Tooth loss and dental prostheses in the oldest old

Along with the increasing life expectancy is a trend that elderly adults retain their natural dentition until later in life. However, tooth loss and its consequences remain a reality in the geriatric population. Poor oral health and neglect of hygiene measures often lead to rapid decay of the dentition. Multiple comorbidities and the subsequent intake of numerous drugs may cause xerostomia and thus accelerate tooth loss. Bacterial plaque also constitutes a risk for aspiration pneumonia. The relations between tooth loss and the psychosocial well being, general health, chewing efficiency and mortality are well documented but the underlying mechanisms are not fully understood yet. The slow and gradual loss of chewing function often leads to an unnoticed change in diet by avoiding foodstuffs, which are difficult to manage. This is of particular concern in malnourished geriatric patients. Not every missing tooth needs replacement, but restorative dental treatment remains frequent among the oldest old. Well-made dentures help increasing the patient's oral health related quality of life and optimize oral function. Restorative dental treatment should be complemented by nutritional counseling to improve nutritional intake. Once fitted, dentures need to be closely monitored for retention, stability, structure and hygiene. Progressing alveolar ridge resorption may require a denture reline. Furthermore, pathologies of the oral mucosa demand regular dental check-up visits. In edentate oldest old, well-made dental prostheses may play a key role in limiting morbidity and supporting successful ageing.