The rapid growth of the elderly population is redefining approaches to organizing dental care. The National Health Service of England has published a new concept that significantly reorients the planning and organization of oral hygiene services for patients in older age groups. The document reflects a fundamental shift in methodology: instead of planning services based on age, it proposes using the level of functional dependence of the patient. This approach recognizes the fact that chronological age does not determine actual care needs. NHS England identifies three categories of elderly patients according to the World Health Organization’s healthy aging model: functionally independent, frail, and functionally dependent.
Over the past 40 years, the number of English people aged 65 and older has nearly doubled. It is projected that over the next 40 years, the number of people over 80 will increase more than twofold — over 6 million people. Simultaneously, there is a trend toward retention of natural teeth: according to a survey on the state of oral hygiene among adults (2021), 52% of patients aged 75+ have 21 or more natural teeth.
This demographic dynamic creates qualitatively new challenges. Elderly patients often present with intensively restored tooth crowns requiring prolonged ongoing repair. Frequently, concomitant polymorbidity, dementia, polypharmacy (use of multiple medications), reduced dental dexterity, and sensory impairments increase the risk of caries, periodontitis, xerostomia, and poor oral hygiene.
The new concept provides for three levels of care corresponding to medical complexity and functional status: routine care (Level 1); care requiring advanced skills or specialized equipment (Level 2); specialized care (Level 3).
Prevention becomes the central line of the strategy. The document emphasizes the importance of plaque control, the use of fluoride-containing agents, xerostomia management, and general lifestyle recommendations. Special attention is paid to training care personnel — agencies working in home care, staff of care facilities for the elderly, and informal caregivers.
NHS England emphasizes that the majority of elderly patients should remain under care in general dental practice if this is clinically justified. Referral to specialists or institutional care should be determined by the complexity of the clinical case and specific treatment needs — not by age, disability, or frailty per se.
It is proposed to implement a unified clinical complexity assessment tool (Case Mix tool of the British Dental Association) for more consistent triage and referral of patients to the appropriate level of care.
The document points to the need for additional training of dental teams in the field of geriatric dentistry (dentistry for the elderly) and management of medically and socially complex cases. Expansion of competencies of auxiliary dental personnel in preventive and clinical programs is required.
NHS England recommends strengthening integration between dental services, primary medical care, pharmaceutical structures, dietetics, social services, and local authorities. It also proposes expanding data exchange for safer and patient-centered treatment planning.
The successful implementation of this concept will depend on the readiness of local health systems to reorient financing and resources, improve staff qualifications, and adapt general dental practice to a model of prevention and long-term supportive care for the growing number of dentate elderly patients.
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