Dentist showing diagnosis and treatment plan on digital tablet to a senior woman patient during consultation in a modern dental clinic

Should gerontology be a dental speciality in Canada?

Dentist showing diagnosis and treatment plan on digital tablet to a senior woman patient during consultation in a modern dental clinic
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Geriatric dentistry, also referred to as gerodontics, gerontology, or gerodontology, focuses on providing dental care to older adults, including the diagnosis, prevention, and treatment of various dental issues. This specialized area of dentistry addresses the oral health needs of older adults, considering their unique challenges. Extending beyond the typical boundaries of standard dental specialities is often necessary to ensure optimal dental care for older patients.1

According to the Canadian government, the recent Canadian Dental Care Plan (CDCP) enabled two million Canadian seniors to receive coverage under the CDCP and access the dental care they needed in 2024.2 However, those seeking geriatric dental care often encounter challenges, including limited access to care, a lack of trained professionals, and misconceptions about oral health in older adults.3 There is a pressing need for increased education and awareness among healthcare providers and the public regarding the importance of oral health in older adults.

Notably, Brazil pioneered this specialization in geriatric dentistry twenty-three years ago. Other countries, including New Zealand, Australia and the UK, have established postgraduate Special Care Dentistry programs that include the geriatric population. Due to age-related changes, older adults are particularly susceptible to certain oral conditions, such as dental caries, periodontal disease, and xerostomia caused or exacerbated by polypharmacy. The latter can be addressed through an interdisciplinary approach, as managing the overall health of elderly patients often necessitates tackling the cause of xerostomia instead of merely providing sy mptomatic treatment. Globally, there has been a noticeable shift from infectious diseases to chronic and lifestyle-related conditions, such as cardiovascular disease. Evidence suggests that poor oral hygiene and low-grade periodontal inflammation are linked to an increased risk of cardiovascular disease.4

Furthermore, a bidirectional relationship between diabetes and periodontal disease highlights the need for managing periodontal disease alongside diabetes.5 The elderly may require additional care owing to their complex health needs. Many who require special accommodations have poor oral health status and malnutrition.6,7 Additionally, they may now have serious health conditions that can contribute to aspiration pneumonia, which is exacerbated by poor oral hygiene resulting from decreased dexterity due to reduced mobility and vision issues.8 The primary goal of geriatric dental care is to maintain or restore oral function, enabling older adults to preserve their quality of life and independence.

The geriatric population includes individuals aged 65 and older who may experience physical disabilities and comorbidities and may also be frail and institutionalized due to other debilitating health conditions. Oral diseases and disorders can affect general health, and oral complications associated with many systemic diseases can also reduce the quality of life. The latter refers to the extent to which a person enjoys life’s essential opportunities.9 Oral health is essential for overall health and quality of life. Oral health-related quality of life (OHRQoL) encompasses a range of factors, including oral health, independence, environmental interactions, and the effects of oral pain, self-esteem, and self-care on daily activities. Positive impacts on oral health can empower individuals to navigate and even transform their environments. A Swedish study of people aged 65 and older revealed that those in short-term care experienced worse OHRQoL if they were women and had oral or swallowing issues.10

Moreover, the role of the general dental practitioner is crucial in the early detection of not only dental diseases but also conditions such as oral cancer, where early detection can influence treatment outcomes and survival rates.11 In Canada, those 60 years and older have the highest incidence of oral cancer.12 When oral health is integrated into a common risk factor approach and a multi-sectoral strategy for educating patients about reducing the environmental and behavioural risk factors prevalent in both oral and general health, the costs associated with these diseases can be reduced.13 Additionally, allied healthcare professionals can empower patients through health education once trained in these strategies. Canada has a significant ageing population. The percentage of seniors (aged 65 and over) is projected to increase from 18.5% in 2021 to between 21.6% in a slow-ageing (SA) scenario and 29.8% in a fast-ageing (FA) scenario by 2068.14

Dental students and graduates must receive training to effectively manage this population with compromised airway reflexes, particularly since they may have more complex restorative needs due to the retention of their natural dentition. A recent article by Thompson et al.15 noted that the lack of interest among dental students in this subject may stem from gerodontology not being a recognized speciality and the insufficient remuneration for treating the elderly, who often require complex care. They emphasised that the need for this specialized training has been discussed for decades among the dental community, yet no action has been taken.15 I concur with them and believe that gerodontology should be taught as a separate speciality in schools owing to the value of this multidisciplinary subject, which is needed for dental students to meet the increasing demand for them as future practitioners, given the ageing population in Canada.

Even in Brazil, where the speciality of geriatric dentistry exists, the elderly population has a high need for tooth treatment, periodontal treatment, and prosthetics.16 Their research suggests a need for investment in speciality centres, as the lack of public health dentistry has created a demand for more complex services.16 Further, with the rising demand for dental care among the elderly in Canada and the CDCP’s increased affordability of dental services, dentists must be willing and prepared to treat this demographic. Aspects of gerodontology are included in various components of the undergraduate curricula. However, there is a distinct advantage to offering it as a separate course that provides a more comprehensive understanding of the management of elderly patients, along with clinical exposure. Most undergraduate timetables are already full, making it challenging to find the necessary space. Nevertheless, the future of dentistry is evolving, as a growing number of elderly patients require dental care, highlighting the importance of dentists treating this population safely and effectively.

