Promoting Dental Health for Older Adults: Strategies and the Health Belief Model

Oral health is crucial at every age, but for older adults, maintaining good dental hygiene is especially significant. As we age, oral health can impact physical wellness, nutritional intake, and overall quality of life. Older adults are particularly vulnerable to a range of oral health issues, including gum disease, tooth loss, dry mouth, and oral cancer, which can complicate other health conditions (Badewy et al., 2021). This post explores dental health promotion as it applies to older adults, considering how the Health Belief Model (HBM) can guide effective strategies for behavior change and oral health maintenance in this population (Haller et al., 2007).

Dental Health in Older Adults: Importance and Challenges

Older adults face unique challenges in dental health. Aging brings physiological changes, such as reduced saliva production, weakening enamel, and a higher likelihood of gum recession. These changes increase the risk of cavities, infections, and oral diseases. For example, dry mouth, often a side effect of medications commonly prescribed to older adults, can lead to an increased risk of tooth decay and discomfort. Additionally, adults with limited dexterity or cognitive decline may find it challenging to maintain regular oral hygiene routines, which can lead to tooth loss, discomfort, and even nutritional deficiencies if chewing becomes painful or difficult (Badewy et al., 2021).

Beyond physical health, oral health can also affect social well-being. Conditions like tooth loss and gum disease impact confidence and social engagement, potentially leading to isolation and reduced mental health in older adults. Considering that about 20% of adults aged 65 and older have untreated tooth decay (NIDCR, 2021) and 68% have gum disease (Petersen & Ogawa, 2018), promoting effective dental health strategies is essential for this population.

The Health Belief Model: A Framework for Promoting Oral Health in Older Adults

The Health Belief Model (HBM) is a psychological model used to predict and encourage health behavior change. Originally developed in the 1950s, the HBM has been widely applied to various health promotion efforts. The model suggests that an individual’s willingness to engage in a health behavior, like regular oral hygiene practices, is influenced by their perceptions of certain key factors (Alyafei & Easton-Carr, 2024):

• Perceived Susceptibility: Belief in the likelihood of experiencing a health problem

• Perceived Severity: Belief in the seriousness of the condition and its potential consequences

• Perceived Benefits: Belief in the advantages of adopting the health behavior

• Perceived Barriers: Belief in the obstacles to performing the behavior

• Cues to Action: External prompts or reminders to perform the behavior

• Self-Efficacy: Confidence in one’s ability to perform the behavior

Using the HBM in dental health promotion for older adults involves addressing each of these factors to encourage healthy oral hygiene habits.

1. Perceived Susceptibility and Severity

Many older adults may underestimate their susceptibility to oral health issues or view dental problems as inevitable with aging. Educating them about the specific risks of poor oral health and the impact of conditions like gum disease or dry mouth can help build awareness. Health professionals can share statistics about the prevalence of dental issues in older adults and explain the link between oral health and chronic diseases like diabetes and cardiovascular disease. When older adults recognize the potential severity and consequences of dental issues, they are more likely to engage in preventive behaviors.

2. Perceived Benefits

Highlighting the benefits of regular oral care can motivate older adults to take preventive action. For instance, maintaining oral health can reduce the risk of infections, improve comfort while eating, and support overall wellness, making it easier to enjoy a varied diet and stay socially active. Health professionals should emphasize that simple practices, such as daily brushing, flossing, and regular dental check-ups, can lead to significant benefits in oral health and quality of life.

3. Perceived Barriers

Older adults may face specific barriers to dental care, including limited mobility, cost of dental visits, and lack of insurance coverage. By identifying these obstacles, health professionals can help patients find solutions, such as recommending adaptive tools like electric toothbrushes or referring them to low-cost dental services. Addressing perceived barriers helps reduce feelings of discouragement and makes oral health goals feel achievable.

