“In the 1960s, when New Zealand adults smiled, they often displayed a set of dentures” (Te Ara).
A key finding from the 1976 national oral health survey was that New Zealand had one of the highest prevalences of total tooth loss (edentulism) in the world. Adults had very high rates of extraction of permanent teeth, and over one-quarter of the population aged 35–44 had lost all of their natural teeth. Over 80% of adults aged 65 plus had lost all of their natural teeth. Almost half of all adults had some type of denture.
Since then, the focus of dental care and oral health has changed from pulling out decayed teeth to filling, restoring and improving the appearance of natural teeth, as well as efforts to prevent decay and gum disease in the first place. New Zealand has gone from having one of the highest levels of oral disease in the Western world to a low disease level in children and marked reductions in tooth loss in all but the oldest age group.
This means that more and more people are entering old age with their own teeth, rather than full dentures. Given this, and the ageing of the population as a whole, means that the demand for oral health services is likely to increase and to be substantial.
Professor Murray Thomson University of Otago says poor oral health in older people is a “major clinical and public health problem which is going to get worse”.
“In some ways, dentistry has been a victim of its success – we have long emphasised the idea of ‘teeth for life’ without much thought to what happens towards the end of life”. 
Why is this important? Dental problems can lead to health problems
Good oral health benefits both individuals and society, yet oral diseases are among the most prevalent chronic diseases in New Zealand and represent a considerable public health burden. Oral health refers not only to the absence of tooth decay and gum disease but also to the contribution made to overall health and wellbeing, and quality of life. Greater rates of tooth decay can result in dental and facial infections, malnutrition and difficulties in communication. There is international evidence of the links between periodontal disease and cardiovascular disease, diabetes and other chronic illnesses.
What do we know about the oral health of older New Zealanders?
The 2009 New Zealand Oral Health Survey (NZOHS) (published by the Ministry of Health in 2010) provided some insight on the oral health of the ‘usually resident older New Zealanders living in private dwellings’, but older adults in residential care facilities were not included in this survey.
The 2012 New Zealand Older People’s Oral Health Survey (OPOHS) was the first nationwide survey to collect information on the oral health of people living in residential care and those aged 65 years plus living in their own homes but requiring assistance for their day-to-day living.
In 2012, just over half of all older adults in both living arrangements had lost all of their natural teeth. There were concerning levels of untreated decay and many vulnerable older people experience a significant burden of oral disease and unmet treatment need.
One third of dentate (meaning having their own teeth) older people in residential care and one in five living in their own homes reported having difficulty cleaning their teeth. The majority usually visited a dental professional only when they had a problem, rather than for routine check-ups. Cost hindered access to oral health services for 17% living in residential care and 32% living in their own home. Other reasons for not visiting a dental professional in the previous year were difficulties in accessing services and a perceived lack of problems.
Disparities in oral health and access to services
The study findings indicated that older people in residential care experience poorer oral health than those living in their own homes. They were more likely to require extractions and less likely to access oral health services.
Older men were less likely to be edentulous than older women. However, the oral health of dentate older men was poorer than for older dentate women. Subsequently, they had greater actual treatment need. Older men also had poorer self-care and self-reported oral health.
Older Māori, Pacific people, and older adults of lower socioeconomic status shared problems with accessing oral health services and cost was a significant barrier for these groups, who also had high levels of unmet need, making them key priority groups in New Zealand’s oral health strategy.
Since these surveys were undertaken only “slow progress” is being made according to clinical commentators. Our Older People’s Oral Health, published in December 2015, urged critical policy development around older people’s oral health
“It’s a very complex situation involving a lot of players – the aged care sector, the Ministry of Health, the dental profession, and the public. An encouraging sign is the inclusion of oral health in the Healthy Ageing Strategy. That’s a starting point, but there is a lot of work to be done.”
The Healthy Ageing Strategy sets out plans to improve oral health in all community and service settings, developing clinical pathways for optimal dental care through to the end of life; and providing information and advice on dental care to aged care providers and older people’s families and carers. Let’s hope this leads to speedy implementation.
The “AWESSoM”proposal – Ageing Well through Eating, Sleeping, Socialising and Mobility,
Given this background it is good to see that the National Science Challenge – “Ageing Well” has funded a research programme, which aims to optimise healthy ageing, maintaining function and independence. This includes co-designed strategies to increase activity, improve nutrition, improve oral health and enhance social support and networks.
It recognises the importance of oral health in maintaining overall wellbeing. Self-management will be prompted, and delivery of health and social services improved for Maori, Pasifika and non-Maori non-Pacific older New Zealanders. We have great hopes for this research initiative.
 Research paper: ‘Oral status, cognitive function and dependency among New Zealand nursing home residents’ by W. Murray Thomson, Moira B. Smith, C. Anna Ferguson, Ngaire M. Kerse, Kathryn Peri, Barry Gribben. Gerodontology 35(3), p. 185-191, September 2018.