Number of teeth in relation to oral health behaviour in dentate elderly patients in Lithuania

Aim: To describe oral self‐care practices and the use of dental services among dentate elderly patients attending public dental service in Kédainiai, Lithuania, and relate these parameters to the number of remaining teeth. Design: Cross‐sectional questionnaire study. Setting: Two public dental offices in Kédainiai, Lithuania. Participants: Dentate patients aged 60+. Methods: A self‐administered questionnaire covering oral hygiene practices, use of sugar, utilisation of dental services, and number of teeth. Age, gender, and education served as background factors. Results: In all, 174 dentate elderly people responded, their mean age being 69.2 years (CI 95% 68.2–70.2) and mean number of teeth reported 16.2 (CI 95% 15.4–17.1). Of these respondents, 30% reported that they brushed their teeth twice daily and 57% that they always used fluoridated tooth paste. Having 21+ teeth was strongly associated (p < 0.001) with these habits, with brushing in the evening, and with enrolment in higher education, but not with gender. After controlling for various self‐care and background factors, frequent tooth brushing remained as the only significant factor in the logistic regression model (OR 2.0, CI 95% 1.2–3.3, p = 0.01) to explain subjects’ retention of 21+ teeth. Conclusions: Elderly Lithuanians’ oral self‐care is far from meeting recommendations. To preserve their natural teeth, dentate elderly people should improve their oral self‐care practices, in particular as regards tooth brushing. To reach that goal, all efforts by the community and dental profession are welcomed.     

Factors affecting the motivation for dental check‐ups and anxiety in the elderly in Tokyo

Objectives: The purpose of this study was to identify factors influencing the motivation for regular dental check‐ups and anxiety about future dental problems in the elderly. Background: Regular dental check‐ups are important to maintain oral health. Anxiety affects the quality of life of the elderly. However, few studies have investigated the factors influencing the motivation for regular dental check‐ups and anxiety in the elderly. Materials and methods: Among 452 elderly persons, 215 participants provided useful answers to our questionnaire. The questionnaire consisted of items concerning oral and living conditions of the subjects. Logistic regression analysis was conducted. Results: The mean age of the study sample was 75.7 ± 5.8 years. The percentage of edentulous subjects was 12.1%. The motivation for regular dental check‐ups was significantly positively correlated with the number of teeth present (p < 0.01), using inter‐dental brushes (p < 0.01), being on regular prescribed medication (p < 0.05), and having experience of providing oral care for the bedridden (p < 0.05). Anxiety about future oral problems was significantly associated with self‐rated health status (p < 0.01) and the presence of dentists who could be counted on to provide domiciliary visits (p < 0.05). Conclusion: The participants of this study had a high motivation for regular dental check‐ups, but were concerned about the future, particularly if they became bedridden.     

Utilization of dental health services by community-dwelling older adults in Japan who attended a weekly educational programme

Objectives: The purpose of this study was to describe dental health services utilization and identify factors which influenced a group of independently living elderly persons in an urban area of Japan. Subjects: The study sample consisted of 2,990 participants, 83% of the total sample of the Senior Citizen's College, who were 60 years and over. Measurements: Their dental utilization and satisfaction with dental treatment were measured by a questionnaire from 1993 to 1998 Results: The mean age of the subjects was 66.5 years and 52% were male. Sixty percent of the subjects had visited a dentist within the previous year, and 33% of them had received a regular oral health check‐up. The majority of the subjects (63%) were satisfied with their dental treatment. A multiple stepwise logistic regression analysis showed that dental services utilization had a significant positive association with presence of teeth (p<0.001), being male (p<0.01) and satisfaction with financial status (p<0.05). A regular oral health check‐ups had a significant association with presence of teeth (p<0.001), satisfaction with financial status (p<0.05) and aging (p=0.001). Conclusions: Dental health services utilization was related to the presence of teeth and financial status, rather than age or medical conditions, among independently living elderly persons in an urban area of Japan.     

