Practice and challenge of age-friendly functional restoration of stomatognathic system based on the strategy of functional tooth loss

doi:10.7518/hxkq.2025.2024188

Abstract

Abstract:

Geriatric oral health care encounters significant challenges with the increase in the proportion of older individuals. Age-related changes in the dentition, muscles, and joints result in a decline in objective masticatory function, subjective restoration requirements, and acceptability among the elderly population, with individual variations influenced by systemic health. Considering functional requirements, the adaptability of stomatognathic and systemic health conditions, health economics and other factors, the authors believe that it should not be limited to the conventional “one-to-one” strategy for replacing missing teeth in geriatric prosthodontics. There is an urgent need for a precise and adaptable restoration strategy that is more suitable for older individuals. The proposal of a new concept of functional tooth loss updates the minimal restoration standards for elderly patients and establishes the theory of age-friendly functional restoration. Based on the restoration strategy of functional tooth loss, this paper proposes a new concept termed “age-friendly functional restoration of the stomatognathic system”, which integrates treatment considerations including endodontics, periodontology, mucosa, muscles, temporomandibular joint, and systemic health. Efforts should be made in four areas as follows. Firstly, the “assessment of accessible function” should be enhanced by considering the interrelationship between stomatognathic and systemic health. Secondly, the “evaluation of appropriate function” is supposed to be optimised in view of subjective needs and objective evaluation of the stomatognathic system. Moreover, the “formulation of treatment plans” needs to be accomplished with the aid of assistive technologies, such as artificial intelligence, to accurately exert appropriate functional restoration. Lastly, the “management and maintenance of health” is likely to be strengthened through follow-ups, propaganda and education, and preventive healthcare, so as to improve quality of life and ultimately achieve healthy ageing among older individuals.

Key words: stomatognathic system, functional restoration, healthy aging, tooth loss, multimorbidity, masticatory function

CLC Number:

Cheng Yiting, Man Yi, Liu Yang, Cai He, Cheng Ran, Cheng Li, Wu Fanglong, Wu Hongkun, Yu Fanyuan, Liao Xueyang, Sun Yimin, Wang Jing, Yang Xue, Zhu Jinyi, Cheng Xingqun, Yi Zumu, Ye Ling, Hu Tao. Practice and challenge of age-friendly functional restoration of stomatognathic system based on the strategy of functional tooth loss[J]. West China Journal of Stomatology, 2025, 43(1): 15-27.