Potential solutions include establishing a postdoctoral or fellowship program in gerodontology17 and allowing undergraduate students to rotate through a geriatric dental clinic and apply their theoretical knowledge in managing elderly patients. Incorporating clinical components into the undergraduate curriculum enhances students’ confidence in treating this demographic. Further specialization is also required to ensure that staff are adequately trained to implement these changes in the undergraduate curriculum and to meet the needs of the frail and elderly population effectively. This is especially important as faculty may feel uncomfortable supervising undergraduates who treat this population as not having adequately been trained to treat the elderly themselves.15

With eleven years of experience in teaching gerodontology and being the first lecturer in Special Needs Dentistry in Trinidad, I advocate for teaching these subjects as separate courses. As the coordinator of the Caribbean’s only Special Needs Dental Clinic (SNDC), which caters to patients aged 0 to 100 with diverse clinical needs stemming from their medical conditions, I recognize the pressing need for Gerodontology and Special Care Dentistry to be established as distinct, recognised dental specialities in Canada. There is a significant difference in the clinical management of a 65-year-old patient with autism compared to an individual who is wheelchair-bound due to a diabetic amputation.

Throughout my experience teaching undergraduate students and dental residents and hosting medical fellows at the SNDC, I noticed a significant difference in how patients were managed after clinical rotations compared to periods of purely didactic training. The confidence gained through clinical experience enhances the intention to treat patients, which, in turn, influences the type of practice graduates choose and alters future access to care for these vulnerable groups. I strongly advocate for these specialities to be made available to undergraduate dentistry students, allied healthcare professionals, and practicing dentists throughout Canada. This should be done uniformly, incorporating both clinical and theoretical training to address the needs of vulnerable populations effectively. It is remarkable that the dental fraternity has recognized the necessity for pediatric dentistry as a speciality, yet the other end of the ageing spectrum has not received similar priority in geriatric dentistry. 

Oral Health welcomes this original article.

References

  1. Gerodontology (2025). Aims and Scope [online] Available at: https://onlinelibrary-wiley-com.ezproxy.utu.fi/page/journal/17412358/homepage/productinformation.html [Accessed: 4 April 2025].
  2. Canada.ca (2024). Two million Canadian seniors are approved for the Canadian Dental Care Plan. [online] www.canada.ca. Available at: https://www.canada.ca/en/health-canada/news/2024/05/two-million-canadian-seniors-approved-for-the-canadian-dental-care-plan.html.
  3. Matear, D., & Gudofsky, I. (1999). Practical issues in delivering geriatric dental care. Journal (Canadian Dental Association), 65(5): 289–91.
  4. Carrizales-Sepúlveda, E.F., Ordaz-Farías, A., Vera-Pineda, R. and Flores-Ramírez, R. (2018). Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease. Heart, Lung and Circulation, [online] 27(11): 1327–34. doi: https://doi.org/10.1016/j.hlc.2018.05.102.
  5. Borgnakke, W.S. (2019). IDF Diabetes Atlas: Diabetes and oral health – a two-way relationship of clinical importance. Diabetes Research and Clinical Practice, 157;107839. doi: https://doi.org/10.1016/j.diabres.2019.107839
  6. Andersson P, Hallberg IR, Lorefalt B, Unosson M, Renvert S. Oral health problems in elderly rehabilitation patients. Int J Dent Hyg. 2004;2(2): 70-7.
  7. Poisson P, Laffond T, Campos S, Dupuis V, Bourdel-Marchasson I. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology. 2016;33(2): 161-68.
  8. Ghezzi EM, Ship JA. Systemic diseases and their treatments in the elderly: impact on oral health. J Public Health Dent. 2000;60(4):289-96.
  9. Locker D. (1997). Concepts of health, disease and quality of life. In: Slade G, Measuring Oral Health and Quality of Life. Chapel Hill. University of North Carolina: 11-23.
  10. Koistinen, S., Olai, L., Ståhlnacke, K., Fält, A., & Ehrenberg, A. (2020). Oral health-related quality of life and associated factors among older people in short-term care. International journal of dental hygiene, 18(2);163–72.
  11. The Lancet. (2011) Oral Health: prevention is key. Lancet; 377: 463-64.
  12. Laronde DM, Hislop TG, Elwood JM, Rosin MP. (2008). Oral cancer: just the facts. Journal of the Canadian Dental Association.74(3):269-72.
  13. Sheiham, A. and Watt, R.G. (2000). The common risk factor approach: a rational basis for promoting oral health. Community Dentistry and Oral Epidemiology. 28(6): 399-406.
  14. Statistics Canada. (2023). Population Projections for Canada (2021 to 2068), Provinces and Territories (2021 to 2043). Available at: https://www150.statcan.gc.ca/n1/pub/91-520-x/91-520-x2022001-eng.pdf [Accessed: 4 April 2025].
  15. Thompson, L. A., Kaplish, S., Park, S. E., & Chamut, S. (2022). Is dental education meeting the oral health needs of older adults? Journal of dental education, 86(9):1233–41.
  16. Fonesca, F. A., Jones, K. M., Mendes, D. C., dos Santos Neto, P. E., Ferreira, R. C., Pordeus, I. A., & Martins, A. M. (2015). The oral health of seniors in Brazil: addressing the consequences of a historic lack of public health dentistry in an unequal society. Gerodontology, 32(1); 18–27.
  17. Ettinger, R.L. (2010). The development of geriatric dental education programs in Canada: an update. Journal of the Canadian Dental Association.

About the author

Dr. Ramaa Balkaran is a part-time Research Assistant at the University of Toronto and a part-time lecturer at the University of the West Indies School of Dentistry in Trinidad and Jamaica. She has completed postgraduate clinical training in International Developmental Dentistry at the University of Louisville School of Dentistry in Kentucky, USA. Furthermore, she holds a Master’s degree in Public Health, with a specialization in the Management of Health Systems from the University of Liverpool. Currently, Dr Balkaran is the Chair of the Research and Education Committee and a board member of the Canadian Society of Oral Health and Disability (CSDH).