Challenges to achieve adequate oral health for older adults in low- and middle-income countries

This article is published in Open Access under the Creative Commons Attribution license, which allows use, distribution, and reproduction in any medium, without restrictions, as long as the original work is correctly cited. For decades, investment in research and public policies related to oral health and geriatric dentistry were neglected, and billions of people currently lack access to prevention and treatment of oral diseases.1-3 According to the World Health Organization (WHO), almost half of the world’s population (3.5 billion people) suffers from oral disease, and its burden globally is about 1 billion higher than those from mental disorders, cardiovascular disease, diabetes mellitus, chronic respiratory diseases, and cancers combined.2 Given that most oral diseases are preventable and can be treated in their early stages,4 and that oral health affects essential abilities (such as speaking, smiling, tasting, swallowing, as well as conveying a range of emotions through facial expressions), its implications for health, well-being, and quality of life are clear, particularly in the oldest old living in lowand middle-income countries (LMIC) and those living in long-term care facilities (LTCF).3,5,6 The impact of poor oral health in older adults reflects profound imbalances among countries, mainly attributable to differences in socioeconomic conditions and the availability of and access to oral health services.2,7 Utilization of dental care is low, especially among those from low-income populations.2,6 Barriers may include the inability to perceive a need to visit the dentist, fear, anxiety, past negative experiences, and lack of awareness of dental problems. Sometimes, the need for dental care is perceived only in persons with natural teeth, while edentulous individuals believe they no longer need such care. To foster and promote access to health services that include comprehensive oral health care, it is essential to understand that oral care incurs high out-of-pocket costs for individuals and their families, notably in LMIC, which are not usually reimbursed or co-financed by the government. The impetus to prevent oral health disorders has only recently prompted educational efforts (e.g., in schools) seeking to modify practices rooted in decades of neglect of oral self-care;8 as a result, most older adults did not have access to prevention and education practices for oral health care.9 The delivery of oral health care largely depends on highly specialized services and providers, expensive equipment, and technologies which may not be well integrated into primary health care models.4 In addition, most LMIC have deficient information and surveillance systems and low priority for developing research and policies that add to public health and oral health.4 For this reason, a Universidade Estadual Paulista – Botucatu (SP), Brazil.