Potential educational and workforce strategies to meet the oral health challenges of an increasingly older population: a qualitative study

The global older adult population (≥65 years) is projected to reach 1.6 billion by 2050, with steady ageing reported in developed countries such as the UK due to declining birth rates and increased life expectancy. Older people have higher prevalence of chronic and oral diseases, sharing risk factors with non-communicable diseases. Greater tooth retention creates challenges, as dentate older adults may require extensive and complex treatment to maintain dentitions. Persistent barriers—patient-related, professional-related, and policy-related—limit routine dental care for older adults. Proposed mechanisms to improve oral health include aligning health systems for access to quality, person-centred services, creating age-friendly environments, improving research, and building a sustainable, appropriately trained interdisciplinary workforce. Despite this, there is a lack of qualitative research capturing views of influential opinion leaders on Gerodontology education and workforce strategies in the UK. This study aimed to qualitatively investigate the overarching issues and educational and workforce strategies required to address the oral health challenges of an increasingly older adult population.

The paper references literature indicating: rising proportions of older adults in developed nations; shared risk factors between oral and systemic non-communicable diseases; increased tooth retention leading to complex restorative needs; and barriers to care categorized as patient-, professional-, and policy-related. Prior works and policy recommendations advocate person-centred, interdisciplinary care models, age-friendly environments, enhanced research, and workforce development. Recent reviews highlight variability and insufficiency in Gerodontology education globally and within the UK, with calls for national/international guidelines to make Gerodontology training mandatory for dental and DCP curricula.

Design: Qualitative study using semi-structured interviews. Topic guide development: Derived from quantitative data from prior research on Gerodontology education. Sampling: Purposeful sample of prominent UK experts in Gerodontology, Dental Education, and Dental Public Health; 11 invited, 9 participated (6 dentists, 3 dental hygiene therapy backgrounds). Participant backgrounds included training of undergraduate/postgraduate dentists and DCPs, general dental practice, restorative dentistry, and dental public health. Ethics: University of Portsmouth (SHFEC 2021-002). Data collection: Zoom interviews (March–April 2021), at participant convenience, no time limit; mean 30 minutes (range 22–40). Interviews conducted by GP. Data handling: Recorded, transcribed verbatim, anonymised. Member checking: Transcripts sent to participants for verification. Analysis: Thematic analysis using NVivo V12; initial coding and theme development by GP; independent secondary analysis by DRR; final themes and subthemes agreed through five remote round table discussions between GP and DRR, with reflexivity regarding potential biases from researchers’ backgrounds. Outcomes: Identification of four themes and fourteen subthemes regarding challenges, roles of DCPs, training needs, and care models for older adults.

- Four themes and 14 subthemes were identified from interviews with nine expert participants. 1) Agreements and disagreements: • Disagreement: Definition of Gerodontology viewed as vague and inconsistently described. • Agreements: (a) Demographic growth of older adults with increasing tooth retention; (b) Strong links between oral and general health; (c) Need for inter-professional, multidisciplinary care. 2) Challenges in providing dental care to older adults: • “Heavy metal generation” with heavily restored dentitions, polypharmacy, xerostomia, root caries; increased demand and expectations (including cosmetic history) but emphasis for many on maintaining a comfortable, functional, pain-free dentition via prevention and maintenance. • Initiatives discussed: Advancing Dental Care review; Oral Health Practitioner (OHP) apprenticeship; Mouth Care Matters; need for coordination and piloting viable business models. • Dementia/care homes seen as a distinct subset requiring tailored approaches and strong communication with carers; logistical challenges of domiciliary care. • Perception that older adult care is less attractive to some younger professionals compared to cosmetic/restorative subfields. 3) Delivery of care by the dental team: • Reorientation to new care models with prevention focus; need to rethink funding and incentivisation (including performer numbers/benefits for DCPs); address NHS vs private market tensions and UDA banding/time constraints. • Support for direct access and greater autonomy of DCPs within team-based models with appropriate oversight; DCPs play key preventive roles and should not be treated as “cheap dentists.” CDTs have roles but require clearer integration and ownership of treatment planning. • Complexity tiers: Primary care dentists (Tier 1) to manage most complex operative needs in independent older adults; Special Care Dentistry (Tier 3) for very complex patients, often as one-off episodes with return to primary care; concern that Special Care Dentistry is already overburdened. 4) Education: • Undergraduate training for dentists and DCPs in older adult care is viewed as inadequate and highly variable; overcrowded curricula are a major barrier. • Strong support for intra- and inter-professional education from early stages to break down barriers and enable team-based, holistic care; logistical challenges acknowledged. • Need for more outreach/primary care exposure beyond the “hospital bubble,” and consideration of training related to domiciliary/care home settings. Overall: Significant concern exists regarding the UK system’s ability to meet older adults’ needs, especially frailer, dependent cohorts; better workforce utilization, preventive focus, and reoriented care models are needed.

Findings address the research question by revealing consensus among expert stakeholders that demographic shifts and increased tooth retention heighten complexity and volume of care needs, while systemic and educational shortcomings hinder effective responses. The ambiguous definition of Gerodontology complicates advocacy and resource allocation. For independent older adults, needs can often be met in primary care with appropriate restorative and preventive care. For frailer, dependent adults (often in care homes, with multimorbidity and dementia), sustained preventive and maintenance-focused care delivered by DCPs within supervised team models is critical. Inter-professional collaboration is essential due to strong oral–systemic links, yet dentistry’s role in broader healthcare remains under-recognized. System barriers, notably funding/contract structures and insufficient incentivisation, limit optimal team utilisation. Educational gaps—overcrowded curricula and limited inter/intra-professional and primary care/care home exposure—contribute to workforce discomfort and reduced attractiveness of older adult care. Aligning funding, commissioning, and education to enable prevention-centric, team-based models could improve access, outcomes, and quality of life for older adults.

This qualitative study provides expert insights into service delivery and educational strategies needed to address oral health challenges of an ageing population. Key contributions include: highlighting the ambiguity surrounding Gerodontology; identifying the need to reorient care models towards prevention; advocating better utilisation and incentivisation of the full dental team (including DCPs and CDTs) within team-based, supervised frameworks; and underscoring inadequacies and variability in undergraduate training for both dentists and DCPs. Independent older adults should typically receive primary care-based management, while frailer, dependent cohorts require coordinated, prevention-focused services, often involving Special Care Dentistry for complex episodes and subsequent shared care. Future directions include clarifying Gerodontology’s definition, establishing national/international educational guidelines, expanding inter- and intra-professional education with primary care and domiciliary exposure, and reforming funding and commissioning to incentivise equitable, prevention-oriented care for older adults.

- Small, purposeful sample (9 experts) limits generalisability; semi-structured single interviews may not capture full stakeholder diversity. - Potential researcher bias: both primary analysts were dentists; one relatively inexperienced and one with strong interests in interdisciplinary education and restorative care for older adults; reflexivity was applied. - Participants were exclusively dental professionals; absence of patient, commissioner, and broader healthcare stakeholder perspectives limits representativeness. - Qualitative method relies on interviewer skill; findings provide depth but not population-level estimates. - Mitigations included member checking and transparent reporting of analytic steps.