Periodontal health of older men: the MrOS dental study

Objective: The purpose of this study was to evaluate the prevalence and severity of periodontitis in men of 65+ years and identify demographic and lifestyle factors associated with its presence. Methods: Participants were recruited from the Osteoporotic Fractures in Men Study, a longitudinal study of risk factors for fractures in older men. Dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque and bleeding on a random half‐mouth, plus a questionnaire regarding access to care, symptoms and previous diagnosis. Results: 1210 dentate men completed the dental visit. Average age was 75 years, 39% reported some graduate school education, 32% smoked 20 + pack years and 88% reported their overall health as excellent/good. In terms of periodontal health, 38% had sub‐gingival calculus, 53% gingival bleeding, 82% CAL ≥5 mm and 34% PD ≥6 mm. The prevalence of severe periodontitis was 38%. Significant demographic and lifestyle factors associated with severe periodontitis in multivariate analyses included age ≥75 (OR 1.4, 95% CI 1.1–1.7) non‐white race (OR 1.9, 95% CI 1.3–2.8), less than an annual dental visit (OR 1.5, 95% CI 1.1–2.0), and 20 + pack years (OR 2.1, 95% CI 1.6–2.7). Conclusion: A high proportion of healthy older men have evidence of periodontal destruction which could, given the growing ageing population, have a significant impact on the dental profession’s ability to provide preventive and therapeutic care. The population at highest risk of periodontitis in MrOS is older minority men who smoke and do not have annual dental visits.     

Factors influencing older people's self reported use of dental services in the UK

Objectives: This study was designed to determine the use of dental services and factors associated with their use among the United Kingdoms' older population. Design: A national study involving 1,116 older people (aged 60 or older). Setting: Home Interview s were undertaken exploring the time and reason for last dental visit. In addition, socio-demographic characteristics and proxy oral health measures (self-reported number of teeth and edentulous status) of the respondents were collected. Results: Forty seven percent (528) claimed they visited the dentist within the past year, 10% (116) claimed that the reason for their last visit was because of a dental emergency, 43% (484) were classified as “regular attenders” - having attended the dentist within the past year for a non dental emergency. Bivariate analysis identified that regular dental attendance was associated with age (P<0.01), social class (P<0.01), income level (P<0.01), educational attainment (P<0.01), self-reported number of teeth possessed (P<0.01) and edentulous status (P<0.01). In regression analysis, self reported edentulous status and number of teeth possessed emerged as the most important factors in determining service utilisation. Possessing a full denture was associated with a 6-fold decrease, having accounted for other factors, in the likelihood of attending the dentist within the past year for a non dental-emergency (OR=0.15, CI 0.10,0.21). Conclusion: Less than half of the sample population were “regular dental attenders”, their attendance was associated with a number of socio-demographic and oral health factors. In particular, edentulous state was a major factor associated with their use of services.     

Oral status and its association with obesity in Southern Brazilian older people

Background and objective: The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil. Materials and methods: A random sample of 872 independently living elderly was evaluated by means of a cross‐sectional study. Socio‐demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)²) data. Participants were categorised into non‐obese (BMI ≤ 30) or obese (BMI > 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders. Results: Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18–4.27) and dentate participants with one to eight teeth wearing 0‐to‐1 prosthesis (OR = 2.96, 95% CI 1.68–5.19) were more likely to be obese. Conclusion: The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.     

Factors associated with remaining teeth of older adults in the state of São Paulo,Brazil, 2002

Objectives: The objective of this study was to verify the association between the number of teeth present with socio-demographic and economic variables and with the access to dental services and self-perception of oral health among the elderly. Materials and Methods: The sample was composed of individuals from 65 to 74 years of age, which was representative of the state of São Paulo (n = 781). In this study, the analysis of data considered dentate elderly only, who were divided into two groups: those with one to 19 teeth and those with 20 teeth or more. The chi-squared test was used in the bivariate analysis and the logistic regression was also performed (p < 0.05). Results: Among the 313 dentate elderly, 235 (75.1%) presented one to 19 teeth. The average number of teeth was 9.5 for the elderly with fewer teeth and 25 for those with more teeth. In the bivariate analysis, all variables related to the access to dental services were associated and the chances of having less teeth was among elderly who did not visit the dentist for a long time and among those who sought public dental services and did not receive information on how to avoid oral problems. In addition, the elderly who classified their speech as not good were those who presented with fewer teeth. Conclusion: Most subjects presented one to 19 teeth and this fact was directly associated, among others factors, to the unsatisfactory perception that they reported in relation to their speech and to the too long period without visiting the dentist.     

