|DENTAL SCIENCE - REVIEW ARTICLE
|Year : 2015 | Volume
| Issue : 6 | Page : 438-442
India's baby boomers: In driving need for dental care
Savita Dandakeri1, Shilpa Dandekeri2, B Gunachandra Rai3, Nitin Suvarna4, Mallikarjuna Ragher1, Rachana Prabhu5
1 Department of Prosthodontics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
2 Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
3 Department of Oral Surgery, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
4 Department of Conservative and Endodontics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
5 Department of Oral and Medicine, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
|Date of Submission||28-Apr-2015|
|Date of Decision||28-Apr-2015|
|Date of Acceptance||22-May-2015|
|Date of Web Publication||1-Sep-2015|
Dr. Savita Dandakeri
Department of Prosthodontics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The present paper aims to review the literature on increasing health care challenges and needs of a growing Indian geriatric population. It also focuses on the need to overcome the shortfalls in its current oral health status in elderly. This review is based on a PubMed database search engine published in the period from 1990 to 2010 in various dental journals. Different strategies are designed to provide better facilities and easy access of these facilities not only to elderly living in the city but to the one's in rural areas. It is emphasized that geriatric dentistry should be included in the educational systems to help resolve problems of oral health care for the elderly in India.
Keywords: Baby boomers, geriatrics, greying, multifarious encounter
|How to cite this article:|
Dandakeri S, Dandekeri S, Rai B G, Suvarna N, Ragher M, Prabhu R. India's baby boomers: In driving need for dental care. J Pharm Bioall Sci 2015;7, Suppl S2:438-42
|How to cite this URL:|
Dandakeri S, Dandekeri S, Rai B G, Suvarna N, Ragher M, Prabhu R. India's baby boomers: In driving need for dental care. J Pharm Bioall Sci [serial online] 2015 [cited 2020 Jan 24];7, Suppl S2:438-42. Available from: http://www.jpbsonline.org/text.asp?2015/7/6/438/163493
Everyone in the present scenario is prone to oral diseases; but a certain generation is more often linked to these problems than the rest of them. This particular generation is known as the baby boomers. Baby boomers are persons who were born during the demographic post-World War II baby boom between the years 1946 and 1964, according to the U.S. Census Bureau,  these are beginning to bombard dentists with various oral problems. The baby boomers health or the Geriatric health is often neglected and underexplored matter worldwide. Oral health in turn reflects the overall well-being of the elderly population. Conversely, geriatric patients are more proned to oral diseases due to age-related systemic conditions and functional changes. , The major drawbacks in the field of geriatric dentistry are the lack of trained specialists, a unformatted curriculum and monetary matters. For successful treatment, the practitioner must adopt a humanitarian approach and develop a better understanding of the feelings and attitudes of the aged. Prevention and early intervention strategies must be formulated to reduce the risk of oral diseases in this population. In future, it's very important that dental professionals must have a proper understanding and knowledge of the magnitude of the services to be provided to the elderly. This could only be done by the realization by the dental health care professionals and hence by conducting more educational oriented program in geriatric dentistry, which must be started without further delay. This article hence sets out the needs, objectives, scenario, present strategies, and types of dental treatment required by the elderly population. 
The term geriatrics is derived from a Greek word "GERON" meaning, old man "and IATROS" means healer. It is also in relation to Sanskrit word "JARA" which means "old." Elderly can be classified into three groups: ,
- Young old (65-74)
- Older old (75-84)
- Oldest old (>85).
This classification of the elderly is based on chronological age rather than biological age of the person, although the latter makes more sense. Geriatric dentistry is the delivery of dental care to older adults involving diagnosis, prevention and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals. , The major objectives of the geriatric dentistry  are shown in the following schematic representation.
| Demographic Profile|| |
Worldwide, the rate of people aged 60 years and over is growing faster than that of the general population. "Greying" of the world's population is related to decreased fertility rate and increasing longevity.  The proportion of the elderly to total population of India is around 8%  amounting to over 80 million and expected to reach 12% in 2025. The world population of elderly individuals is expected to reach 830 million by the year 2025, of which India alone will contribute to 110 million,  which means one out of every 7 aged persons in the world will be an Indian.