Figures/Tables 3

References 101

1	Dibello V, Zupo R, Sardone R, et al. Oral frailty and its determinants in older age: a systematic review[J]. Lancet Healthy Longev, 2021, 2(8): e507-e520.
2	Fang EF, Xie C, Schenkel JA, et al. A research agenda for ageing in China in the 21st century (2nd edition): focusing on basic and translational research, long-term ca-re, policy and social networks[J]. Ageing Res Rev, 2020, 64: 101174.
3	Shao R, Hu T, Zhong YS, et al. Socio-demographic factors, dental status and health-related behaviors associated with geriatric oral health-related quality of life in Southwestern China[J]. Health Qual Life Outcome, 2018, 16(1): 98.
4	Yin W, Yang YM, Chen H, et al. Oral health status in Sichuan Province: findings from the oral health survey of Sichuan, 2015-2016[J]. Int J Oral Sci, 2017, 9(1): 10-15.
5	Wang L, Cheng L, Yuan B, et al. Association between socio-economic status and dental caries in elderly people in Sichuan Province, China: a cross-sectional study[J]. BMJ Open, 2017, 7(9): e016557.
6	Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge[J]. Lancet, 2019, 394(10194): 249-260.
7	Agudio G, Buti J, Bonaccini D, et al. Longevity of teeth in patients susceptible to periodontitis: clinical outcomes and risk factors associated with tooth loss after active therapy and 30 years of supportive periodontal care[J]. J Clin Periodontol, 2023, 50(4): 520-532.
8	王兴. 第四次全国口腔健康流行病学调查报告[M]. 北京: 人民卫生出版社, 2018.
	Wang X. Report of the fourth National Oral Health Epidemiological survey[M]. Beijing: People’s Medical Publishing House, 2018.
9	Omar R. The evidence for prosthodontic treatment planning for older, partially dentate patients[J]. Med Princ Pract, 2003, 12(): 33-42.
10	Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme[J]. Community Dent Oral Epidemiol, 2005, 33(2): 81-92.
11	Recent advances in oral health. Report of a WHO Expert Committee[J]. World Health Organ Tech Rep Ser, 1992, 826: 1-37.
12	Cheng Y, Cheng L, Zhu F, et al. New measure of functional tooth loss for successful oral ageing: a cross-sectional study[J]. BMC Geriatr, 2023, 23(1): 859.
13	Duong HY, Roccuzzo A, Stähli A, et al. Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses[J]. Periodontol 2000, 2022, 88(1): 201-237.
14	Xie Y, Chen S, Sheng L, et al. A new landscape of human dental aging: causes, consequences, and intervention avenues[J]. Aging Dis, 2023, 14(4): 1123-1144.
15	Lamster IB, Asadourian L, Del Carmen T, et al. The aging mouth: differentiating normal aging from disease[J]. Periodontol 2000, 2016, 72(1): 96-107.
16	Huang YF, Liu SP, Muo CH, et al. The impact of occluding pairs on the chewing patterns among the elderly[J]. J Dent, 2021, 104: 103511.
17	Barreto de Oliveira RD, de Sousa FB, Algarni AA, et al. Susceptibility of dental enamel of different ages to ca-ries-like lesion development[J]. Caries Res, 2020, 54(5/6): 475-482.
18	Coll PP, Lindsay A, Meng J, et al. The prevention of infections in older adults: oral health[J]. J Am Geriatr Soc, 2020, 68(2): 411-416.
19	Sommerfeldt W, Gellert P, Müller A, et al. Older patients’ perception of treating root caries with silver diamine fluoride-a qualitative study based on the Theoretical Domains Framework[J]. J Dent, 2023, 130: 104408.
20	Sterenborg BAMM, Kalaykova SI, Loomans BAC, et al. Impact of tooth wear on masticatory performance[J]. J Dent, 2018, 76: 98-101.
21	Okura M, Ogita M, Arai H. Are self-reported masticatory ability and regular dental care related to mortality[J]. J Nutr Health Aging, 2020, 24(3): 262-268.