Prevalence of oral and dental disorders in institutionalised elderly people in Rasht,Iran

doi:10.1111/j.1741‐2358.2009.00313.x
Prevalence of oral and dental disorders in institutionalised elderly people in Rasht, Iran Objective: The aim of this study was to determine the prevalence of dental and oral mucosal lesions in institutionalised elderly people in Rasht. Background: Oral health in the elderly people is important to tailor the health programmes for this increasing age group within the population. Methods: A total of 216 elderly people residing in a geriatric nursing home were included in the study. Subjects were interviewed and examined clinically and registered in a data collection form and analysed using spss version 11 program (SPSS Inc, Chicago, Illinois, USA). Results: The prevalence of dental and oral disorders was 44.9% and 86.1% respectively. The most frequent oral disorders were dry mouth (42.1%), fissure tongue (25.9%), atrophic of tongue (25%), sublingual varicosity (22.7%), burning sensation (16.7%) and varix (15.3%). The prevalence of edentulousness was 56% (95%CI: 49–63%). The mean level of retained teeth was 3.22. The odds of an oral mucosal disorder in females were significantly more than in males (OR = 2.79, 95%CI: 1.25–6.23). Discussion: The findings revealed a high prevalence of dental and oral disorders in institutionalised elderly people in Rasht in comparison to similar studies. The mean of retained teeth was also much lower than in other reports. Therefore, the necessity for regular oral examination of these rapidly expanding age groups of people is essential.     

Oral health status in a group of the elderly population residing at home

doi: 10.1111/j.1741‐2358.2011.00556.x Oral health status in a group of the elderly population residing at home Objectives: To determine the oral health status and treatment needs of subjects aged 65 years and older residing in different districts of Ankara. Materials and methods: A total of 1300 patients, 751 females and 549 males, age 65 and over with a mean age of 72.8 ± 6.34 were included in this study. The subjects were visited at home and toothbrushing habits, visiting the dentist, tooth loss, denture needs were questioned and body mass index values were recorded. Results: 52.5% of the subjects were completely edentulous, 83.3% subjects reported wearing a removable denture. Females had a higher total tooth loss frequency when compared to males (p < 0.05). Total tooth loss between 65 and 69 ages was 47.3%, and increased to 62.4% among those aged 75 and over (p < 0.05). 16.2% of the subjects had not visited a dentist in the last 10 years, and only 3% visited a dentist for control check‐ups; no gender‐based difference was observed as to the frequency of dental visits (P > 0.05). No significant relationship was found between tooth loss and BMI values (P > 0.05). 46.3% of the subjects had chewing problems. Conclusions: The subjects included in this study showed high tooth loss frequency and poor oral hygiene habits. Education regarding maintenance of oral hygiene and regular dental check up should be stressed for the elderly.     

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul

doi: 10.1111/j.1741‐2358.2010.00363.x
General health, dental status and perceived dental treatment needs of an elderly population in Istanbul Background: Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. Objectives: This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. Method: Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. Results: The three most prevalent reported general health problems were associated with genito‐urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one‐third of the subjects had not been to the dentist within the previous 5–10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two‐thirds of denture‐wearing subjects wore their dentures only during eating. Conclusions: There was significant perceived dental treatment and care need for the sample population of elderly studied.     

Dental status and dental caries in 85-year-old Danes

Objectives: This study reports findings on the dental status and the prevalence of dental caries among a group of 85‐year‐old Danes from the Glostrup 1914 Cohort, Denmark. The purpose of the study was to analyse whether caries experience was related to number of teeth and to indicators of functional ability and cognitive function. Methods: A total of 191 individuals (78 men and 113 women) participated in a cross‐sectional population study conducted in 2000. Using mobile dental equipment, a clinical oral examination and an interview were administered to all participants in their homes. Functional ability was measured by the Mob‐H scale and cognitive function was assessed by the Mini‐Mental State Examination. Results: Fifty‐nine per cent of the participants had their own natural teeth and for the dentate participants, the mean number of teeth was 13 (range 1–27). A high prevalence of active caries on coronal and root surfaces was observed. Older adults with few natural teeth had a higher prevalence of active coronal and root caries and a higher unmet treatment need than older adults with many teeth. Further, the study showed that 85‐year‐old persons with reduced functional ability and cognitive impairment tended to have more active caries than 85‐year‐olds with no impairment. Conclusions: A substantial proportion of 85‐year‐old individuals had retained a natural dentition; however, active dental caries is a problem of concern among the most elderly.     