Among the elderly women are of larger proportion (52% of the >60 years and >55% of the >80 years age groups). 80% of the elderly population lives in rural areas. 9% of the elderly live alone or with persons other than their immediate family members. Nearly 75% of the elderly are economically dependent, with the little difference between the urban and rural elderly. Three-fourth of the dependent elderly population is supported by their own family members. 30% of the elderly are below the poverty line. Only 53.5% of the urban elderly and 37% of the rural elderly possess some kind of financial assets. Only 28% of the elderly population is literate (low compared with the national average). 
| Geriatric Health - 'A Multifarious Encounter'|| |
Old age is associated with several risk factors, both general as well as specific to the oral cavity. Hence, geriatric health is a "multifarious encounter". The general risk factors include various systemic problems, drug-induced side effects, and psychological problems. Dental risk factors are the presence of restorations, dry mouth gingival recession, removable partial dentures, and age-related odontometric changes. 
Most of the systemic diseases have oral manifestations, the first sign of which may be noticed by the dental clinician. There are many research studies suggesting the relationship between oral disease and systemic diseases such as cardiovascular disease, diabetes, stroke, respiratory infections, Alzheimer's disease, and other medical conditions. ,
Most of the elderly population is under medications both by prescription and over the counter, which can cause a dry mouth or xerostomia. This in turn would affect the ability to do basic functions like speaking, chewing, and would increase the rate of conditions such as caries, periodontal disease, traumatic ulcers, fungal infections, and reduces denture retention in the edentulous patient. In geriatric dentistry, a dental surgeon will have to take into account the drug regimen that a patient is on and plan their use of prescription and follow-up care accordingly. 
Oral infections have a significant role on morbidity and mortality of medically compromised patients. Elimination of oral infections before initiating radiation therapy, chemotherapy or various cardiac conditions today is the standard of care in most medical institutions and which as to be followed in all dental institutions. ,
| Different Treatment Modalities for Elderly Patients|| |
As the age progresses, their dental needs become progressive, they show rapid signs of deterioration with respect to their orofacial structures.
The treatment modalities are broadly divided into: ,
- Emergency care
- Preventive measures
- Restorative measures.
Active preventive measures suggest oral health-maintaining behavior. Recommended oral self-care consists of tooth-brushing twice daily, use of fluoride toothpaste, daily inter-dental cleaning, and avoidance of sugar. ,, Regardless of dentate status, it is recommended that the elderly make frequent dental visits at least every 6 months for clinical re-evaluation, depending upon their ability to perform oral hygiene. 
Geriatric dentistry excels in restoring or rehabilitating the maxillofacial and its related structures, which includes implants, surgical endodontics, surgical periodontics, esthetic rehabilitation. 
| Problems in Oral Healthcare for the Elderly|| |
In India, the geriatric population suffers from various dental and oral health problems. The different reasons for the increased occurrence of oral health problems in the elderly are as follows: 
- India does not have a well-formatted oral health education regime or prevention programme
- Faulty dietary and oral hygiene practices followed by the old age are the prime factor leading to the prevalence of common dental diseases such as periodontal diseases and dental caries. Edentulousness and meager prosthodontic rehabilitation are the prime problems prevalent among the elderly from the lower socioeconomic groups
- Oral cancer, which is considered a disease of old age, has a high prevalence in India, constituting 13-16% of all cancers. Chewing of tobacco, betel nut and betel quid, inhalation of snuff, and the use of tobacco are common and increase the rate of dental diseases such as severe attrition, abrasion, mucosal lesions, and oral cancer 
- Poor accessibility to oral healthcare facilities in the rural areas and uneven distribution of dental expertise are among the major drawbacks in providing oral healthcare to the elderly in India. 80% of the elderly population resides in rural areas, but the healthcare facilities are meagre and oral healthcare provision is nonexistent in these areas
- Primary Health Centers, the first contact point between patients and doctors, do not have dental surgeons appointed. Only at Community Health Centers and the camps conducted by few of the dental institution, which cater to a population of 120,000 can one have access to dental care. However, sometimes due long distances, difficult geographic terrain, poor roads and, sometimes, lack of an escort often dissuade the elderly from seeking dental treatment
- There are few health insurance schemes. However, they too do not cover dental treatment except in an emergency. In government hospitals, though dental treatment is provided either free or at a nominal cost, there is a long waiting list. Dental treatment in private hospitals and clinics is expensive and not within the reach of most of the elderly
- Lack of awareness and social support may prevent the elderly people accessing healthcare facilities for their oral health problems. The elderly living alone or in institutions simply have very less provision for oral healthcare. The financial support provided by the State government to the destitute elderly is too meagre even for sustenance. Thus, healthcare utilization is out of question and least priority of the elderly.
| Steps to Improve the Problems in Oral Healthcare for the Elderly|| |
A mix of strategies can be planned and regulated so as to effectively reach the geriatric population. First and foremost, the dental professionals should provide a service that is sensitive and caring. The dental team should be cognisant of the life circumstances of these patients and administer treatment plans accordingly. 
