Abstract
The purpose of this article is to detail the oral health status of Early Baby Boomers and how it is affected by the cultural influences after WWII. National data on clinically and self-assessed oral conditions from the 2021 NIDCR Oral Health in America Report, National Health and Nutrition Examination Survey (2011–2014), Center for Disease Control and Prevention, National Cancer Institute (2018), the Indian Health Service (2022), and the Health and Retirement Study (2018) were tabulated and compared (where available) to similar data for older and younger cohorts. Data analyses show that there is more tooth retention overall. There are higher levels of tooth loss, unrestored caries, and periodontitis among Black, American Indian, Alaskan Native, and Hispanic Baby Boomers, and the poor. Smokers had higher rates of periodontitis.
Keywords: Dental, oral health, dental caries, edentulous, tooth loss, periodontal diseases, cancer, baby boomer, oral health disparities
Introduction
The end of World War II in 1945 gave rise to the largest population increase in U.S. history. When veterans returned home from WWII, the economy was booming. The post-war industrialization coupled with the Serviceman’s Readjustment Act of 19441 (GI bill), which funded education and down payment-free mortgages, meant that many returning veterans married and began raising new families.
The resultant Baby Boomers, estimated at 73 million, were born from 1946–642. By 2018, there were 52 million people over age 65 in the U.S., up from 12% to 16% of the population in less than 20 years. By 2034, older adults will outnumber children under age 18 for the first time in U.S. history, putting stress on the Federal Financial Programs that help people over age 65, including Medicaid, Supplemental Nutrition Assistance Program (SNAP), and Medicare Part B Physicians Fee Schedule Services3.
Baby Boomers are a unique group culturally. Collectively they grew up after the war in an extension of the “Can Do” environment, with tremendous resources compared with those who grew up during World War II or the preceding Great Depression. The economy, universities, cities, and many neighborhoods flourished. As large families of Baby Boomers grew, more attended secondary school and college than ever before. Boomers experienced Vietnam, the space race, and the cold war. The late forties, fifties and sixties gave rise to the “beat” generation, the great migration, blues, jazz, flower power, Black power, antiwar protests, beach music, and Motown. It was a heady time to grow up, with a lot of freedom in the neighborhoods.
Baby Boomers are dentally unique. Boomers were the first generation to experience fluoride in the water supply, billed as one of the ten major public health accomplishments in the 20th century. Coupled with high-speed handpieces, better amalgams, glass ionomers, composites, and crowns, Baby Boomers experienced less caries and tooth loss than ever before. This article describes the oral health issues of Early Baby Boomers from both the dental examinations and self-reported perspectives.
Methods
Definitions of Baby Boomers
Different national data sources use different age definitions of Baby Boomers, as shown in Table 1. For example, while the U.S. Census considers persons born from 1946–1964 to be Baby Boomers2, the Health and Retirement Study (HRS)4 defines Baby Boomers as persons born from 1948–65. Relevant data from the National Health and Nutrition Examination Survey (NHANES) are available from 2011–2014, and data from National Cancer Institute (NCI) and HRS are from 1918, and from the Indian Health Service are from 2022.
Table 1.
Definitions of Baby Boomers and Data Availability by Age Group and Study Year
| Category | Birth Year | Ages in 2011 | Ages in 2014 | Ages in 2018 |
|---|---|---|---|---|
| Boomers† | 1946–64 | 47–65 | 50–68 | 54–72 |
| Early boomers† | 1946–53 | 58–65 | 61–68 | 65–72 |
| HRS Boomers‡, | 1948–65 | 46–63 | 49–66 | 53–70 |
| HRS Early boomers‡, | 1948–53 | 58–63 | 61–66 | 65–70 |
Census definition
HRS definition
Data Sources
National data from NHANES, the NCI, the National Center for Health Statistics (NCHS), the Indian Health Service and the HRS are presented4–12. Because sources are publicly available de-identified data, and although IRB approval was sought for use of HRS data4, the IRB determined it was not required. The NHANES and NCI data5,9,11 on Baby Boomers correspond to the data on 65–74 year-olds from 2011–2014, and are largely from the 2021 NIDCR Report, Section 3B. Older Adults5.