Eight-year mortality associated with dental occlusion and denture use in community-dwelling elderly persons

Objective: To evaluate the influence of dental occlusion, with or without the use of dentures, on mortality in community‐dwelling elderly persons. Subjects: A total of 1030 randomly selected healthy independent elderly aged 65 and over were surveyed in 1995. For the study reported here, subjects were classified into three groups according to the presence or absence of maxillo‐mandibular tooth contacts. Subjects with no maxillo‐mandibular tooth contacts were further subdivided into those with and without dentures. Methods: Data on mortality were obtained from Kure City Council in September 2003. Cox regression models were used in analysing the risk for death with gender and age as covariates. Results: Individuals whose teeth had contact in at least the bilateral premolar regions at baseline had 0.78 times (95% CI: 0.60–0.99) smaller risk for death during the succeeding 8 years than those who had no occlusion. Among those who had no occlusion with their own teeth, the risk for mortality among denture non‐users was 1.52 times (95% CI: 1.25–1.83) higher than the risk for denture users. Conclusion: These results may support the view that, in the elderly, poor dental occlusion is associated with an increased risk for mortality and that, in the edentulous, the use of dentures is associated with a decreased risk for mortality.     

Associations of instrumental activities of daily living and handgrip strength with oral self-care among home-dwelling elderly 75+

doi: 10.1111/j.1741‐2358.2010.00427.x Associations of instrumental activities of daily living and handgrip strength with oral self‐care among home‐dwelling elderly 75+ Objective: To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self‐care among dentate home‐dwelling elderly people in Finland. Materials and methods: The study analysed data for 168 dentate participants (mean age 80.6 years) in the population‐based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004–2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry. Results: Study participants with high IADL (scores 7–8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1–6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8–5.2) and for having good oral hygiene of 2.8 (CI 1.0–8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4–1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4–1.8) and for good oral hygiene of 1.1 (CI 0.5–2.4) in comparison with the study subjects in the lowest tertile of handgrip strength. Conclusion: The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self‐care among the home‐dwelling elderly.     

Prevalence and Correlates of Dental Caries in an Elderly Population in Northeast China

Objectives

The present study aimed to investigate the prevalence and correlates of dental caries in elderly population in northeast China.

Methods

A community-based, cross-sectional study among 2376 elderly subjects (age: 65–74 years) from nine urban areas and nine rural areas in three provinces of northeast China was conducted using multistage stratified random sampling per the World Health Organization oral health survey methodology. Decayed-missing-filled teeth (DMFT) and decayed-filled teeth (DFT) indices were used to evaluate the prevalence of dental caries. Face-to-face questionnaire survey on oral health was performed in a randomly selected subset (n = 1197). T test and chi square test were employed to compare groups for continuous and categorical variables, respectively. Multivariate logistic regression was used to estimate odds ratios (ORs) and corresponding confidence intervals (CIs).

Results

67.5% of elderly subjects reported dental caries (average DFT = 2.68±3.40), and the prevalence was higher in urban areas (P<0.01). Missing teeth accounted for 80.72% of DMFT, and filled teeth due to caries accounted for 2.08% with a rate higher in urban areas (P<0.01). Logistic regression analysis indicated significant association among elderly population in urban areas (OR 1.713; 95% CI 1.337–2.195), smoking (OR 1.779; 95% CI 1.384–2.288), and individuals without dental insurance (OR 2.050; 95% CI 1.120–3.754) with dental caries.

Conclusions

The prevalence of dental caries in the elderly population in northeast China is high. The elderly from urban areas who smoke and who do not have a dental insurance are at a higher risk to develop dental caries.     

Oral health status in elders from South Brazil: a population-based study

doi: 10.1111/j.1741‐2358.2011.00617.x Oral health status in elders from South Brazil: a population‐based study Objective: To assess the oral health status of community‐dwelling adults aged 60 years and older from southern Brazil and to determine demographics, socioeconomic, behavioural and dental risk indicators. Materials and methods: This cross‐sectional study used a multistage, probability sampling method to draw a representative sample of the metropolitan area of Porto Alegre, Brazil. A subsample of 217 subjects was included in this analysis. Oral mucosal lesions, dental caries, tooth loss and periodontal status (full‐mouth, six sites per tooth exam) were assessed by calibrated examiners. Results: Prevalence of edentulism was 39.5%, and mean tooth loss was 20.2 (SE = 0.6). Older individuals [Odds Ratio (OR) = 2.2], women (OR = 2.3), white people (OR = 5.9), individuals of lower socioeconomic status (OR = 5.6) and smokers (OR = 3.5) had higher likelihood of being edentulous. Approximately 36% of dentate individuals had caries and/or restoration affecting, in average, 5.0 teeth. Periodontitis affected 79% of subjects, and it was associated with older age (OR = 4.0), men (OR = 3.4) and large amounts of supragingival plaque (OR = 3.0). Conclusion: Poor oral health was observed in this elderly population from South Brazil. Sociodemographic disparities accounted for most of the burden of disease and treatment needs.     