Dental educational programs
Dental surgeons should initiate by participating in educational programs, which will enhance its ability to effectively treat and manage the elderly. It is of utmost importance for dental surgeons to be well-trained, understand and compassionate, and to be aware of the special needs of the elderly population. 
Facilities and infrastructure
Dental facilities should be readily accessible to the elderly and private dental clinics or dental institution should be designed for easy access. Some important factors to consider are: 
- Making arrangements for carefully selecting and placing signs to support the independence of the elderly patient
- Providing firm, standard-height chairs with arms for support and ease of use
- Adequate lighting in each room should be provided to reduce any visual disorientation or mental confusion
- To facilitate good communication and access, the dental furniture should be designed accordingly
- In addition, wheelchair patients or those who use walkers are also taken into consideration while providing the dental therapies.
Mass media: Public communication
Educational newsletters and materials regarding dental health care facilities should be circulated and a number of appointment cards and brochures could be printed in extra-large type. Large-print leisure and educational magazines should be kept in the reception room. Articles on geriatric dentistry could be placed in senior's magazines and newspapers, and informative talks given to community groups to demonstrate an awareness regarding the dental needs.
Broadcasting sources such as TV and radio play a major role in spreading knowledge of oral self-care and broadcasting may provide preventive oral health information for the elderly subjects due to their accessibility to these media sources. 
Internet facilities offers a modern way to educate regarding oral health-related information and seems to be more popular. However, this is more commonly seen among older subjects in better-off countries. 
Equipment: Mobile dental service
Portable dental equipment can be used to make the service reach the functionally dependent elderly at home or in nursing homes. 
It's easy to talk about access to care, hold symposia and conferences and write articles about it, and also discuss the matters with the government. However, the inference is that we hold the key in successfully providing the care for this ageing segment of our population. The choice is left to the dentist to lead in the provision of that care, or wait until governments force us to provide it. It is obvious that oral health care to the older population is not a priority in our health care system. Governments are struggling to keep up with rising health costs and growing demand. It is, therefore, incumbent on us, as dental health care professionals, to deal with this need and provide access to care for elderly patients. 
National policy for older persons
In January 1999, the Government of India announced a National Policy for Older Persons, which aimed to provide financial, food, health and shelter security. There were several schemes such as provident funds, pensions, and gratuity, etc., provide financial security in old age. However, there is no social and financial security plan for workers in unorganized sectors such as farm laborers, daily wage earners, etc., The National Old Age Pension Scheme covers only 1% of the elderly population and the amount given is a paltry Rs. 75-150/month. ,
However, the government of India has introduced a new National Health Policy-2002; wherein few initiatives are undertaken to improve the healthcare system; better emphasis on the accessibility to health care facilities, improvising the role of private sectors in delivery of health care, promoting Indian and traditional system of medicine both to preurban and rural masses. Establishing mobile Medicare units by voluntary agencies and insurances both for employees in organized and unorganized sector are promoted. In addition, special rules are set to promote the creation of outdoor and indoor facilities for elderly persons, separate counters are established in government hospitals and priority to elderly persons in admission and treatment. ,
| Oral Healthcare System in India|| |
Oral health services in India are rendered through: ,,
- Government and private institutions
- Private practitioners
- Professionals employed by government, e.g. dentists in defense services
- Dental services are also being rendered in district hospitals and in nursing home with dental wings, etc.
In the present scenario, India has 185 dental schools. Most of them are run by individuals, charitable trusts or are private institutions. Only 39 dental schools are owned by the government. Each year, 12,000 dental graduates, 1160 postgraduates, and 723 each of dental mechanics and dental hygienists come out as qualified personnel.
In the recent past, the Government of India as put forward certain guidelines for starting new medical and dental schools. Only if the new school is started in a peri-urban or rural area the sanction was given. This has been done with the dual purpose of limiting congestion in the cities as well as for the better accessibility to the rural population. This scheme as definitely brought about a slow and steady change in healthcare delivery to the underserved rural population. These colleges have to provide clinical training to dental students and conduct many health care camps to provided special conveyance and free treatment. Since 80% of the elderly reside in rural areas, this scheme is beneficial to them and will help to fill the void in geriatric oral healthcare. ,
| Conclusion|| |
There is a burgeoning demand for oral healthcare among the geriatric population in India. Following steps are to be taken for the overall betterment of general and dental health of the elderly.
