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Elderly dental care reimagined: Global models, Canadian responsibility

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The past two years have ushered in a quiet but consequential evolution in geriatric dentistry or gerodontology, one driven by demographic urgency and sharpened by cross-continental scholarship. From Tokyo to Tübingen, Boston to Bern, leading researchers are shaping a new model of care: less reactive, more anticipatory; less mechanical, more integrative.

Japan, with the world’s oldest population, has taken the global lead in defining and diagnosing oral frailty, a preclinical state of functional decline involving chewing inefficiency, tongue weakness, and dysphagia risk. A consensus by Japan’s Geriatrics and Gerodontology Societies now positions oral frailty as a distinct, modifiable syndrome. This is not mere academic taxonomy, it reframes the clinical agenda: early detection, multidisciplinary rehabilitation, and prevention of systemic deterioration.

Germany’s recent implementation of the “Expert Standard on Oral Health Promotion in Nursing Care” marks a milestone. Yet even as protocols are formalized, studies reveal that institutionalized elders receive significantly less care than their independent counterparts, echoing Canada’s own gaps in long-term care (LTC). The lesson? Policy without implementation is poetry. Integration, not aspiration, is key.

While Switzerland has issued no recent policies, it remains a model of systems-level alignment. With structured insurance coverage, a strong public-private interface, and an ethos of prevention, Swiss dentistry quietly exemplifies what other nations draft in white papers. For Canada, the implication is plain: design matters.

Across the Atlantic, the American literature has moved from intent to introspection. Studies now examine how we educate for aging, not merely if. There is growing consensus: curriculum reform is overdue. Functional assessments, caregiver communication, and cognitive impairment must move from electives to essentials. Canada would do well to follow suit, lest we train for a patient base that no longer exists.

What should Canada do?

The implications are neither exotic nor unattainable. Canada must:

  • Recognize oral frailty as a clinical entity, not an abstract construct.
  • Tailor care to multimorbid, functionally impaired patients; not all older adults are the same.
  • Bridge the LTC chasm with mobile units, teledentistry, and caregiver-trained protocols.
  • Reform education across the dental continuum; Gerodontology must become foundational.
  • Advocate policy change that funds complexity, not just simplicity.

A quiet revolution, if we listen

This is not the era of the heroic full-mouth reconstruction for every octogenarian. It is the era of reasoned compromise, risk-based triage, and quality-of-life metrics. The challenge before us is not technological, it is conceptual. We must unlearn the age-neutral dentistry of yesterday and adopt a model that honours age, complexity, and context. In so doing, Canada can transition from reactive repair to proactive care, anchored in international best practices, and guided by its own quiet strengths. 

Oral Health welcomes this original article.

References

  1. Tanaka T, Hirano H, Ikebe K, Ueda T, Iwasaki M, Minakuchi S, Arai H, Akishita M, Kozaki K, Iijima K. Consensus statement on “Oral frailty” from the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty. Geriatr Gerontol Int. 2024 Nov;24(11):1111-1119. doi: 10.1111/ggi.14980.
  2. Matsumoto, K., Tsutsui, T., Hashimoto, R. et al. Multimorbidity patterns and prevalence among geriatric patients in Japanese hospital dentistry. BMC Geriatr 25, 362 (2025). https://doi.org/10.1186/s12877-025-06012-6
  3. Nitschke I, Schulz F, Ludwig E, Jockusch J. Implementation of the Expert Nursing Standard: Caregivers’ Oral Health Knowledge. Geriatrics. 2024; 9(5):112. https://doi.org/10.3390/geriatrics9050112
  4. Afrashtehfar KI, Jurado CA, guest editors. Advancing Oral Health Care for the Ageing Population: Exploring Gerodontology and Geriatric Dentistry [Special Issue]. Geriatrics. MDPI; 2023-2025. Available from: https://www.mdpi.com/journal/geriatrics/special_issues/535H26A520
  5. Afrashtehfar KI, Jurado CA, Abu Fanas SH, Del Fabbro M. Short-term data suggests cognitive benefits in the elderly with single-implant overdentures. Evid Based Dent. 2024 Jun;25(2):71-72. doi: 10.1038/s41432-024-00999-4.
  6. Pazdziernik D, Stummer H. Acceptability of the Expert Standard for Oral Health Care in Older Adult Patients Among Nursing Staff in German Hospitals and Care Facilities: Protocol for a Cross-Sectional Study. JMIR Res Protoc. 2025 Jun 3;14:e72528. doi: 10.2196/72528.
  7. Weening-Verbree LF, Douma A, van der Schans CP, Huisman-de Waal GJ, Schuller AA, Zuidema SU, Krijnen WP, Hobbelen JSM. Oral health care in older people in long-term care facilities: An updated systematic review and meta-analyses of implementation strategies. Int J Nurs Stud Adv. 2025;8:100289. doi:10.1016/j.ijnsa.2024.100289

About the author

Dr. Afrashtehfar is a board-certified Prosthodontist and clinician-scientist with advanced postgraduate training in Switzerland and Canada. He provides specialist implant-focused care in clinics across Dubai and Canada, and remains actively engaged in academic collaborations throughout Europe and North America. He has held affiliation with the Department of Reconstructive Dentistry and Gerodontology at the University of Bern since 2016.