Edentulism and dental caries in Victorian nursing homes

doi: 10.1111/j.1741‐2358.2011.00510.x Edentulism and dental caries in Victorian nursing homes Objectives: The aim of this project was to investigate edentulism and dental caries in nursing home residents in Victoria, Australia. Background: The Australian population is ageing with a growing number of people living in nursing homes. These residents are at increased risk for dental caries, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Materials and methods: Clinical dental examinations were conducted at 31 nursing homes in Melbourne and regional Victoria between May 2005 and June 2006. A total of 510 residents were examined out of 1345 eligible participants. Socio‐demographic and medical history was collected via questionnaire. Results: Just over half of the residents were dentate (53.9%), and dentate residents had a mean of 14.4 teeth present and 2.66 untreated decayed teeth. Residents who required total assistance with oral hygiene had more decayed teeth and fewer filled teeth than residents who did not require assistance. Conclusions: Nursing home residents in Victoria are retaining an increasing number of natural teeth and have more tooth surfaces at risk for dental caries. Untreated dental caries was a significant problem for residents, particularly for those who are dependent on others for their daily oral hygiene care.     

Oral health and treatment needs of the long-term hospitalised elderly

Objectives: To determine the oral health and treatment needs of the long‐term hospitalised elderly. Setting: The Laakso long‐term hospital, Helsinki, Finland. Design: A cross‐sectional study with clinical oral examinations. Subjects: All long‐term patients (n = 260) aged 60 and older. Main outcome measures: Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment. Results: Subjects’ mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions. Conclusions: Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long‐term hospitalised elderly.     

Relationships between higher‐level functional capacity and dental health behaviors in community‐dwelling older adults

doi: 10.1111/j.1741‐2358.2012.00654.x Relationships between higher‐level functional capacity and dental health behaviors in community‐dwelling older adults Objective: The aim of the present study was to elucidate relationships between higher‐level functional capacity and dental health behaviours in community‐dwelling older adults. Background: In ageing society, it is necessary to promote oral health in the elderly, because good oral health is a significant contributing factor to good general health. Higher‐level functional capacity has been considered a crucial factor for successful independent living in the elderly. We hypothesised that functional capacity is a significant indicator of dental health behaviours. Methods: Three hundred and thirty‐eight adults aged 65 years or older were enrolled in this study. Higher‐level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG‐index). Univariate and multivariate models were constructed with dental health behaviours, such as regular visits to a dentist, brushing frequency and use of extra cleaning devices, as the dependent variable, and the total TMIG‐index score and its subcategory scores as the principal independent variable. Results: Univariate logistic regression analysis demonstrated a significant correlation between low TMIG‐index and ‘intellectual activity’ subcategory scores to lack of regular visits to a dentist and not using extra cleaning devices. Using a multivariate model, significant relationships remained after adjusting for a number of variables including demographics, medical status, lifestyle and number of remaining teeth. Conclusion: Intellectual activity of higher‐level functional capacity may be an accurate indicator of dental health behaviours in community‐dwelling older adults. Intellectual activity should be taken into consideration to effectively promote oral health behaviours and oral hygiene in elderly persons living independently.     

Perspectives on providing good access to dental services for elderly people: patient selection,dentists’ responsibility and budget management

doi: 10.1111/j.1741‐2358.2012.00646.x Perspectives on providing good access to dental services for elderly people: patient selection, dentists’ responsibility and budget management Objectives: To suggest a model for organizing and financing dental services for elderly people so that they have good access to services. Background: There are few studies on how dental services for elderly people should be organized and financed. This is surprising if we take into consideration the fact that the proportion of elderly people is growing faster than any other group in the population, and that elderly people have more dental diseases and poorer access to dental services than the rest of the adult population. In several countries, dental services are characterized by private providers who often operate in a market with competition and free price‐setting. Private dentists have no community responsibility, and they are free to choose which patients they treat. Material and methods: Literature review and critical reasoning. Results: In order to avoid patient selection, a patient list system for elderly people is recommended, with per capita remuneration for the patients that the dentist is given responsibility for. The patient list system means that the dentist assumes responsibility for a well‐defined list of elderly people. Conclusion: Our model will lead to greater security in the dentist/patient relationship, and patients with great treatment needs will be ensured access to dental services.