Dental News - Interview: “The oral environment becomes more hostile with age”

Dental Tribune International

Wed. 4. April 2018

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SINGAPORE: Professor Hien Ngo has extensive experience in private practice, research and education. Over the last 30 years, he has been active as an international speaker on cariology, minimal intervention and restorative dentistry. At present, his focus in research revolves around the clinical management of caries, especially in elderly and medically compromised patients and the interactions between glass ionomers and the oral environment. Dental Tribune Online had the opportunity to speak to him about the concept of “lifelong oral health” and the major demographic change in ASEAN countries.

The term “lifelong oral health” was used by the FDI World Dental Federation in one of its policy statements. What does it mean?
Previously, edentulous among older individuals was accepted as a norm. However, with recent advances in preventive and restorative dentistry, the FDI stated, “The goal of reaching old age with a full set of teeth is feasible if preventive measures and oral health care are accessible throughout life.”

The key term here is “throughout life” because a good oral health foundation in childhood is the key determinant of oral health at a later stage in life.
Lifelong Oral Health was the title of a policy statement that was adopted by the FDI General Assembly in August 2017. It identified the four pillars supporting lifelong oral health as oral health promotion, risk assessment, disease prevention and early diagnosis and intervention at all stages of life. These four pillars will form the framework for discussing clinical cases during the Silver Wave symposium at IDEM.

There is a global phenomenon of population ageing on an unprecedented scale. What is the situation in South East Asia?
Ageing is universal and there is no exception among ASEAN countries. It is expected that the percentage of the population aged over 60 will more than double in the next 30 years. By 2050, 2 out of 10 people in the region will be aged over 60. However, the pace of change is much faster in Singapore than in neighbouring countries. It is predicted that by 2050, 4 out of 10 Singaporeans will be over 60 while this ratio will be 2 out of 10 in Indonesia and approximately 3 out of 10 in Thailand and Vietnam.

What are the consequences of this demographic change for oral health professionals?
If you are working in the private sector, it means that a higher portion of your clientele base will be older individuals and most of them will be dentate. As they belong to the baby boomer generation and were born between 1946 and 1964, they grew up during a period of rising living standards after economic prosperity, so their expectations are different from previous generations.

The Australian Institute of Health and Welfare proposed a broad classification for this group: active and capable, limited activity and capability and very limited activity and capability. For the last two groups, you may need to modify your practice to allow accessibility, or there is the option of referring them to specialised public institutions and specialists.

For clinicians, the care pathways for elderly patients are more complex, as damage to their dentition is accumulative, so its manifestation is much more severe later in life. The oral environment also becomes more hostile with age. Root caries, which are rare in younger individuals, are common in the older patients.

When these conditions are coupled with either severe health or mental illness, then referral to a specialist in geriatric dentistry could be required. Gerodontology is now a recognised dental specialty; however, specialists in this field are still not common in ASEAN countries. The engagement of international bodies such as the FDI and WHO on the concept of lifelong oral health will encourage healthy discussions and policy developments to ensure that preventive measures and oral healthcare are accessible.

What is happening in this field during the IDEM conference in Singapore?
Singapore recognised the importance of this major demographic change and has made large investments to ensure that lifelong oral health is delivered to its population.

With the Silver Wave Symposium at IDEM 2018 on Saturday 14 April, there will be a full day dedicated to managing the ageing population and patients. Six international speakers and clinicians will be brought together to discuss the management of oral health issues, of the ageing population, and of older individuals. The day will start with discussions on the changes that were made in the public health and education institutions, then move on to clinical issues. The day will be clinically oriented and discussions will be patient focused. The symposium will be supported by The Silver Wave booklet, which will be distributed during IDEM.

More information about the symposium can be obtained from the congress programme schedule.

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