These include the following:
- Preserving the oral health of the elderly such that they can maintain adequate physical and psychosocial functions should be the prime focus
- Oral health and its relationship with their overall health should be first understood and also achieved
- The oral health status data must be collected, then planned and then made available to the persons who are in need of it
- Measures should be taken to improve the oral health care strategies in the aged and also keep an eye on the effectiveness of these measures
- Oral health should be incorporated into Routine assessment of the oral health of the elderly by health care staff should be included
- It is important to integrate the curative, preventive, and educational oral health care program into the existing health and educational infrastructure
- Easy access and timely approach to oral health services and to oral hygiene equipments should be available, especially to the rural areas
- Continuous dental educational programs must be organized to improve the skills, attitudes, and knowledge of health professionals and health care workers regarding the oral health of the geriatric patients.
| References|| |
Ellis JS, Pelekis ND, Thomason JM. Conventional rehabilitation of edentulous patients: The impact on oral health-related quality of life and patient satisfaction. J Prosthodont 2007;16:37-42.
Issrani R, Ammanagi R, Keluskar V. Geriatric dentistry - meet the need. Gerodontology 2012;29:e1-5.
Nadig RR, Usha G, Kumar V, Rao R, Bugalia A. Geriatric restorative care - The need, the demand and the challenges. J Conserv Dent 2011;14:208-14.
Persson RE, Persson GR. The elderly at risk for periodontitis and systemic diseases. Dent Clin North Am 2005;49:279-92.
Mulligan R. Geriatrics: Contemporary and future concerns. Dent Clin North Am 2005;49:xi-xiii.
Thomas S. The need for geriatric dental education in India: The geriatric health challenges of the millennium. Int Dent J 2013;63:130-6.
Beers H, Berkow MD. Merk manual of geriatrics. Demographics. Ch.2. Newyork: Wiley, John and Sons, Incorporated; 2000.
Report of Expert Committee on Population Projections for India up to 2001-Registrar General of India, Minister of Planning and Programme Implementation, Government of India, New Delhi; 1998.
Shah N. Geriatric dentistry: The need for a new specialty in India. Natl Med J India 2005;18:37-8.
Long RG, Hlousek L, Doyle JL. Oral manifestations of systemic diseases. Mt Sinai J Med 1998;65:309-15.
Glick M. Exploring our role as health care providers: The oral-medical connection. J Am Dent Assoc 2005;136:716, 718, 720.
Van Loveren C, Duggal MS. Experts′ opinions on the role of diet in caries prevention. Caries Res 2004;38 Suppl 1:16-23.
Brunton PA, Kay EJ. Prevention. Part 6: Prevention in the older dentate patient. Br Dent J 2003;195:237-41.
Yeh CK, Katz MS, Saunders MJ. Geriatric dentistry: Integral component to geriatric patient care. Taiwan Geriatr Gerontol 2008;3:182-92.
Rao DN, Ganesh B. Estimate of cancer incidence in India in 1991. Indian J Cancer 1998;35:10-8.
Matear D, Gudofsky I. Practical issues in delivering geriatric dental care. J Can Dent Assoc 1999;65:289-91.
Otsuni E, Mohl GR. Communicating with elderly patients. Dent Econ 1994;84:27-30, 32.
Chestnutt IG. The nature and quality of periodontal related patient information on the world-wide web. Br Dent J 2002;193:657-9.
Morreale J. In support of geriatric dentistry at the undergraduate level. J Can Dent Assoc 2007;73:149-50.
Vijaya Kumar S. Quality of Life and Social Security of the Rural Elderly. An Indian Council of Social Studies Research (ICSSR) Sponsored Study; 1991.
Shah N. Need for gerodontology education in India. Gerodontology 2005;22:104-5.
Ministry of Social Welfare Document. National Policy on Older Persons. Ministry of Social Welfare Document, Government of India; 1999.
Panchbhai AS. Oral health care needs in the dependant elderly in India. Indian J Palliat Care 2012;18:19-26.
Vivekanand SK. Dental Public Health, Manual of Community Dentistry. 1 st
ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. India; 2004.
Rao TR. National health care programme - Implementation of strategy. In: Textbook of Community Dentistry. New Edition. Chennai: All India Publishers and Distributors; 2004. p. 17-24.