22	Higashi K, Hatta K, Mameno T, et al. The relationship between changes in occlusal support and masticatory per-formance using 6-year longitudinal data from the SONIC study[J]. J Dent, 2023, 139: 104763.
23	Poudel P, Paudel G, Acharya R, et al. Oral health and healthy ageing: a scoping review[J]. BMC Geriatr, 2024, 24(1): 33.
24	张月, 雷蕾, 杨英明, 等. 社会经济地位对四川省老年人牙周健康状况的影响[J]. 中华老年口腔医学杂志, 2021, 19(6): 333-338.
	Zhang Y, Lei L, Yang YM, et al. Association between socio-economic status and periodontal health status in elderly people in Sichuan Province[J]. Chin J Geriatr Dent, 2021, 19(6): 333-338.
25	Hu KF, Lin YC, Huang YT, et al. A retrospective cohort study of how alveolar ridge preservation affects the need of alveolar ridge augmentation at posterior tooth implant sites[J]. Clin Oral Investig, 2021, 25(7): 4643-4649.
26	Zhang L, Shimada A, Kusunoki T, et al. Effect of ageing and tooth loss on sensory function of alveolar mucosa[J]. J Oral Rehabil, 2022, 49(4): 391-397.
27	An JY, Darveau R, Kaeberlein M. Oral health in geros-cience: animal models and the aging oral cavity[J]. Geroscience, 2018, 40(1): 1-10.
28	Le Bars P, Kouadio AA, Bandiaky ON, et al. Host’s immunity and candida species associated with denture stomatitis: a narrative review[J]. Microorganisms, 2022, 10(7): 1437.
29	Gendreau L, Loewy ZG. Epidemiology and etiology of denture stomatitis[J]. J Prosthodont, 2011, 20(4): 251-260.
30	Toan NK, Ahn SG. Aging-related metabolic dysfunction in the salivary gland: a review of the literature[J]. Int J Mol Sci, 2021, 22(11): 5835.
31	Chia CW, Yeager SM, Egan JM. Endocrinology of taste with aging[J]. Endocrinol Metab Clin North Am, 2023, 52(2): 295-315.
32	Park YS, Hong HP, Ryu SR, et al. Effects of textured food masticatory performance in older people with diffe-rent dental conditions[J]. BMC Geriatr, 2022, 22(1): 384.
33	Yamaguchi K, Hara K, Nakagawa K, et al. Association of aging and tooth loss with masseter muscle characte-ristics: an ultrasonographic study[J]. Clin Oral Investig, 2020, 24(11): 3881-3888.
34	Cicek M, Tumer MK, Unsal V. A study of chewing muscles: age-related changes in type I collagen and matrix metalloproteinase-2 expression[J]. Arch Oral Biol, 2020, 109: 104583.
35	Azzolino D, Passarelli PC, De Angelis P, et al. Poor oral health as a determinant of malnutrition and sarcopenia[J]. Nutrients, 2019, 11(12): E2898.
36	Huang YF, Chang WH, Liao YF, et al. Lip and tongue strength associated with chewing patterns in aging population[J]. BMC Oral Health, 2023, 23(1): 848.
37	Yamaguchi K, Hara K, Nakagawa K, et al. Ultrasonography shows age-related changes and related factors in the tongue and suprahyoid muscles[J]. J Am Med Dir Assoc, 2021, 22(4): 766-772.
38	Zhou Y, Xu M, Yadav S. Temporomandibular joint aging and potential therapies[J]. Aging (Albany NY), 2021, 13(14): 17955-17956.
39	Zhou Y, Al-Naggar IMA, Chen PJ, et al. Senolytics alleviate the degenerative disorders of temporomandibular joint in old age[J]. Aging Cell, 2021, 20(7): e13394.
40	Cha S, Lee SM, Wang J, et al. Enhanced circadian clock in MSCs-based cytotherapy ameliorates age-related temporomandibular joint condyle degeneration[J]. Int J Mol Sci, 2021, 22(19): 10632.
41	Chen PJ, Dutra EH, Mehta S, et al. Age-related changes in the cartilage of the temporomandibular joint[J]. Geroscience, 2020, 42(3): 995-1004.
42	Zheng H, Shi L, Lu H, et al. Influence of edentulism on the structure and function of temporomandibular joint[J]. Heliyon, 2023, 9(10): e20307.
43	Zhang Y, Xu X, Zhou P, et al. Elder mice exhibit more severe degeneration and milder regeneration in temporomandibular joints subjected to bilateral anterior crossbite[J]. Front Physiol, 2021, 12: 750468.