NHANES data collection began in the 1960s and is used to estimate vital and health statistics of Americans10. Data include demographic, socioeconomic, dietary interviews, and examinations of medical, dental, physiologic and laboratory measurements. NHANES is a major program of the NCHS, which in turn is a part of the Centers for Disease Control and Prevention (CDC). The authors used data from surveys from 1999–2018, as indicated in the Tables.
Data on the oral health status of American Indian and Alaskan Native (AIAN) Baby Boomers were obtained from the 2022 Indian Health Service (IHS) Oral Health Survey12 of adult dental patients served by IHS and Tribal clinics.
The HRS is a nationally representative longitudinal survey of more than 37,000 individuals over age 50 in 23,000 households in the USA4. Fielded every 2 years since 1992, the survey is a national resource for data on the changing health and economic circumstances associated with ageing. The HRS is sponsored by the National Institute on Aging (U01AG009740) and conducted by the University of Michigan.
Self-reported oral and general health questions used in the HRS are from core and supplemental HRS data, short-form self-assessments13 and questions used in national surveys (NHANES, NCHS)4–11. HRS core questions included age, gender, race and ethnicity, marital status, wealth (in quartiles), self-rated health (Excellent, Very Good, Good, Fair, Poor), self-reports of diabetes, cardiovascular disease (CHD), or stroke. HRS Core dental variables were dental visit in last two years, and edentulous in both arches. Additional HRS dental variables are from the 2018 dental module Supplement (~10% of participants). They include the single item self-report of oral health (Excellent, Very Good, Good, Fair, Poor, reported as percent Fair or Poor), percent with at least 4 teeth missing in maxilla, and percent with at least 4 teeth missing in mandible. Also in the supplement were items that described avoiding eating some foods, finding it difficult to relax, and avoiding going out, or uncomfortable dentures because of problems with teeth or dentures13. Possible responses were never, hardly ever, occasionally, fairly often, or very often. The supplement also asked if the participants were nervous or self-conscious because of problems with their teeth or dentures (responses were never, sometimes, or always) and how much pain they had from their teeth or dentures, with possible responses: none at all, a little bit, some, quite a bit, or a great deal. Chi square and t-test statistics tested for differences between early and middle baby boomers as appropriate.
Results
Data from NHANES, NCI and NCHS, highlighted in the 2021 NIDCR Report, Section 3B from 2009–2018 are shown in Table 25. Available data include dentition status, tooth retention, unrestored caries in permanent teeth, periodontitis11,12 and cancer deaths5,9 among baby boomers. The impact of demographics and social determinants of health, including income, race, and ethnicity are readily apparent on the percent with intact and functional dentitions, edentulism, unrestored caries in permanent teeth, periodontitis, severe periodontitis, and cancer deaths. For example, three in four white Americans, six in ten of Mexican Americans, two in three AIAN, and four in ten Non-Hispanic Blacks who were 65–74 year olds had 21 or more teeth. Three in four of non-poor 65–74 year olds had 21 or more teeth, compared with only half of the persons designated as poor and near poor. Similarly, among 65–74 year olds in 2011–2014, one in five Black elders were edentulous, compared to one percent of Mexican American and two percent of White Americans.
Table 2.
Oral Health Data by Age, Race, Ethnicity, Income and Year, NHANES, NCI, NCHS, IHS (in %)
