**Abstract**

The most prevalent oral diseases such as tooth decay and chronic periodontitis, are the main responsible for tooth loss, this causes a disability in the chewing function, which alters the selection of food, the pleasure of eating, and the state of nutrition. Even the use of total prostheses to replace this loss is not always satisfactory. In the emotional sphere, poor oral health causes discomfort and a decrease in self-esteem. Unfortunately, this continues to occur in older people despite the great scientific and technological advances in dentistry today. Health promotion, which includes health education and prevention, must be present in the course of people's lives. In the prevention of oral diseases, consider not only biological factors as the only causes, but also alleviate and modify the social determinants of the disease. All those involved in the care of the older adults must promote prevention as the most important tool in favor of oral health, and make older people enjoy life with quality. Oral health is an invaluable asset and reward at this stage of life.

**Keywords:** oral health, prevention, older adults, health promotion, socioeconomic determinants

### **1. Introduction**

Population aging is a human success story. A reason to celebrate the triumph of public health, medical advancement, and economic and social development over the diseases, injuries and early deaths that have limited human life spans throughout history. Globally, there were 703 million people aged 65 and over in 2019. In the next three decades, the number of older people in the world is projected to double, reaching more than 1.5 billion in 2050. All regions will see an increase in the size of their older population between 2019 and 2050.

There are not only improvements in life expectancy at birth, but also even faster improvements in life expectancy at later ages. Globally, a 65-year-old could expect to live 17 more years in 2015-2020 and 19 more years by 2045-2050 [1]. The World Health Organization (WHO) notes that life expectancy in older age is increasing at a much faster rate in high-income countries than in lower-resource settings conditions. See **Figure 1** [2].

#### **Figure 1.**

*Changes in life expectancy from 1950, with projections until the year 2050, by region of the WHO and worldwide [2].*

This demographic transition is a major challenge for health authorities around the world, particularly as disease patterns will change at the same time. With age, the risk of losing years of healthy life is compounded by low individual resistance, poor nutritional status, chronic diseases, and adverse socio-environmental conditions [3]. Responding to this challenge requires the whole society.

One of the most important strategies we have to control and lessen the danger that this represents is the promotion of health. Health promotion uses education, prevention and health protection. This is of particular importance among developing countries where economic resources are scarce and where the largest growth in the older adult population is taking place in the world [4]. All these efforts to keep away older people from suffering and physical, emotional and social limitations as a result of disease must include the maintenance of oral health.

### **2. Health promotion and the prevention of health risks in older adults**

In the last decades of the 20th century and the beginning of the 21st, a global agenda has been disseminated on the implementation of public policies that reduce the burden of disease in the older adults. For example, since 1995, in response to the global challenges of population aging, the WHO launched a program on aging and health. This was designed to promote knowledge about health care in old age through specific research and training activities, information dissemination, and policy development.

In 1998 in the World Health Report, WHO reported the need to strengthen health promotion among older people. The health implications of aging should be better clarified and understood. Later, in 2000, WHO reiterated the priority of older people's health through the "Aging and Life Cycle" program, which focused on the concept of "active aging". In 2002, WHO published a document entitled "Active Aging: A Policy Framework", which outlines essential approaches to achieving healthy aging. The proposed policy framework was based on three basic pillars: health, social participation and security [4].

#### **2.1 The burden of oral diseases in old age**

The WHO in its report on aging and health, 2015, emphasized: "Oral health is a crucial and often neglected area of healthy aging" [5].

#### *Oral Health and Prevention in Older Adults DOI: http://dx.doi.org/10.5772/intechopen.101043*

In this regard, oral health is a key component in maintaining and promoting a healthy body and a high quality of life [6]. The growing body of scientific evidence confirms that good oral health is integral and essential to a person's overall health. Oral health and disease are closely related to health and disease in general. Unfortunately, older people are representative of a vulnerable population group that suffers heavily from oral diseases.

Given the comorbidities associated with the chronic disease profiles of older people, poor oral health further compromises healthy aging. The literature consistently describes oral health as a significant determinant of an individual's quality of life [7].

Health authorities around the world now face a growing public health problem, including an increasing burden of oral disease among older people. Globally, poor oral health in this age group has been shown particularly in high levels of tooth loss, decay tooth, periodontal disease, xerostomia, and oral cancer [2].