44	Αntoniadou M, Varzakas T. Breaking the vicious circle of diet, malnutrition and oral health for the independent elderly[J]. Crit Rev Food Sci Nutr, 2021, 61(19): 3233-3255.
45	Colombo AP, Wu B. Aging and oral health: Biological and sociobehavioral perspectives[J]. J Dent Res, 2023, 102(8): 841-843.
46	Fan Y, Shu X, Leung KCM, et al. Associations of general health conditions with masticatory performance and maximum bite force in older adults: a systematic review of cross-sectional studies[J]. J Dent, 2022, 123: 104186.
47	Lahoud T, Yu AY, King S. Masticatory dysfunction in older adults: a scoping review[J]. J Oral Rehabil, 2023, 50(8): 724-737.
48	Schimmel M, Aarab G, Baad-Hansen L, et al. A conceptual model of oro-facial health with an emphasis on function[J]. J Oral Rehabil, 2021, 48(11): 1283-1294.
49	Nihtilä A, Tuuliainen E, Komulainen K, et al. Preventive oral health intervention among old home care clients[J]. Age Ageing, 2017, 46(5): 846-851.
50	Gibney JM, Naganathan V, Lim MAWT. Oral health is essential to the well-being of older people[J]. Am J Geriatr Psychiatry, 2021, 29(10): 1053-1057.
51	Kiuchi S, Cooray U, Aida J, et al. Effect of tooth loss on cognitive function among older adults in Singapore[J]. J Dent Res, 2023, 102(8): 871-878.
52	Da D, Ge S, Zhang H, et al. Association between occlusal support and cognitive impairment in older Chinese adults: a community-based study[J]. Front Aging Neurosci, 2023, 15: 1146335.
53	Lo CH, Kwon S, Wang L, et al. Periodontal disease, too-th loss, and risk of oesophageal and gastric adenocarcinoma: a prospective study[J]. Gut, 2021, 70(3): 620-621.
54	Homsi G, Kumar A, Almotairy N, et al. Assessment of masticatory function in older individuals with bimaxillary implant-supported fixed prostheses or with a natural dentition: a case-control study[J]. J Prosthet Dent, 2023, 129(6): 871-877.
55	Qian SJ, Liu B, Shi J, et al. Effects of dental implants and nutrition on elderly edentulous subjects: protocol for a factorial randomized clinical trial[J]. Front Nutr, 2022, 9: 930023.
56	Watanabe Y, Okada K, Kondo M, et al. Oral health for achieving longevity[J]. Geriatr Gerontol Int, 2020, 20(6): 526-538.
57	Matsuyama Y, Listl S, Jürges H, et al. Causal effect of tooth loss on functional capacity in older adults in England: a natural experiment[J]. J Am Geriatr Soc, 2021, 69(5): 1319-1327.
58	Kotronia E, Brown H, Papacosta O, et al. Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States[J]. J Am Geriatr Soc, 2022, 70(7): 2080-2092.
59	Skou ST, Mair FS, Fortin M, et al. Multimorbidity[J]. Nat Rev Dis Primers, 2022, 8(1): 48.
60	Chen Y, Zhang P, Luman ET, et al. Incremental dental expenditures associated with diabetes among noninstitutionalized U.S. adults aged ≥18 years old in 2016-2017[J]. Diabetes Care, 2021, 44(6): 1317-1323.
61	Graves DT, Ding Z, Yang Y. The impact of diabetes on periodontal diseases[J]. Periodontol 2000, 2020, 82(1): 214-224.
62	Al-Nasser L, Lamster IB. Prevention and management of periodontal diseases and dental caries in the older adults[J]. Periodontol 2000, 2020, 84(1): 69-83.
63	Ogawa H, McKenna G, Kettratad-Pruksapong M. Prevention of oral functional decline[J]. Int Dent J, 2022, 72(4S): S21-S26.
64	Elani HW, Giannobile WV. Harnessing artificial intelligence to address oral health disparities[J]. JAMA Health Forum, 2024, 5(4): e240642.
65	Jablonski RY, Barber MW. Restorative dentistry for the older patient cohort[J]. Br Dent J, 2015, 218(6): 337-342.
66	Lamster IB. Geriatric periodontology: how the need to care for the aging population can influence the future of the dental profession[J]. Periodontol 2000, 2016, 72(1): 7-12.