4. Cues to Action

Cues to action are external reminders that encourage individuals to maintain health-promoting behaviors. For older adults, these might include setting a routine for brushing and flossing, using medication reminders to signal when it’s time to brush, or receiving reminders from caregivers or family members. Additionally, healthcare providers can schedule follow-up calls or messages to remind patients of the importance of dental appointments.

5. Self-Efficacy

Self-efficacy, or the belief in one’s ability to successfully perform a behavior, is particularly important for older adults who may face physical limitations. Empowering them with simple, manageable steps and showing them adaptive tools, such as flossing aids or mouthwashes, can boost confidence. Health professionals can offer in-office demonstrations or share online videos to help older adults build these skills.

Evidence-Based Strategies for Promoting Dental Health in Older Adults

In addition to applying the HBM, several practical strategies have been shown to improve oral health outcomes in older adults. These include:

Community Dental Programs: Programs that bring dental care into senior centers, assisted living facilities, and low-cost community clinics help bridge the access gap for older adults who face mobility or financial barriers (ADA, n.d.).

Fluoride and Antimicrobial Mouth Rinses: Older adults can benefit from using fluoride rinses to strengthen enamel and antimicrobial rinses to reduce gum disease risk, especially those with limited dexterity who may struggle with flossing.

Education and Training for Caregivers: Educating caregivers about the importance of oral hygiene and how to assist with brushing and flossing can enhance the quality of care for older adults who may rely on assistance (Gibson et al., 2022).

Telehealth Consultations: Telehealth options can provide older adults with guidance on their oral health needs and facilitate consultations when in-person visits are not feasible (Ben-Omran et al., 2021).

Research Gaps and Future Directions

While there are established methods for promoting oral health in older adults, research is still needed on the most effective ways to sustain behavior change. Long-term studies that examine the impact of dental health education on older adults' oral health outcomes are limited. There is also a need to explore personalized approaches that address diverse cultural, economic, and cognitive factors influencing oral health behaviors in aging populations.

Conclusion

Promoting dental health in older adults requires addressing unique challenges associated with aging, from physical limitations to increased susceptibility to oral diseases. By applying the Health Belief Model, health professionals can better understand and address the perceptions and barriers older adults may face in maintaining their oral health. Through targeted education, adaptive tools, and accessible community resources, older adults can be empowered to prioritize oral hygiene, preserving both their physical and social well-being as they age.

References

ADA. (n.d.) Community dental health coordinator. American Dental Association. https://www.ada.org/resources/community-initiatives/action-for-dental-health/community-dental-health-coordinator

Alyafei, A., & Easton-Carr, R. (2024). The health belief model of behavior change. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK606120/

Badewy, R., Singh, H., Quiñonez, C., & Singhal, S. (2021). Impact of poor oral health on community-dwelling seniors: A scoping review. Health Services Insights, 14, 117863292198973. https://doi.org/10.1177/1178632921989734

Ben-Omran, M., Livinski, A., Kopycka-Kedzierawski, D., Boroumand, S., Williams, D., Weatherspoon, D., Iafolla, T., Fontelo, P., & Dye, B. (2021). The use of teledentistry in facilitating oral health for older adults. The Journal of the American Dental Association, 152(12), 998-1011.e17. https://doi.org/10.1016/j.adaj.2021.06.005

Gibson, G., Wehler, C., & Jurasic, M. (2022). Providing effective dental care for an ageing population. International Dental Journal, 72(4), S39–S43. https://doi.org/10.1016/j.identj.2022.06.011

Haller, D., Sanci, L., Sawyer, S., & Patton, G. (2007). Do young people’s illness beliefs affect healthcare? A Systematic review. Journal of Adolescent Health, 42(5), 436–449. https://doi.org/10.1016/j.jadohealth.2007.09.013

National Institute of Dental and Craniofacial Research(US). (2021). Oral health across the lifespan: older adults. Oral Health in America - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK578296/

Petersen, P., & Ogawa, H. (2018). Promoting oral health and quality of life of older people - The need for public health action. Oral Health & Preventive Dentistry, 16(2), 113–124. https://doi.org/10.3290/j.ohpd.a40309