In oral health, global inequalities persist both within and between regions and societies and undermine the fabric, productivity and quality of life of many communities of the world [8]. Despite advances in prevention, restorative techniques, and dental materials, tooth loss remains a reality in both industrialized and developing countries [9]. While there have been significant improvements in oral health in the last 30 years, inequalities persist and a marked social gradient in oral health is observed similar to that of general health [8].

According to the WHO Oral Health Database, high levels of decay tooth are found in national surveys of older people; regionally, the average number of teeth affected by decay varies from an average of 9 teeth in the countries of the African region to an average of 24 teeth in Europe. In all regions, the experience of decay tooth in older people led to tooth loss, while the number of teeth treated after decay is quite limited, especially in the countries of the African region.

Regarding periodontitis, globally, surveys have reported that the percentage of older people with deep periodontal pockets is within the range of 5–30%. Data from Madagascar reported that 17.1% of people aged 65 to 74 had superficial or deep periodontal pockets, while these conditions were observed in 55.5% of Chinese older adults [10].

Poor oral health negatively affects the daily performance of older people, this condition can lead to reduced chewing performance, limited food choices, weight loss, poor communication, low self-esteem and well-being. Obviously, these conditions influence the quality of life. The increase in life expectancy without a better quality of life has a direct impact on government spending on health, and is becoming a key public health problem in the most developed countries. It will also be of great concern to developing countries and countries with high population density and emerging economies, such as China and India [2].

#### **2.2 Oral health promotion in older adults: preventive strategies**

At all ages, a healthy natural dentition and a pleasant dental appearance contribute to quality of life. Bad breath and tooth decay can promote social isolation, limit participation in social activities, and influence our judgments about personality traits [9].

Older people in good health can contribute to society, their families, their communities and economic productivity through formal or informal channels, e.g. through volunteer work, etc. [11]. Searching for effective, systematic and wide-ranging interdisciplinary solutions aimed at the current and future burden of oral diseases in our older people will be a great challenge and opportunity in the 21st century [6].

Goals in dentistry cannot be achieved solely on the basis of providing clinical treatment alone. As for any age, health promotion and self-managed disease prevention measures are important to achieve better oral health outcomes. Health promotion interventions are key to improving oral health in old age, as it encourages older people to be proactive about their health [11].

Through the Ottawa Charter, WHO, 1986, health promotion was defined as: "the process of allowing people to increase control over their health and improve it". To achieve a state of complete physical, mental, and social well-being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment [12].

Failure to prevent or control the progression of oral disease can increase the risk of adverse health outcomes. A recent systematic review in Cochrane found evidence that periodontal disease treatment improved metabolic control among people with type 2 diabetes. Also, it was shown that better care of oral hygiene can prevent respiratory infections and death from pneumonia. in older people in hospitals and nursing homes. Furthermore, frequent tooth brushing was reported to be associated with lower levels of cardiovascular disease [13].

The literature also indicates that health promotion activities should include the active participation of stakeholders in their planning, implementation, and evaluation. This will ensure that health promotion activities are based on the target group's own goals and needs.

Greater efforts should be made to identify opportunities for health promotion activities and the development of community models that encourage older people to improve and maintain their oral health. Ignoring health promotion and disease prevention opportunities in these groups is unfair and can increase inequalities in health standards [11].

## *2.2.1 Health education for older adults*

Health promotion uses education, prevention and health protection. This is of particular importance among developing countries where economic resources are scarce and where the world's largest population growth is taking place [3].

Health literacy, which is within the framework of health promotion and preventive strategies, is necessary to counter oral diseases. Health literacy has been defined as "the cognitive and social skills that determine people's motivation and ability to access, understand, and use information in a way that promotes and maintains good health." In the case of older people, it is important to take into account, in addition to health literacy, functional literacy. Health professionals should consider literacy difficulties among older people than younger adults, if they associate aging with visual and/or cognitive impairments, or think that older cohorts had more likely to have missed school as children. Therefore, they need to provide clear or improved oral instruction to older people [14].