| Year | Oral condition | Age-group | Race/Ethnicity (%) | Income (%) |
|---|---|---|---|---|
| 2011–20145 202212 |
21+ teeth | 65–74 | NH Black: 38.3 MexAm: 60.34 NH White: 77.7 AIAN: 64 |
Poor: 45.6 Near Poor: 48.7 Nonpoor: 78.4 |
| 2011–20145 | Complete permanent dentition | 65–74 | NH Black: 5.5 MexAm: 9.4 NH White: 20.6 |
Poor: 10.5 Near Poor: 8.5 Nonpoor: 20.1 |
| 2011–20145 | Edentulous | 65–74 | NH Black : 20 MexAm: 1 NH White: 2 |
Poor-25.7 Near Poor: 20.6 Nonpoor: 7.7 |
| 2011–20145 202212 |
Untreated caries in permanent teeth | 65–74 | NH Black: 25.5 MexAm: 17.5 NH White: 21.0 AIAN: 40 |
Poor: 42.2 Near Poor: 39.8 Nonpoor: 13.4 |
| 2009–201411 | Any periodontitis | 65+ | NH Black: 56.6 MexAm: 59.7 Other Hispanic: 48.5 NH White: 37 |
Poor: 60.4 Near Poor: 53.6 >400 FPL: 28.6 Smoker: 62.4 Nonsmoker: 34.4 |
| 2009–201411 202212 |
Severe periodontitis | 65+ | NH Black: 14.7 MexAm: 13.4 Other Hispanic: 7.8 NH White: 5.9 AIAN: 20 |
Poor: 13.9 Near Poor: 12.1 >400 FPL: 4.0 Smoker: 16.9 Nonsmoker: 4.9 |
| 20178 | % of persons age by age group with a dental visit in U.S., by age, race, ethnicity and income | 65–74: 67.7 75–84: 64.1 |
NH Black: 52.6 NH Asian: 52.8 Hispanic: 54.7 NH White: 69.1 |
Poor: 42.7 Near Poor: 42.8 Not Poor: 74.4 |
| 20178 | % of persons age by age group with a dental insurance in U.S., by age, race, ethnicity and income | 65–74: 34.3 75–84: 22.3 |
NH Black: 28.6 NH Asian: 29.8 Hispanic: 17.5 NH White: 30.6 |
Poor: 8.1 Near Poor: 13.2 Not Poor: 36.1 |
| 2014–20189 | % of deaths for persons with oropharyngeal cancer by age group | 55–65: 27 65–74: 28 75–84: 19 |
Median age of death: 68 | |
| 1999–20045 | 1+ implant | 65 + | All: 1.4 | |
| 2011–20165 | 1+ implant | 65 + | All: 7.4 |
MexAm=Mexican American; NH Black=Non-Hispanic Black; NH White=Non-Hispanic White; Poor=<100% Federal Poverty Guideline (FPG); Near poor=100–199 FPG; Non poor>=200 FPG; 8NCHS Data Brief No. 337, May 2019. 9NCI: National Cancer Institute; Some prevalences are from data published in NIDCR Report in 20215. NHANES defined severe periodontitis as having 2 or more interproximal sites with CAL 6 mm or greater (not on the same tooth) and 1 or more interproximal sites with PPD 5 mm or greater. AIAN=American Indian Alaskan Native12. Data (from 2022) on percent with 21+ teeth for AIAN were on persons 55 and older.
The percent of older adults with dental visits and dental insurance are also shown in Table 28. Importantly, both vary demonstrably by age, race, ethnicity, and income. The inequities by income and insurance mirror inequalities seen in the prevalence of oral diseases. Access to care and insurance are lowest among the oldest old, non-Hispanic Black, Asian Americans, and Hispanics. Both dental visits in the last year and dental insurance are lowest among both the poor and near poor.
Self-reported HRS data from 2018 for War Babies (Born 1942–47), Early Baby Boomers (1948–53), and Middle and Late Baby Boomers (1954–65) are shown in Table 3. Differences in sample race/ethnicity are apparent, as the younger cohorts reflect the HRS decision to increase recruitment of participants of non-white race and Hispanic ethnicity. Wealth differs somewhat by cohort, and chronic diseases (diabetes, CHD, stroke) are more common in the older cohorts. Self-rated health and oral health are remarkably consistent across cohorts while edentulism is less prevalent in younger cohorts. Maxillary tooth loss (>=4 teeth) is also less prevalent among younger cohorts; mandibular tooth loss less so. Few baby boomers report avoiding eating certain foods, finding it difficult to relax, being nervous or self-conscious, have pain or distress or uncomfortable dentures because of problems with their teeth and dentures.
Table 3.