67	Persson GR. Dental geriatrics and periodontitis[J]. Periodontol 2000, 2017, 74(1): 102-115.
68	Nelson S, Kim EGR, Kaelber DC. Integrating oral heal-th into primary care: perspectives for older adults[J]. J Dent Res, 2023, 102(8): 849-853.
69	Nakai N, Kurogi T, Murata H. Oral health-related quality of life of conventional removable partial dentures, unilateral nonmetal clasp dentures, and shortened dental ar-ch with 2-or 3-tooth unilateral distal extension tooth loss in the mandible: a randomized, crossover, clinical trial[J]. J Prosthet Dent, 2024, 131(2): 220-226.
70	Gotfredsen K, Rimborg S, Stavropoulos A. Efficacy and risks of removable partial prosthesis in periodontitis patients: a systematic review[J]. J Clin Periodontol, 2022, 49 (): 167-181.
71	Choong EKM, Shu X, Leung KCM, et al. Oral health-related quality of life (OHRQoL) after rehabilitation with removable partial dentures (RPDs): a systematic review and meta-analysis[J]. J Dent, 2022, 127: 104351.
72	Martori E, Ayuso-Montero R, Martinez-Gomis J, et al. Risk factors for denture-related oral mucosal lesions in a geriatric population[J]. J Prosthet Dent, 2014, 111(4): 273-279.
73	Campos Sugio CY, Mosquim V, Jacomine JC, et al. Impact of rehabilitation with removable complete or partial dentures on masticatory efficiency and quality of life: a cross-sectional mapping study[J]. J Prosthet Dent, 2022, 128(6): 1295-1302.
74	Duong HY, Roccuzzo A, Stähli A, et al. Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses[J]. Periodontol 2000, 2022, 88(1): 201-237.
75	Park JC, Baek WS, Choi SH, et al. Long-term outcomes of dental implants placed in elderly patients: a retrospective clinical and radiographic analysis[J]. Clin Oral Implants Res, 2017, 28(2): 186-191.
76	Nitschke I, Slashcheva LD, John MT, et al. Dental patient-reported outcomes in geriatric dentistry: a call for clinical translation[J]. J Evid Based Dent Pract, 2024, 24(1s): 101958.
77	Tan H, Peres KG, Peres MA. Retention of teeth and oral health-related quality of life[J]. J Dent Res, 2016, 95(12): 1350-1357.
78	Witter DJ, van Palenstein Helderman WH, Creugers NH, et al. The shortened dental arch concept and its implications for oral health care[J]. Community Dent Oral Epidemiol, 1999, 27(4): 249-258.
79	Curtis DA, Lin GH, Rajendran Y, et al. Treatment planning considerations in the older adult with periodontal disease[J]. Periodontol 2000, 2021, 87(1): 157-165.
80	McKenna G, Tada S, McLister C, et al. Tooth replacement options for partially dentate older adults: a survival analysis[J]. J Dent, 2020, 103: 103468.
81	Funke N, Fankhauser N, Mckenna GJ, et al. Impact of shortened dental arch therapy on nutritional status and treatment costs in older adults: a systematic review[J]. J Dent, 2023, 133: 104483.
82	Schierz O, Reissmann DR, Rauch A, et al. Impact of shortened dental arch on oral health-related quality of life[J]. J Evid Based Dent Pract, 2021, 21(4): 101622.
83	Zaugg FL, Molinero-Mourelle P, Abou-Ayash S, et al. The influence of age and gender on perception of orofacial esthetics among laypersons in Switzerland[J]. J Esthet Restor Dent, 2022, 34(6): 959-968.
84	Reis LOB, Silva AER, Cascaes AM, et al. Agreement between self-rated denture condition and clinical examination in older adults[J]. Gerodontology, 2023, 40(1): 135-141.
85	Mangano FG, Admakin O, Lerner H, et al. Artificial intelligence and augmented reality for guided implant surgery planning: a proof of concept[J]. J Dent, 2023, 133: 104485.
