Making the Right to Oral Health a Reality for Older Adults

The global population of older people is growing exponentially. By 2050, 25% of the world's population – around 2 billion people – will be over 60 years old. The UN estimates that regional life expectancy is now approaching 65 years in Africa and between 75 and 80 years in Asia, Europe, North America, Latin America and Oceania.¹ Thus, it is imperative that we strengthen the capacity of society to ensure that older people can live with dignity and security. The keys to success in this endeavour are the development of a sustainable social security system that provides integrated health and long-term care services, secure and long-term funding for these services, and the continual accumulation of scientific evidence.

Oral function is an essential component of health and wellbeing. Universal health coverage (UHC) systems must include the coverage of dental care; this is an urgent global challenge. Ageing leads to a decline in the physical and mental functions needed for daily living, as well as increasing vulnerability to disease. In the oral cavity, loss of teeth, decline of chewing and swallowing functions, and reduced saliva production often occur. The systemic and oral health effects of ageing have a reciprocal relationship, affecting each other in a vicious cycle. This is particularly observable when it comes to chewing function, undernutrition and frailty, as well as oral health-related quality of life (QOL) and decline of social participation. Maintaining good oral health is crucial for lifelong QOL; good oral health contributes to the prevention of noncommunicable diseases (NCDs), cognitive decline and frailty. Good oral hygiene helps prevent dental caries, periodontal diseases, tooth loss and oral functional decline, thereby contributing to healthy longevity. Oral health directly affects the ability to eat, talk and smile, which are essential functions for QOL. Receiving oral health care services must therefore be considered a universal right in all countries and regions.

The above realisations, which arose from the accumulation of scientific evidence, were top of mind as participants gathered at the 2015 World Congress on Dental and Oral Health Care for Healthy Longevity in Tokyo, hosted by the Japan Dental Association and co-organised by WHO. On the last day of that Congress, the Tokyo Declaration was adopted and disseminated to the world.² The purpose of the Declaration was to alert the world to the importance of the right to receive dental care and oral health services in the context of ageing societies, especially in light of the contribution of oral health to the prevention of NCDs and frailty; to emphasise the importance of evidence accumulation and evidence-based policy; and to encourage the various countries and regions to share their challenges and work toward solutions through discussions with each other.

Following the World Congress and the Tokyo Declaration, a partnership was established between FDI and GC International, leading to the launch of the Oral Health for an Ageing Population (OHAP) project. The work is supported by a task team that discusses, provides information and makes recommendations on oral health in an ageing society. Since its inception the, the task team has completed Season I (2016-2019) and Season II (2020-2024) and has now initiated Season III (2024-2027), with 2025 marking the 10th anniversary of the project.

OHAP Season I produced a guide for managing the dental treatment of older adults, an oral health care pathway for older people, and a roadmap for healthy ageing, all of which are available through the FDI website.³ Season II focused on preventing the decline of oral function through a people-centred approach. This was accomplished by developing and disseminating a web application to assist dental professionals in assessing frailty and oral frailty, as well as by publishing a brochure to help individuals perform exercises to prevent oral functional decline. To achieve these objectives, OHAP has surveyed national dental associations, published supplementary issues of IDJ, organised symposia at FDI's annual World Dental Congress and conducted webinars.

Season I focused on evaluating the current situation and creating awareness-raising media. Season II increased interest and the number of practitioners working to improve oral function through the development of media applications. The objective of Season III is to facilitate the implementation of community oral health screenings that are linked to effective oral care services in each country and region, as well as to accumulate and share best practices (“success stories”). A future challenge for the task team will be to implement a system for ongoing evaluation and monitoring.

The health challenges of older people and the trends in oral health issues and initiatives, including the burden of oral diseases, have been significant global developments over this past decade. The following describes critical reports on global ageing and health.

In 2015, the WHO published the World Report on Ageing and Health, proposing a public health framework for healthy ageing. This report stated that as people age biologically, they become more susceptible to disease, and their risk of frailty increases, along with the likelihood of developing conditions that require long-term care. This naturally heightens the need to provide healthcare and long-term care services, as well as a barrier-free living environment and a robust social support system, to maintain intrinsic and functional capacities.

Also in 2015, the 2030 Agenda for Sustainable Development was adopted at the UN Summit. The Sustainable Development Goals (SDGs) established in that document are international targets for the period 2016–2030 across 17 areas, ranging from poverty, hunger, and education to climate change and environmental protection. Health-related issues are outlined in Goal 3, ‘Health and well-being for all’. The specific targets most relevant to the field of oral health are: (1) prevention and control of NCDs and (2) establishment of universal health coverage (UHC), a system where everyone has access to health services at a cost they can afford.

In January 2019, the WHO published the Integrated Care for Older People (ICOPE) Guidance for Person-Centred Assessment and Pathways in Primary Care handbook. This handbook assists in setting person-centred goals, screening for loss in various domains of intrinsic capacity, and assessing health and social care needs to develop personalised care plans.