Self-reported Health and Oral Health for Different Generational Cohorts, U.S. Health and Retirement Study, 2018
| Variable | War babies (Born 1942–47) | Early Baby Boomers (BB) (Born 1948–53) | Middle/Late Baby Boomers (Born 1954–65) | p-values for Early BB vs Middle/Late |
|---|---|---|---|---|
|
| ||||
| Mean age (SD) | 73.1 (1.9) | 67.0 (1.8) | 58.1 (3.4) | <0.0001† |
|
| ||||
| % Female | 1197 (59.7%) | 1768 (58.0%) | 4110 (56.7%) | 0.24‡ |
|
| ||||
| Race/ethnicity | ||||
| Black | 306 (15.3%) | 760 (25.1%) | 1917 (26.9%) | |
| Other | 56 (2.8%) | 107 (3.5%) | 506 (7.1%) | |
| White | 1451 (72.5%) | 1608 (53.1%) | 3282 (46.1%) | |
| Hispanic | 189 (9.4%) | 555 (18.3%) | 1411 (19.8%) | <0.0001‡ |
|
| ||||
| Marital status | ||||
| Married or Partnered | 1162 (60.7%) | 1675 (56.7%) | 3863 (54.4%) | |
| Not | 752 (39.3%) | 1278 (43.3%) | 3233 (45.6%) | 0.04‡ |
|
| ||||
| Wealth in quartiles | ||||
| Lowest | 460 (26.0%) | 736 (36.2%) | 231 (39.8%) | |
| Low middle | 448 (41.4%) | 497 (24.5%) | 136 (23.5%) | |
| High middle | 408 (23.1%) | 438 (21.5%) | 122 (21.0%) | |
| High | 453 (25.6%) | 362 (17.8%) | 91 (15.7%) | <0.0001‡ |
|
| ||||
| Self-rated health | ||||
| %Fair or Poor | 1415 (73.6%) | 2132 (72.0%) | 5031 (70.6%) | 0.16‡ |
|
| ||||
| Diabetes | 601 (31.6%) | 908 (31.1%) | 1770 (25.1%) | <0.0001‡ |
| CHD | 593 (31.2%) | 655 (22.4%) | 1039 (14.7%) | <0.0001‡ |
| Stroke | 178 (9.3%) | 202 (6.8%) | 384 (5.4%) | 0.005‡ |
|
| ||||
| Self-rated Oral Health | ||||
| %Fair or Poor | 51 (30.9%) | 82 (32.8%) | 208 (34.7%) | 0.60‡ |
|
| ||||
| % without a dental visit in last 2 years | ||||
| 642 (33.6%) | 1058 (35.9%) | 2632 (37.2%) | 0.22‡ | |
|
| ||||
| % edentulous | 366 (18.8%) | 517 (17.3%) | 872 (12.2%) | <0.0001‡ |
|
| ||||
| % edentulous in Maxilla only | ||||
| 25 (16.8%) | 25 (11.0%) | 36 (7.0%) | 0.07‡ | |
|
| ||||
| % edentulous in Mandible only | ||||
| 7 (4.7%) | 9 (4.0%) | 12 (2.3%) | 0.22‡ | |
|
| ||||
| % with >=4 teeth lost in Maxillary arch | ||||
| 23 (18.9%) | 48 (24.7%) | 77 (16.4%) | 0.01‡ | |
|
| ||||
| % with >=4 teeth lost in Mandibular arch | ||||
| 30 (27.0%) | 34 (19.4%) | 64 (14.9%) | 0.17‡ | |
|
| ||||
| Avoid eating some foods | ||||
| Never | 93 (56.4%) | 156 (62.4%) | 345 (57.6%) | |
| Hardly ever | 38 (23.0%) | 37 (14.8%) | 104 (17.4%) | |
| Occasionally | 23 (13.9%) | 33 (13.2%) | 86 (14.4%) | |
| Fairly often | 6 (3.6%) | 7 (2.8%) | 23 (3.8%) | |
| Very often | 5 (3.0%) | 17 (6.8%) | 41 (6.8%) | 0.72‡ |
|
| ||||
| Difficult to relax | ||||
| Never | 128 (77.6%) | 184 (73.6%) | 420 (70.1%) | |
| Hardly ever | 22 (13.3%) | 34 (13.6%) | 87 (14.5%) | |
| Occasionally | 12 (7.3%) | 19 (7.6%) | 52 (8.7%) | |
| Fairly often | 1 (0.6%) | 6 (2.4%) | 16 (2.7%) | |
| Very often | 2 (1.2%) | 7 (2.8%) | 24 (4.0%) | 0.84‡ |
|
| ||||
| Avoid going out | ||||
| Never | 150 (90.9%) | 220 (88.0%) | 523 (87.9%) | |
| Hardly ever | 9 (5.5%) | 7 (2.8%) | 39 (6.6%) | |
| Occasionally | 2 (1.2%) | 14 (5.6%) | 15 (2.5%) | |
| Fairly often | 1 (0.6%) | 3 (1.2%) | 5 (0.8%) | |
| Very often | 3 (1.8%) | 6 (2.4%) | 13 (2.2%) | 0.046‡ |
|
| ||||
| Nervous or self-conscious | ||||
| Never | 149 (90.3%) | 200 (80.0%) | 486 (81.1%) | |
| Sometimes | 14 (8.5%) | 41 (16.4%) | 90 (15.0%) | |
| Always | 2 (1.2%) | 9 (3.6%) | 23 (3.8%) | 0.87‡ |
|
| ||||
| Pain and distress | ||||
| None at all | 107 (64.9%) | 162 (64.8%) | 366 (61.1%) | |
| A little bit | 44 (26.7%) | 53 (21.2%) | 150 (25.0%) | |
| Some | 9 (5.5%) | 21 (8.4%) | 51 (8.5%) | |
| Quite a bit | 4 (2.4%) | 12 (4.8%) | 18 (3.0%) | |
| A great deal | 1 (0.6%) | 2 (0.8%) | 14 (2.3%) | 0.26‡ |
|
| ||||
| Uncomfortable dentures | ||||
| Never | 18 (32.7%) | 29 (42.0%) | 42 (33.9%) | |
| Hardly ever | 20 (36.4%) | 7 (10.1%) | 22 (17.7%) | |
| Occasionally | 11 (20.0%) | 19 (27.5%) | 28 (22.6%) | |