#### *2.2.2 Preventive strategies for oral diseases, WHO recommendations*

In recent years, the WHO developed a series of essential principles for the prevention of oral and general diseases and the quality of life, which must be followed by all actors involved in the health care of older people. In the report on health in the world of 2015, the strengthening of health promotion and the creation of healthy environments adapted to the older adults are highlighted in the first place. Promote a healthy

#### *Oral Health and Prevention in Older Adults DOI: http://dx.doi.org/10.5772/intechopen.101043*

diet and nutrition, especially less sugar consumption and increased consumption of fruits and vegetables, in accordance with the "WHO Global Strategy on Diet, Physical Activity and Health, and Reduction of Malnutrition."

One of the most relevant recommendations of this report is to emphasize the importance of educating caregivers about oral health knowledge, to dependent older people, in addition to involving their families, it is extended to independent older adults. As well as, to "other important people", which can be interpreted as the entire team that cares for older people. A relevant point is to ask that care models be developed thinking of older people with primary oral health care capacity. As well as, nursing homes and institutions for dependent older people in order to meet the needs of the many people neglected.

On the other hand, the economic cost of treatments is identified as a barrier to oral health care in older people. So it is requested to improve social security for this age group, and to establish health care financially fair mouthpiece for the older adults. Attention is paid to evidence-based medicine, and this report calls for the implementation of national evidence-based public health programs to achieve better oral health, general health, and quality of life. Finally, within these principles of the WHO, the surveillance of the oral health of the older adults and important risk factors is recommended [10].

#### *2.2.3 Educational action plans*

Meeting the oral health needs of the growing older population will require a diverse and capable dental workforce. A two-pronged approach is required, focusing both on (a) new entrants to the profession through dental schools and (b) existing dentists. The latter will be achieved through the continuing professional development of most dentists, but there will also be a greater need for postgraduate education and training. Undergraduate education is the hotbed of conscientious professionals, so it is important to place appropriate emphasis on oral health care for older patients in the undergraduate curriculum [15].

In this regard, the group made up of The common Task and Finish of the European College of Gerodontology (ECG) and the European Society of Geriatric Medicine (EUGMS), proposes a series of educational training actions aimed at dentists, and non-dentists in order to improve dental care for the older adults. They call this strategy "Educational Action Plans", and which in our opinion are of such importance for the prevention of oral diseases in older adults that we underline them.

According to this proposal, educational action plans should involve dental and nondental health care providers, giving them the opportunity for interprofessional training, practical training and improvement of attitudes towards the promotion of oral health. Better training for dental professionals in oral care for frail dependent older people.

Non-dental health professionals should receive education at the undergraduate, graduate and specialty levels, in the evaluation and promotion of oral health. This includes physicians, nurses, nursing assistants, physical therapists, occupational therapists, medical assistants, pharmacists, dietitians and others. It is proposed that these health providers should recognize oral health as part of multimorbidity. Also relate medication to the impact on oral health, initially assess oral health status, and demonstrate oral hygiene measures for the older adults and their caregivers. All this by developing strategies to overcome barriers to maintaining oral health and access to dental care, deciding when to refer to the dentist, and supporting collaborative practice [16, 17].

#### *2.2.4 Educational interventions in oral health*

As the population ages, one of the main challenges for the future will be to translate existing knowledge and strong experiences in disease prevention and health promotion into appropriate programs [3]. Educational interventions on oral health in older people have shown their potential benefit to improve the level of knowledge and their application in preventive oral care measures. The most remarkable result to emerge from the data is the significant decrease in the O'Leary index and in the index of tongue coating [18].

Educational interventions have shown to significantly reduce the number of plaque-covered teeth and improve prosthetic hygiene in older people who require the care of a home health nurse. However, multiple approaches based on individual needs are required to improve the oral health of vulnerable older people, including integrating preventive dental care into the daily care plan carried out by home care nurses. It is important to consider the functional capacity and cognitive function of the older adult, as it has been associated with poorer oral hygiene [19]. Oral hygiene education programs for institutionalized older people caregivers have shown a positive impact on improving this condition of residents. The ratio of residents to caregivers should be considered, as it could play an important role in the provision of oral hygiene services, and has received little attention in the literature [20].

Unfortunately, oral health competence and attitudes towards oral care have been reported to be inadequate in nursing home care. Poor oral health has been reported for people most dependent on care, showing the need for preventive actions [21].
