Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany

This article reviews access to and financing of dental care for aging populations in selected nations in Europe. Old age per se does not seem to be a major factor in determining the use of dental services. Dentition status, on the other hand, is a major determinant of dental attendance. In addition to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental care to these patients. One reason may be that the fee for treating these patients is too low, considering high dental office expenses. Another reason may be problems related to management of medically compromised patients. This raises an important question: does inadequate training in geriatric dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in Europe as well as in the United States.

Utilization of dental health services among middle-aged people in Sweden and Denmark

In 1999, questionnaires were sent to random samples of 1001 Swedish citizens aged 55-79 years and 1175 Danish citizens aged 45-69 years. Various questions were asked concerning dental conditions, dental visit frequency per year, and money spent annually on dental care, etc. The objectives were to assess differences in the utilization of dental services and to compare out-of-pocket costs for dental care in Sweden and Denmark with control for age, gender, dental conditions and income. More than 80% of the subjects reported that a dentist had examined them less than 1 year previously. However, 77% of the Danes reported dental visits twice a year or more compared to 28% of the Swedes. Although the Danes reported a more frequent use of dental services, they had poorer dental conditions compared to the Swedes. Even though the Swedes used dental services less often than the Danes did, more subjects reported high 12-month out-of-pocket costs. In the present study, separate models were constructed for the two countries because there could be different mechanisms at play, as indicated by the results. The different insurance systems along with different degrees of commercialization in the two countries might be the most decisive factors in this context.

Subjective need for implant treatment among middle-aged people in Sweden and Denmark

BACKGROUND

The use of oral implants in prosthodontics has become widespread and regarded as a predictable treatment modality. However, there is a lack of knowledge among the general population about the prevalence and need for implant treatments.

PURPOSE

This study was undertaken to register and compare the prevalence of dental implants and the subjective need for implant treatment among people in Sweden and Denmark.

MATERIALS AND METHODS

Random samples taken from the national population registers in Sweden and Denmark comprised 1001 Swedish subjects aged 55 to 79 years and 1175 Danish subjects aged 45 to 69 years. Subjects were requested to fill out questionnaires regarding dental conditions, subjective need for implant treatment, whether they had received treatment with dental implants during the previous 10 years, and so on.

RESULTS

Of the Swedes, 4.8% reported that they had dental implants, compared with 2.5% of the Danes. In the Swedish sample, age was significantly associated with subjective need for implant treatment. In the Danish sample, women showed a significantly higher subjective need for implant treatment than did men.

CONCLUSIONS

Compared with the Swedish sample, the subjective need for treatment with dental implants was higher in the Danish sample, although the patient fees were substantially higher in Denmark.

Characteristics and study motivation of Danish dental students in a longitudinal perspective

This survey encompasses 3 comparable datasets of newly admitted dental students in 1972 (n=236), 1982 (n=197), and 1994 (n=108). The objectives of the survey were to describe selected socio-demographic characteristics of dental students and to analyze possible changes over time as well as possible changes in the reasons reported by the students for choosing dentistry as a career, their motivations and their expectations concerning the study and the profession of dentistry. The results showed that the ratio of women to men remained unchanged at 6:4 in all 3 cohorts of students and that the students were increasingly recruited from the 2 upper social classes. The motives for choosing dentistry mainly included altruistic motives, the desire for varied work with the opportunity to put theory into practice, economic rewards, and the implicit social status. Compared to the 1972 students, those in 1994 placed greater emphasis on social status as a motive, on the opportunity to work in the biological and scientific field, and on the ready availability of work outside Denmark. The students in all 3 years had strong altruistic motives for choosing dentistry, and it would seem that this stable continuity in the cohort of dental students would ensure the continuous controlled development of dentistry in the new millennium.

A survey of the use of dentin-bonding systems in Denmark

OBJECTIVES

Dentin-bonding systems, which usually involve multistep procedures, are relatively new in dentistry. This study was conducted to survey dental practitioners in Denmark concerning their use of dentin-bonding systems.

METHODS

A questionnaire regarding dentin-bonding systems was distributed to dentists at an annual dental conference, and 462 dentists were included in the survey.

RESULTS

Dentin-bonding systems were used by 99% of the dentists. Twenty-one different dentin-bonding systems were being used, with six of the systems being used by 78% of the dentists. Of the 456 dentists who used a dentin-bonding system, 77% recalled a clinical procedure for their dentin-bonding system that was in accordance with the written instructions of the manufacturer. The degree to which the dentists complied with the instructions for use, was influenced by the number of operating steps involved for a given dentin-bonding system, by the frequency with which the dentin-bonding system was used, and by the degree to which the dentist was satisfied with the instructions for use provided by the manufacturer. The frequency with which dentin-bonding systems were used, was influenced by year of graduation, place of work, and gender of the dentist.