| Fairly often | 3 (5.5%) | 5 (7.3%) | 8 (6.5%) | |
| Very often | 3 (5.5%) | 9 (13.0%) | 24 (19.4%) | 0.40‡ |
t-test
Chi Squared
Discussion
Data from available national sources show large differences in oral health status and access to care among Baby Boomers based on age, race, ethnicity, insurance, and income. Disparities based on race and ethnicity have been apparent since oral health data were collected14. Further, there are scant national published data that describe oral health status among persons with disabilities, Asians, American Indians, Alaskan Natives, and people with multi-racial identities or living in a variety of supportive housing for older adults, such as residential and/or long-term care facilities. These are critical omissions.
In general, as we have known for many years, more people are keeping their teeth than ever before5. This is especially true for Baby Boomers, according to data from 2011–2014. Yet the data on tooth retention and tooth loss presented underscore the inequities by race, ethnicity and poverty in our society.
Similar inequities exist when you consider untreated caries in permanent teeth and severe periodontitis5,11,12. Only 13.4% of non-poor older adults had untreated caries, compared with 40% of AIAN, poor or near poor older adults5. Race, ethnicity (Non-Hispanic Black, AIAN, Hispanic or Mexican American older adults), poverty, and smoking status are major factors in the prevalence of periodontal diseases11,12. Use of care and dental insurance vary markedly with age, race and ethnicity among Baby Boomers8. Whites and non-poor have the highest use of care, but access is lower among older age-groups making effective prevention difficult.
All older adults need access to care. And care must be “appropriate” as suggested by the Seattle Care Pathway15. Oral health care must be integrated and involve other professional and family caregivers as needed. As older adults age and become frail or dependent, the primary focus needs to shift to maintenance and prevention. As Baby Boomers age, survivors are more likely to become frail and/or dependent. Impending dependency will affect oral hygiene and oral health. The Seattle15 and Lucerne Care16,17 pathways and the ‘Mouth care without a battle’18 processes were developed to guide dental professionals in their approaches to care15–18.
A lifecourse approach to oral health care is warranted. Only by regular access and preventive care throughout life can avoidable, unnecessary, overly complex, and invasive procedures be prevented. As suggested by the NIDCR Report, “a policy that mandates dental coverage in Medicare would reduce health inequities by assuring access to preventive and other oral health services for all older adults5.” This includes all Baby Boomers.
Conclusion
A lifecourse approach including effective prevention up to and including old age is key to oral health for aging Baby Boomers. Data from NHANES, NCI, HRS, and IHS and the NIDCR 2021 Oral Health in America Report show that oral health of older adults has improved over the last six decades. And yet “many older Americans (aka Baby Boomers) experience poor oral health… Better oral health and oral health care for older Americans is achievable and critical to avoid new and recurrent oral diseases, to maintain dignity and quality of life, and to ensure general health and well-being throughout life5.”
Acknowledgements and Funding
Health and Retirement Study. Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number U01AG009740), Ann Arbor, MI.
Analyses were supported by the NIH/National Institute of Dental and Craniofacial Research, grant number 1 R03DE030161-01. Publicly available data are online at the Health and Retirement Study website: https://hrs.isr.umich.edu/data-products.
