Faculty of Dentistry, University of Hong Kong, Hong Kong, China.
European Research Group on Periodontology, Genova, Italy.
J Clin Periodontol. 2017 Mar;44 Suppl 18:S135-S144. doi: 10.1111/jcpe.12681.
BACKGROUND: Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems. AIMS: The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. METHODS: Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. RESULTS: Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. CONCLUSIONS: Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders.
背景:在过去的二十年中,龋病和牙周病的预防和治疗取得了进展,从而提高了成年人的口腔健康水平并延长了牙齿的保留时间。人口老龄化以及人们对老年人口口腔健康相关生活质量的期望不断提高,这对临床护理和医疗保健系统构成了巨大挑战。
目的:本次研讨会的目的是批判性地审查科学证据,并制定具体建议:(i)通过预防和治疗老年人群中的龋病和牙周病来预防和保留牙齿并维持口腔功能;(ii)提高对口腔健康作为健康老龄化基本组成部分的健康益处的认识。
方法:通过涵盖老年人龋病和牙周病流行病学、衰老对龋病和牙周病的影响以及干预措施有效性等方面的三项系统评价来启动讨论。建议是根据系统评价和专家意见中的证据制定的。
结果:关键信息包括:(i)人口老龄化、危险因素的趋势以及牙齿保留率的提高表明,老年人中由龋病和牙周病引起的疾病总负担预计会增加;(ii)需要进行特定监测以监测老年人群中口腔健康的变化;(iii)衰老会影响口腔健康,包括牙周炎,并且可能会影响龋齿易感性;(iv)有证据表明,即使是老年人也可以预防和治疗龋病和牙周病;(v)老年期保持口腔健康和功能性牙齿保留不仅在口腔和总体生活质量方面有益,而且在预防身体衰退和依赖性方面也有益,因为它促进了健康的饮食;(vi)口腔保健专业人员和个人不应仅根据年龄决定是否保留牙齿,而应根据依赖性水平、预期寿命、虚弱程度、舒适度和生活质量来决定;(vii)卫生政策应为弱势老年人提供口腔保健扫清障碍。
结论:与会者就公共卫生官员、口腔保健专业人员、教育工作者和劳动力规划者、护理人员和亲属以及公众和老年患者的具体可操作重点达成了共识。其中一些重点对政策制定者具有重大影响,因为卫生系统需要通过全系统的变革来适应这一挑战,以便在老年期保留牙齿,并对依赖性日益增强的老年人日益恶化的口腔健康进行管理。
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