In 2019, the WHO World Health Assembly extended the Global action plan for the prevention and control of NCDs 2013–2020 to 2030 and called for the development of an Implementation Roadmap 2023–2030 to accelerate progress on preventing and controlling NCDs. The roadmap supports actions to achieve a set of nine global targets that have the greatest impact on the prevention and management of NCDs. The UN defined oral disease as an NCD in a 2011 resolution and specified that oral health coverage should be included in UHC in a 2019 resolution.

The need for global action on oral health has received unprecedented attention and is at a tipping point.⁴ The pertinent facts regarding global oral health are as follows: (1) many oral diseases are preventable; (2) oral diseases have high prevalence and a lifelong impact on people's health; (3) dental and oral health services are still not included in UHC in many countries, which means that dental care and preventive services are often unaffordable; and (4) many oral diseases share common risk factors with other NCDs.

An estimated 3.5 billion people worldwide have oral diseases, and according to the Global Burden of Disease Study; untreated dental caries in permanent teeth ranks first in prevalence among all diseases. Severe periodontal disease ranks sixth, untreated dental caries in deciduous teeth ranks tenth, and severe tooth loss ranks 36th. The prevention of oral diseases promotes food intake, communication, social participation, and general health maintenance, which are requirements for maintaining well-being throughout one's life.⁵

Against the above backdrop of evidence, WHO policy on oral health has made significant progress as described below.^6,7

• •In 2021, the Resolution on oral health was adopted at the 74th World Health Assembly (WHA 74.5).
• •In 2022, the Global strategy on oral health (WHA75.11) was published as a follow-up to the political declaration of the third High-Level Meeting of the General Assembly on the prevention and control of NCDs. WHO also published the Global oral health status report: towards universal health coverage for oral health by 2030.
• •Building on the strategy, in 2023 WHO outlined a comprehensive action plan for improving oral health surveillance, data collection, and monitoring to inform decision-making and advocacy, including a framework for tracking progress. In 2024, the WHO released the combined Global strategy and action plan on oral health 2023–2030.
• •In 2024, the first-ever global oral health meeting highlighted the goal of achieving universal health coverage by 2030, with the launch of the Bangkok Declaration: No Health Without Oral Health.

However, despite this policy trend regarding oral health in a global ageing society, progress remains far from satisfactory. There are significant challenges in addressing older people's oral health under UHC, highlighting the crucial role of the OHAP project.

Oral disease is highly prevalent all worldwide, regardless of a nation's economic development, and older adults are particularly susceptible. The need for universal access to oral health services is growing rapidly in low-, middle-, and high-income countries; however, resource availability—including the quantity and quality of dental professionals and facilities, as well as education—varies greatly both within and among countries.

In light of these challenges, international organisations such as the WHO and FDI World Dental Federation (FDI) are encouraging researchers and policymakers to establish monitoring systems in each country and share this information globally. By analysing this data, each country can effectively plan, implement, and improve its own oral healthcare programmes, policies, and evaluation frameworks. This information can, in turn, be shared globally, feeding a cycle of continuous improvement.

The global oral health monitoring system envisioned here represents a departure from the unidirectional model, which is characterised by a flow of information from high-income to low- and middle-income countries. Instead, it proposes a multidirectional information-sharing cycle designed to benefit all countries. This approach, which accommodates natural variations among nations in the pace and method of adoption, is likely to be more efficient in the long term than promoting uniform goals with deadlines that are unachievable for most countries. Additionally, a global repository for data collection and access will be needed.

Such a monitoring system might be based on our 4-step cycle.⁸ Essential to step 1, ‘Needs assessment and monitoring’, are standardised measurement instruments based on common oral health indicators, which can be derived from FDI's definition of oral health: ‘Oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.^9,10

Dental professionals contribute not only to the maintenance of oral health but also to the prevention of NCDs and frailty, with both effects promoting social participation. They achieve this by delivering preventive care, education and treatment at all stages of life, thereby contributing to the prevention and control of dental caries, periodontal disease, tooth loss and oral functional decline. When assessing, diagnosing and treating older adult patients, dental professionals must carefully consider each patient's multimorbidity status and medication regimen, as well as assess their patients’ physical and mental status. They can then proceed to make an objective assessment of gradual changes in oral function due to ageing (oral frailty).

Performing these assessments in outpatient dental clinics is insufficient to improve the early detection of oral functional decline. Given the close and bidirectional relationship between oral and systemic health, dental professionals must increasingly maintain close lines of communication with a variety of other healthcare professionals. An effective way to achieve this is to develop comprehensive community healthcare networks that utilise collaborative assessment systems, or at the very least, information-sharing systems to integrate the efforts of dental clinics, nursing homes and families.

Ageing cannot be stopped, and as society ages, the risk of healthcare-related injustices increases. To combat this, dental professionals must cultivate a heightened awareness of social responsibility and their role in contributing to public health. All countries have limited financial and human resources, but they must take efficient and effective measures to utilise those resources to achieve their public health goals. No matter a country's level of economic and social development, we all need to learn from each other's efforts and mistakes as we each strive to improve our own society.

Conflict of interest

None disclosed.