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Background: Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems. Aims: The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. Methods: Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. Results: Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. Conclusions: Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Udgivelsesdato: 2001-Aug OBJECTIVES: The aim of this 3-year community intervention trial was to determine the caries preventive effect of sugar-substituted chewing gum among Lithuanian school children, and to assess compliance with the instructions for gum use. METHODS: A total of 602 children, aged 9-14 years, from 28 school classes in five secondary schools in Kaunas, Lithuania, were given a baseline clinical and radiographic caries examination. The schools were randomly allocated to receive one of the following interventions: sorbitol/carbamide gum; sorbitol gum; xylitol gum; control gum; and no gum. Children in the four active intervention groups were asked to chew at least five pieces of gum per day, preferably after meals. The children were reexamined clinically after 1, 2 and 3 years, and radiographically after 3 years. Self-reported compliance was monitored anonymously four times during the study. RESULTS: A total of 432 children were available at the 3-year clinical follow-up examination. The crude mean 3-year caries increments (DMFS--all stages of lesion formation) were 11.8 for the sorbitol/carbamide gum group; 9.0 for the sorbitol gum group; 8.1 for the xylitol gum group; 8.3 for the control gum group; and 12.4 for the no gum group. The adjusted 3-year caries increments were statistically significantly lower in the sorbitol gum group, the xylitol gum group and the control gum group than in the no gum group, whereas no statistically significant difference was seen between the no gum group and the sorbitol/carbamide gum group. Adjusted 3-year caries increments in the xylitol gum group and the sorbitol gum group did not differ statistically significantly from the caries increments in the control gum group. Compliance with the study protocol was better in School C (xylitol gum) than in the other schools. In all schools, compliance decreased over time. CONCLUSION: The results indicate that the caries preventive effect of chewing sugar-free gum is related to the chewing process itself rather than being an effect of gum sweeteners or additives, such as polyols and carbamide.