SIGNIFICANCE

Further studies, which focus on the adherence of dental practitioners to instruction manuals are warranted as are investigations of the potential clinical consequences of incorrect use of dentin-bonding systems.

Influence of dental care systems on dental status. A comparison between two countries with different systems but similar living standards

OBJECTIVE

To evaluate the influence of two different dental care systems on dental status, taking into account relevant socio-economic factors.

BASIC RESEARCH DESIGN

Questionnaire studies on randomly sampled subjects in Denmark and Sweden using questionnaire forms as identical as possible with regard to the different languages.

SETTING

The studies were performed late in 1998 in both countries.

PARTICIPANTS

Questionnaires were sent to 1,175 subjects aged 45-69 years in Denmark (response rate 73%) and to 1,001 subjects aged 55-79 years in Sweden (response rate 67%).

MAIN OUTCOME MEASURES

Questions about dental status and about socioeconomic factors and attitudes toward dental care were included. In logistic regression models, various dichotomies of dental conditions were used as dependent variables. State (Denmark vs. Sweden) was used as an independent variable together with socioeconomic factors and attitudes.

RESULTS

There were great differences between the countries in dental status. In the regression model with 'wearing removable denture(s)' as the dependent variable, state was the strongest predictor with an OR of above 4.1 for Denmark compared to Sweden. much stronger than variables such as age, income, education and residence.

CONCLUSION

The results indicate that the Swedish dental care system has been superior to the Danish one regarding dental status in middle aged and older populations in these two countries.

Dental conditions in middle-aged and older people in Denmark and Sweden: a comparative study of the influence of socioeconomic and attitudinal factors

In 1998-99 two parallel questionnaire studies were performed in Denmark and Sweden. In Denmark the age group was 45-69 years and in Sweden 55-79 years. One aim was to study the influence of socioeconomic and attitudinal factors on dental status in the two countries. For the comparable age groups 55-69 years there was a striking difference in dental conditions between the countries. In Sweden, 72% had either all teeth remaining, missing teeth replaced by fixed prosthodontics, or only one or two single missing teeth not replaced. The corresponding figure for Denmark was 44%. Among Danes, 34% were wearing removable denture(s) or were edentulous in one jaw or both jaws, compared with 15%, among Swedes. In logistic regression models, higher income and longer education were significantly associated with the best dental status categories in Denmark but not in Sweden. In the model with wearing removable denture(s) as the dependent variable, lower income and lower education level showed a significant influence for the Danes. In Sweden, lower income showed a significant influence but education level was insignificant. In both Denmark and Sweden, a positive attitude toward the importance of dental appearance was associated with an increased risk of wearing removable denture(s).

An oral health programme for schoolchildren in Kuwait 1986-97

OBJECTIVES

To assess whether it was possible to implement an oral health programme in Kuwait which followed guidelines underlying the public Danish Child Oral Health Service, and thereby improve the oral health of Kuwaiti children.

DESIGN

Successive cross-sectional surveys were carried out in one governorate in Kuwait (Al-Ahmadi) during the period 1986-97 interrupted by the Gulf War. Data were collected by clinical examinations.

SETTING

The programme was initiated by the Ministry of Health in Kuwait in order to improve the community services through a school-based oral health care programme.

PARTICIPANTS

The study population comprised incrementally all children in the four primary school classes in the governorate.

INTERVENTIONS

The children received bi-weekly tooth brushing instructions with fluoridated toothpaste and fluoride rinsing, fissure sealing, oral health education, and restorative treatment of dental caries.

OUTCOME MEASURES

The children were clinically examined each year before the start of the treatment. Dental caries was scored at surface level in accordance with the Danish registration system, using the WHO criteria for dental caries.

RESULTS

The average participation rate was 94%. The percentage of caries-free children, exemplified by second class, increased from 64% in 1987 to 78% in 1990, dropped to 71% in 1992 and increased again to 79% in 1997.

CONCLUSION

It is concluded that it has been possible to adapt the principles from the Danish Child Oral Health Service programme to Kuwait, that parents and teachers accepted the principle of treating the children during school hours, and that the oral health of the children improved. Whether the improvement in the oral health is due to the programme or to changes in the society is discussed.

Oral health behaviour of 12-year-old children in Kuwait

OBJECTIVES

The objectives of the study were: (1) to describe the pattern of oral health behaviour of 12-year-old children in Kuwait, (2) to analyse this in relation to parental education, dental visiting habits and location, and (3) to establish a baseline for planning and evaluation of an oral health care programme for secondary schoolchildren.

