Oral Health and Rehabilitation Among the Institutionalized Elderly

1.IntroductionIn the last century, the world has witnessed an unparalleled decline in mortality rates, causing a considerable increase among the human population. Increased life expectancy is one of the greatest achievements of mankind. The medical and scientific communities have as their primary objective the continuous maintenance of the quality of life of the senior citizens (Lunenfeld & Stratton, 2013; Veras, 2009; Lutz et al., 2008). Thus, there is an increased incidence of disorders that last for years, with a need for care, treatment and constant medication. This situation is directly associated with aging and therefore, a challenge for both the senior citizen and the family, reflecting an increased burden on health systems and specialized units in the comprehensive care of these patients (Veras, 2009).The World Health Organization (WHO) points to the senior population as an important target for oral health care. The causes of aging, directly or indirectly, increase of-the risk of oral disease development and the presence of problems in the overall health associated with chronic diseases or drug therapy that can be the source of various oral manifestations (Dolan et al., 2005; Ghezzi & Ship, 2000).There are several prevalent oral conditions in geriatric patients: dentition status changes, root caries, periodontal support loss and tooth loss affecting the functional and aesthetic levels. Conditions related to the use of prosthesis, oral lesions, oral malignancy, xerostomia, pain and craniofacial discomfort are also considered frequent complications in the elderly that decrease the quality of life of patients and should be efficiently diagnosed and treated (Shay, 2002; Ghezzi & Ship, 2000).The general deterioration of health as well as the physical and psychological state of the elderly brings us to the need to maintain their quality of life. The preservation of the masticatory capacity and taste, verbal expression and aesthetics are important factors for the personal and social performance of these patients and should be valued and achieved through regular oral health care (Shay, 2002).However, there are several obstacles that stand between the institutionalized elderly and access to oral health care, namely, the high cost of the treatments, the lack of perception of their needs, the lack of education for oral health and the lack of preparation of health professionals (Dolan et al., 2005; Fiske et al., 2000).Within the senior population, individuals from disadvantaged or institutionalized socioeconomic strata may present an increased risk of oral disease development by the fact that there is an association with the presence of a weak general health or some degree of functional limitation (Vargas et al., 2001).The challenge is to overcome the remaining obstacles between the geriatric patient and oral health care and create appropriate strategies and policies that can educate professionals and geriatric doctors and caregivers to improve the oral health of this population (Dolan et al., 2005).The WHO has presented a program to improve oral health in the twenty-first century, which states that oral health must not be confined to the existence of healthy teeth, but also involve the absence of orofacial chronic pain, oral or pharyngeal cancer, lesions in the oral tissues, oral birth defects or other problems or complications that affect the dental, oral and craniofacial tissues (Petersen, 2003).Although oral health should be seen as a whole which surrounds the craniofacial complex, it should not be undervalued as it contributes to the two most prevalent oral diseases in the world, and very common among the elderly - dental caries and periodontal disease. Edentulism, in turn, is still very present in adults over 65 years in many industrialized countries (Petersen, 2003).2. Problem statementDespite advances in preventive dentistry, edentulism and oral diseases remain major public health issues in Portugal, mainly among the elderly. …