Keynote Address: The Impact of Tooth Loss in Late Life

Tooth loss is still a reality in old age, but tends to occur later in life. The dental profession is therefore confronted with more challenging prosthodontic cases where difficult anatomical conditions, poor motor co-ordination and reduced neuroplasticity are predominant and often accompanied by frailty and multiple chronic diseases. Dental prostheses often fail to fully restore oral function, which leaves denture wearers with a compromised chewing function, indirectly affecting their food selection. These shortcomings might also contribute to a lack of training and thus enhance chewing muscle waste. It may furthermore decrease the neuronal activity and blood flow in the brain and an association to a decline in cognitive function is suggested in the literature. Restorative measures for edentulous patients comprise implant-supported overdentures or fixed dental prostheses which can alleviate some aspects of functional impairment, pain and discomfort and provide a positive effect on psychological and social aspects. However, their acceptance is limited in an aged, edentulous population. A recent RCT extended their indication to very old patients depending on help for the activities of daily living. Compared to a reline, implant-supported overdentures provided significantly higher denture satisfaction, but raised concerns for a close follow-up when further functional decline and frailty aggravate denture handling and oral hygiene. The impact of tooth loss in late life is significant and can to date only partly be reversed by restorative means.