DESIGN

Cross-sectional, interviews with children in 1995.

SAMPLE AND METHODS

The sample included 500 12-year-old schoolchildren (250 boys and 250 girls) selected from schools in Kuwait. All the children agreed to take part. Interviews with the children were carried out in the schools by four trained and calibrated Arabic speaking interviewers.

RESULTS

During the previous 12 months, 28% of the children had experienced oral health problems--toothache (10%), or had felt discomfort (18%) either often or occassionally. The children reported that they needed oral hygiene instruction (71%), fillings (32%) and tooth extraction (23%). For 53% of the children the reason for the most recent visit to a dentist was pain or problems with teeth or gums. At their last dental visit 26% of the children had undergone a tooth extraction. The consumption of sugary foods and drinks was extremely high. Children who had visited a dentist within the last 12 months and children whose parents had higher education levels more often claimed frequent toothbrushing than those with no previous dental visiting experience and those whose parents had a low level of education.

CONCLUSIONS

Oral health education and oral health care programmes should be established in secondary schools in Kuwait to influence the oral health behaviour of the children and to avoid further deterioration in their oral health.

A one-year follow-up of an oral health care programme for residents with severe behavioural disorders at special nursing homes in Denmark

OBJECTIVES

To describe a one-year follow-up study of an oral health care programme in special nursing homes for citizens with severe behavioural disorders.

METHODS

An oral health care programme for residents (n = 264) at special nursing homes, which included an initial oral examination, subsequent dental treatment based on the principles of realistic treatment need and visits by a hygienist every three months, was evaluated one year after implementation.

RESULTS

The follow-up data revealed a significant decrease in the mean number of teeth with primary decay and periodontal treatment need. Also less calculus and visible plaque were present. Regarding denture related conditions, a decrease was found in the presence of traumatic ulcers, denture stomatitis and the need for prosthodontic treatment. Finally, an improvement in denture hygiene was observed. A high rate of participation in the programme was obtained.

CONCLUSION

Professional dental intervention has an effect on oral health indicators even when introduced to rather unapproachable recipients of dental care services.

Oral health problems and treatment needs in Danish military personnel recruited for United Nations service

A group of 223 men from the Danish Army designated to serve in the United Nations forces in the former Yugoslavia were examined to determine their oral health status and estimate their needs for dental treatment and the related dental treatment time. The population studied consisted of privates (63%), noncommissioned officers (28%), and officers (9%). About 80% of the population was younger than 28 years. Among the persons older than 27 years, 29% had not consulted a dentist within the past 3 years. Subjective symptoms were recorded in 19% of the study population. The average number of teeth per person was 29.52, and none had removable dentures. Only 5 had a decayed-missing and filled surfaces value of zero. The officers had almost twice as many untreated dental caries as the privates and the noncommissioned officers. The dental fitness of 52% permitted immediate service. Among the remaining 48% (N = 107), 2 needed extensive treatment and 105 needed some cardiological and/or periodontal treatment. The estimated dental treatment time of the population was 185 hours, examination time included.

Dental caries and dental fluorosis among 4-, 6-, 12- and 15-year-old children in kindergartens and public schools in Kuwait

The purpose of the present study was 1) to describe the occurrence of dental caries and fluorosis among children in kindergartens and public schools in Kuwait, and determine their need for dental health care, 2) to describe changes in caries prevalence and experience from 1982 to 1993 and 3) to provide a baseline for the evaluation of the preventive oral health programmes starting in Kuwait in 1994. The study population comprised 3,500 4-, 6-, 12- and 15-year-old children in kindergartens and public schools in Kuwait, selected by stratified cluster sampling. Dental caries was scored by surface in accordance with WHO criteria, and dental fluorosis was registered by Dean's index (modified). The mean deft was 4.6 at age 4 years, and 6.2 at age 6; 8 and 11 percent of the decay had been treated by extractions or fillings in the two respective age groups. Among the 6-, 12- and 15-year-old children DMFT was 0.2, 2.6 and 3.6 respectively; 12 and 14 percent of the decayed teeth of 12- and 15-year-old children had been treated. As to the 4- and 6-year-old children, 19 and 9 percent were caries-free in the deciduous teeth, while 86, 21 and 14 percent of the 6-, 12- and 15-year-old children were caries-free in the permanent teeth. Among the 4-year-old children 47 percent had caries in the front teeth. None of the children had severe dental fluorosis, but 6 percent at 12 and 15 years showed mild to moderate, but manifest, dental fluorosis. The survey revealed that caries experience as well as caries prevalence had increased since 1982, although there was a marked increase in the number of filled tooth surfaces in all age cohorts. However, in 1993 the DMFT of 12-year-old children was still well within WHO's global goal for the year 2000, whereas the prevalence of dental caries among 6-year-old was considerably higher than the WHO goal.

