was associated with a decrease in subjective well-being, even after taking into account changes in disability and other potential health and socioeconomic/demographic confounding factors.
Becoming edentate or experiencing a deterioration in oral health leading to an impact on your daily functioning are important risk factors for well-being and depression among older adults. Researchers in gerontology should consider the impact of poor oral health among older adults on their quality of life and well-being. For practitioners and geriatric clinicians, our study emphasises the importance of maintaining good oral health in later life, as this can have consequences on the wider social life of older adults that goes beyond their oral health.
Oral health and general health are inextricably linked and should not be treated as separate entities. The late Professor Aubrey Sheiham emphasised “The compartmentalization involved in viewing the mouth separately from the rest of the body must cease because oral health affects general health by causing considerable pain and suffering and by changing what people eat, their speech and their quality of life and well-being.”
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