There are standard jokes about older people, usually involving lost teeth and dentures. The cruel thing is that most people laugh out loud at these jokes, but in reality, losing one's teeth is anything but funny. As people are living longer, the issue of maintaining one's teeth in good health is becoming more important.

Gerodontology, a branch of dentistry dealing with ageing and aged persons, allows a better understanding of the predicament of losing one's teeth to age, and how this can be effectively solved.

Dr Alexander Schembri has been practising dentistry for the past 25 years and is a visiting lecturer at the University of Malta, which recently introduced a module for dentistry and dental hygiene students related to dental issues concerning the aged. A member of the European College of Gerodontology, Dr Schembri has been instrumental in amplifying on the importance of gerodontology, including by collaborating with the European Centre of Gerontology at the University of Malta.

"There are the 'young old', and the 'old old'," he says. "Both groups have different and unique needs where dentition is concerned. The 'young old' are aged 60+, generally still independent and living within the community, whilst the 'old old' are aged 75+. They may be dependent and may be home-bound or living in a residential home. At these ages, oral health may not be in optimal order, especially when dental problems start cropping up.

Some aged people who need and want to have dental services may find physical hurdles in reaching a clinic because they lack mobility or assistance. In other cases, medical issues and impaired mental health may also affect the condition of oral health. The high costs of some aspects of dental care may also be a deterrent for people living on a low pension income."

Dr Schembri explains the multiple challenges which face a dentist who is asked to visit a home-bound elderly patient. A key difficulty is pulling down barriers to good oral health maintenance, breaking old negative habits, maintaining treatment and helping an elderly patient to deal with change and the possibility of having dental replacements.

"Imagine having to carry out an extraction in a private home. It takes a lot of experience to be able to extract a molar when your patient is lying on a sofa rather than on a clinic couch," he says. "Many dentists will refuse to do this. Educating the elderly is also a huge problem, but more so, educating the carers of the elderly, people who usually have to prioritise on the kind of care they are able to give, especially when there are multiple medical issues involved."

Ensuring a good quality of life should be applied to everybody irrespective of their age. The three key sources of a good quality of life from a dental perspective are being free from pain, having the ability to eat a good variety of food in order to maintain a good diet of a high nutritional value, and being able to communicate effectively in order to maintain a good level of self-esteem and to avoid social stigma.

With all of this in mind, Dr Schembri is working to increase awareness of this specialised field, also by communicating with the elderly themselves, delivering talks in day centres, local councils, and homes for the aged.

"Contrary to what many might believe, older people still want to look good, and still want to be able to kiss their partners without being hampered by dentures. Widowed people may still be interested in dating, and good looks albeit the wrinkles, are still of great importance for an aged person's self-esteem," he explains.

"Losing even a single tooth is interpreted as a sign of further loss, especially in this phase of life when a person has already had to deal with several losses such as children leaving home, retirement, the death of a partner, the inability to keep driving, etc. The process of losing one's teeth is often coupled by bad breath, painful gums, depression and slacking appetite, all of which are directly related to higher incidences of depression. The truth is that all this can be avoided."

Older people are still encouraged to have their mouth checked every six months, to report any instances of pain and bleeding gums, and consult with their dentist about possible improvements which can be carried out. It helps if dentists are trained to take on the dental issues of an ageing population.

"Dentistry students are generally young people who would not have had much contact with aged relations or patients," Dr Schembri says. "Apart from lecturing on this specialised topic, I also take them for practice placements in old people's homes, such as St Vincent De Paule, which is incidentally opening its very own dental centre next year.

"Students are generally pleasantly surprised to find that old people can be very lively, interesting, and extraordinary people who are just dealing with a slower pace of life. The amazing thing is that today, thanks to knowledge and technology, they don't have to suffer loss of teeth at all."

 

Emily Serracino from Pieta, 61

I have had a fixed bridge put into my mouth and connected to my only four good teeth. Today my mouth looks and feels better than it was when I was a young woman. I must say that I was always terrified of dentists and I have procrastinated for too long to get this done. But I really shouldn't have worried. I had my last treatment in February and am very happy with the result. I am eating easily and normally and feel totally revitalised by the change. In hindsight, I must advise parents to never ever frighten children about visiting the dentist.

 

Doris Pullicino from Naxxar, 64

I had a bridge fixed in my mouth some while ago. I had suffered gum problems and the dentist had to pull out most of my teeth. However, he managed to save my good ones and do something which seemed impossible. He did not replace them entirely with a denture, but fixed a bridge on to my good teeth. While this is more costly than dentures, the bridge is not as expensive as implants would have been. This has been an enormous improvement for me and I feel like a new edition of my former self.

 

Frank Borg from Sliema, 80

I am fortunate to have still all my own teeth in place. Since I was a child I have always taken great care of my mouth's health and still wash my teeth twice a day. I go to the dentist every year for a check-up and although I have a couple of fillings, I have had no major instances of complaint.

 

Salvina Brincat from Msida, 82

I had gone to the dentist to remove some broken teeth. One front tooth had gone and my dentist replaced it with a fixed tooth. Then another anterior tooth was on the way out. My dentist suggested removing any rotting teeth, cleaning my good ones, filling the ones which could be saved, and after waiting the necessary time for my gums to dry, I had a fixed bridge installed and attached to my good teeth. It is very convenient. I don't have any dentures to remove and clean, and now my upper gums have a full set of 12 teeth. It was a long process but today I am very, very happy with the results. I go for regular check-ups, especially to make sure my gums are healthy, and I lead a very normal life.

 

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