Footnotes
Declaration of Conflicting Interests
The authors declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article.
References:
- 1.Wikipedia. GI Bill. https://search.yahoo.com/search?fr=mcafee&type=E211US739G0&p=GI+Bill. Accessed 12/12/22. [Google Scholar]
- 2.America counts staff. 2020. Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers. 12/10/2019.https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html. Accessed 12/12/22. [Google Scholar]
- 3.Hotchkiss M, Phelan J. Uses of Census Bureau Data in Federal Funds Distribution. Issued September 2017, Version 1.0. U. S. Department of Commerce, Economics and Statistics Administration. U.S. Census Bureau. 2020. Accessed 12/12/22. [Google Scholar]
- 4.Sonnega A, Faul JD, Ofstedal MB, Langa KM, Phillips JW, Weir DR. Cohort Profile: the Health and Retirement Study (HRS). Int J Epidemiol. 2014. Apr;43(2):576–85. doi: 10.1093/ije/dyu067. Epub 2014 Mar 25. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.National Institutes of Health. Oral Health in America: Advances and Challenges. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2021. https://www.nidcr.nih.gov/research/oralhealthinamerica. Accessed 2023 1/9. [Google Scholar]
- 6.National Health and Nutrition Examination Survey, Centers for Disease Control and Prevention, public use data, 1988–1994, 1999–2004, 2011–2014. 2021. https://www.cdc.gov/nchs/nhanes/index.htm. Accessed July 14, 2021.
- 7.National Institute of Dental and Craniofacial Research. Oral Cancer. 2021. https://www.nidcr.nih.gov/health-info/oralcancer. Accessed November 1, 2021.
- 8.Kramarow EA. Dental care among adults aged 65 and over, 2017. NCHS Data Brief, no 337. Hyattsville, MD: National Center for Health Statistics. 2019. [PubMed] [Google Scholar]
- 9.National Cancer Institute. Cancer Stat Facts: Oral Cavity and Pharynx Cancer. 2020a. https://seer.cancer.gov/statfacts/html/oralcav.html. Accessed June 13, 2021.p.3B–10.
- 10.Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey Overview. National Health and Nutrition Examination Survey Overview; (cdc.gov). Accessed 1/4/23. [Google Scholar]
- 11.Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009–2014. J Am Dent Assoc. 2018; 149(7): 576–588.e6. doi: 10.1016/j.adaj.2018.04.023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Phipps KR, Ricks TL, Mork NP, and Lozon TL. The oral health of American Indian and Alaska Native adult dental clinic patients 35 years and older – a follow-up report to the 2015 survey. Indian Health Service data brief. Rockville, MD: Indian Health Service. 2022. [Google Scholar]
- 13.Kressin NR, Jones JA, Orner MB, Spiro A 3rd. A new brief measure of oral quality of life. Prev Chronic Dis. 2008. Apr;5(2): A43. Epub 2008 Mar 15. [PMC free article] [PubMed] [Google Scholar]
- 14.Jones JA, Fedele DJ, Bolden AJ, Bloom B Gains in dental care use not shared by minority elders. J Pub Health Dent. 1994; 54(1):39–46. [DOI] [PubMed] [Google Scholar]
- 15.Pretty IA, Ellwood RP, Lo EC et al. The Seattle Care Pathway for securing oral health in older patients. Gerodontology. 2014;31(Suppl 1):77–87. [DOI] [PubMed] [Google Scholar]
- 16.FDI World Dental Federation. Oral health and the United Nations Political Declaration on NCDs: A guide to advocacy. Geneva, Switzerland: FDI World Dental Federation; 2012. https://www.fdiworlddental.org/sites/default/files/2020-11/oral_health_and_un_political_dec_on_ncds.pdf. Accessed July 13, 2021. [Google Scholar]
- 17.FDI World Dental Federation. Roadmap for healthy ageing. Geneva, Switzerland: FDI World Dental Federation; 2018. https://www.fdiworlddental.org/resource/roadmap-healthy-ageing. Accessed June 4, 2021. [Google Scholar]
- 18.Zimmerman S, Sloane PD, Cohen LW, Barrick AL. Changing the culture of mouth care: mouth care without a battle. Gerontologist. 2014. Feb;54 Suppl 1:S25–34. doi: 10.1093/geront/gnt145. [DOI] [PubMed] [Google Scholar]