Dentists get their teeth into challenges of the post-denture generation

Dentistry is having to adapt its attitudes and treatments as more people keep their own teeth well into old age, writes CLAIRE O'CONNELL

Here’s something to smile about: older people in Ireland are generally more likely to have their own teeth than in decades gone by. That’s according to a dental expert who has been evaluating a more “functional” approach to managing that trend.

“Over the last 30 years, there has been a big shift away from people losing all their teeth at a relatively early age to instead people keeping part of their dentition in older age,” says Prof Finbarr Allen, head of the Cork Dental School and Hospital at University College Cork (UCC).

Adult oral health survey figures suggest that in 1979, the prevalence of total tooth loss in people aged 65 and over in Ireland was 72 per cent, but this had dropped to 41 per cent by 2000-2002, says Allen, who has witnessed the trend during his own career in dentistry.

“When I was a student 25 years ago, about 30 per cent of the adult Irish population had no natural teeth – it was almost standard practice for people to wear complete dentures,” he says.

“But that has changed quite dramatically, and now while for people in their 80s there’s a fairly high chance that they will have lost all of their teeth, people in their 60s are more likely to have kept many of their own teeth. The challenge now [is for] as many older people as possible to maintain a healthy, natural and functioning dentition for life.”

Changes in environment and attitude

Prof Allen attributes the trend at least in part to changes in attitude in recent decades.

People didn’t expect to keep their teeth for life, so the dental treatment was often quite rudimentary: if you had a problem with a tooth then you got that tooth out, he says.

And if people came in with lots of dental decay, the solution was to remove the damaged teeth right away and give them dentures.”

Attitudes and treatments have changed substantially in the past couple of decades.

“As people became more tuned in to the importance of aesthetics and oral health, they became much more anxious to keep their teeth than to lose them. And we are moving from an emergency-led type of profession to a more demand-led approach.”

Functional approach

Allen has been evaluating a “functionally-oriented” approach to treating a person aged 65 or over who is missing some teeth.

“We want to develop a means of giving patients a functional and aesthetic dentition without necessarily replacing all of the missing teeth,” he says.

He and colleagues in Cork are carrying out a study that treats participants who have lost some but not all of their teeth.

Some patients are assigned to a conventional course of treatment, through which all missing teeth are replaced with a removable partial denture, while others undergo the more functionally-oriented treatment strategy, which seeks to preserve 10 pairs of occluding teeth.

“The functionally-oriented treatment strategy is designed to give adequate biting contact and appearance but it doesn’t replace all the teeth that are missing,” explains Allen, who is professor of prosthodontics and oral rehabilitation at UCC.

“It is not a new concept, but to date there has been very little clinical research on it.”

Lower-cost option

The Health Research Board-funded study so far suggests that the functionally-oriented approach brings a similar quality of life, but costs substantially less, according to Allen.

Last March, a paper in the journal Gerodontology outlined the findings from 44 participants assessed in the year following the treatment.

“Initially both treatments had a positive impact, both on how the dentition functioned for the person, and how the person scored on quality of life,” says Allen.

“But we are finding that the functionally-oriented treatment is twice as cost-effective as the conventional treatment. Both treatments are equally acceptable to patients but one gives better quality of life and it is more cost effective.”

He describes the preliminary results as “very convincing” and adds that even the researchers were surprised at the data: “We half-expected this might happen but we didn’t think it would be quite as dramatic as it is,” he says.

Long-term impact

The UCC researchers are continuing to follow up with the study participants to compare the conventional and functionally-oriented treatments in the longer term.

And more generally, Allen hopes the findings will help dental health policy in Ireland to respond to the longer life expectancy of teeth in the population here.

“We need to find a way to shift the focus further from an intervention-oriented strategy and more towards prevention,” he says.

“We don’t want people who are substantially dentate until 70 years of age suddenly losing all their teeth: that would be a disaster.

From a quality of life and health perspective, natural teeth are important to older adults and, as public resources are contracting hugely, we need to approach treatment in a more cost-effective way.”