86	Revilla-León M, Gómez-Polo M, Vyas S, et al. Artificial intelligence models for tooth-supported fixed and removable prosthodontics: a systematic review[J]. J Prosthet Dent, 2023, 129(2): 276-292.
87	Angst L, Nüesch N, Grandjean ML, et al. Caries mana-gement using silver diamine fluoride and providing do-miciliary dental care for dependent older adults: a qualitative study of Swiss dentists[J]. Community Dent Oral Epidemiol, 2023, 51(3): 469-482.
88	Paris S, Banerjee A, Bottenberg P, et al. How to intervene in the caries process in older adults: a joint ORCA and EFCD expert Delphi consensus statement[J]. Caries Res, 2020, 54(5/6): 1-7.
89	Ericson D, Carlsson P, Gabre P, et al. Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomi-sed clinical trial[J]. Gerodontology, 2023, 40(3): 390-397.
90	Zheng FM, Yan IG, Duangthip D, et al. Silver diamine fluoride therapy for dental care[J]. Jpn Dent Sci Rev, 2022, 58: 249-257.
91	Hu S, Muniraj G, Mishra A, et al. Characterization of silver diamine fluoride cytotoxicity using microfluidic too-th-on-a-chip and gingival equivalents[J]. Dent Mater, 2022, 38(8): 1385-1394.
92	Hiraishi N, Sayed M, Takahashi M, et al. Clinical and primary evidence of silver diamine fluoride on root ca-ries management[J]. Jpn Dent Sci Rev, 2022, 58: 1-8.
93	Kühnisch J, Meyer O, Hesenius M, et al. Caries detection on intraoral images using artificial intelligence[J]. J Dent Res, 2022, 101(2): 158-165.
94	Li S, Liu J, Zhou Z, et al. Artificial intelligence for ca-ries and periapical periodontitis detection[J]. J Dent, 2022, 122: 104107.
95	Mertens S, Krois J, Cantu AG, et al. Artificial intelligence for caries detection: randomized trial[J]. J Dent, 2021, 115: 103849.
96	Umer F, Habib S. Critical analysis of artificial intel-ligence in endodontics: a scoping review[J]. J Endod, 2022, 48(2): 152-160.
97	Müller F, Srinivasan M, Krause KH, et al. Periodontitis and peri-implantitis in elderly people experiencing institutional and hospital confinement[J]. Periodontol 2000, 2022, 90(1): 138-145.
98	Gomez-Rossi J, Hertrampf K, Abraham J, et al. Interventions to improve oral health of older people: a scoping review[J]. J Dent, 2020, 101: 103451.
99	Rokhshad R, Mohammad-Rahimi H, Price JB, et al. Artificial intelligence for classification and detection of oral mucosa lesions on photographs: a systematic review and meta-analysis[J]. Clin Oral Investig, 2024, 28(1): 88.
100	Elmakaty I, Elmarasi M, Amarah A, et al. Accuracy of artificial intelligence-assisted detection of oral squamous cell carcinoma: a systematic review and meta-analysis[J]. Crit Rev Oncol Hematol, 2022, 178: 103777.
101	Ducret M, Mörch CM, Karteva T, et al. Artificial intelligence for sustainable oral healthcare[J]. J Dent, 2022, 127: 104344.

[1]	Tao Yufei, He Mengna, Hu Hongyan, Gao Ziwen, Huang Ziang, Li Hui, Li Yuqing, Li Xiaoshu. Correlation study of periodontitis with cognitive impairment [J]. West China Journal of Stomatology, 2022, 40(5): 549-553.
[2]	Lili Yang, Debiao Du, Ruoyu Ning, Deying Chen, Junling Wu. Application of single-retainer all-ceramic resin-bonded fixed partial denture in replacing single anterior tooth [J]. West China Journal of Stomatology, 2017, 35(4): 399-402.
[3]	CHENG Ruibo, ZHANG Ying, TAO Wei, LIU Lu. Study on tooth loss and prosthetic condition of middle- aged and elder s in Liaoning province [J]. West China Journal of Stomatology, 2007, 25(06): 576-579.
[4]	TANG Qian1,HUANGLan2,LIANG Xing3,LI Xing-hong3,BAO Xiang-jun4,SUNHui-qiang3,LU Shao-heng3,YANG Xiao-yu3. Clinical Evaluation of Masticatory Function of Implant Supported Dentures in Partially Edentulous Patients [J]. West China Journal of Stomatology, 2005, 23(05): 391-392.