Benefit related assessment of treatment need among institutionalised elderly people

It has been assumed that improved oral health leads to a better quality of life for elderly people. It is, however, difficult to assess the benefit of oral health care, especially dental treatment in terms of life quality. The normative assessment, based solely on clinical diagnosis, often leads to an overestimation of the true need for treatment, especially among the 'frail elderly', some of whom do not want treatment, either because there is no perceived need or expressed demand. Others are very ill, and some in such a poor mental condition that they can not express any demand for treatment, and would probably not benefit from treatment e.g. new dentures. The realistic treatment need is an attempt to assess the true need for treatment in relation to the benefit provided. It is a combination of the normative need, the self-perceived need, and the expressed demand for treatment, and takes into account the mental and physical state of the individual, as well as ethical considerations.

Oral health and treatment needs among patients in psychiatric institutions for the elderly

The purpose of the study was to assess oral health and treatment needs among elderly in psychiatric institutions in a Danish county. The study serves as baseline for the evaluation of a newly established oral health care program in the county. The study population comprised the residents in eight institutions (n = 407). Two thirds of the residents were edentulous, 34% of the dentate had one or more root remnants, and 55% had untreated decay. The dentate with regular dental visiting habits had significantly less untreated decay than the irregular users. The oral hygiene was poor, but was not related to whether or not the elderly were assisted in daily oral hygiene. The evaluation of the program will show to what extent treatment takes place, and whether or not oral hygiene improves.

Evaluation of an oral health service for nursing home residents

The purpose of this study was to evaluate a comprehensive, on-site, oral health care program for nursing home residents. Before and after a 1-year evaluation period the elderly residents in the nursing home (NH-1) were interviewed and examined clinically. A comparable control group comprising the elderly residents in another nursing home (NH-2) were also interviewed and clinically examined before and after a 1-year period. The main objectives of the program were to increase the utilization of the dental care system, to meet the need for immediate attention, to improve oral hygiene, to reduce the prevalence of oral mucosal lesions, gingivitis, and untreated decay, and to meet the realistic prosthodontic treatment need. All the elderly residents accepted a yearly examination by a dentist, and 50% were treated in NH-1 during the evaluation period, compared with 16% in NH-2. The need for immediate attention was reduced by 56% in NH-1 and had increased by 20% in NH-2. Whether the activities in NH-2 qualify as an oral health program with on-site examinations and referral for treatment outside the institution is discussed. The annual cost per resident during the evaluation period was a little more in NH-2 than in NH-1. The conclusion is that oral health improved during the observation period in both nursing homes. The rate of participation and the improvement in oral health was most evident in NH-1.

[Oral health in institutionalized elderly]

In Denmark, approximately 7% (50,000) of the population above 65 years of age live in nursing homes (NH), where they stay for the rest of their lives, whereas elderly in hospital long-term care (LTC) are institutionalized only for a few months. Numerous studies report generally poor oral health among the institutionalized elderly, and the existing oral health care services are far from satisfactory. Attitudes towards the elderly, transportation problems, age, and dental status are among the variables that have been mentioned as possible determinants for utilization of dental services and for the standard of oral health among the residents. Utilization of health care services, including dental services, depends not only on the characteristics of the consumer, but also on the society and the provider. The planning of dental care for the institutionalized elderly requires information about the need for treatment, the existing possibilities for oral health care, and the institutional staff's attitude towards the elderly and dental care. It is also necessary to take into account the perceived need and the expressed demand for treatment as well as the mental and physical health of each individual in order to estimate what in the present study is defined as the realistic treatment need.

A model for oral health care for elderly persons in nursing homes with an estimate of the resources needed

The study proposes a model for oral health care for elderly persons living in nursing homes. It is suggested that the oral health services should take place at the nursing home and should be the responsibility of one dentist and that part of the activities should be performed by a dental hygienist. The goals for the program are to meet the realistic need for treatment, to cover emergency and palliative treatment, and to institute measures to prevent the onset of oral diseases. The realistic need takes into consideration the expressed demand for treatment and the mental and physical state of the elderly. The resources required for the establishment of the program are assessed on the basis of time estimates for the various activities necessary to meet the goals. The annual cost per elderly person will be around DKK 1000 (USD 150). It is concluded that the program would lead to a much needed improvement of oral health care for the nursing home residents at a relatively modest extra expense when compared with the cost of the existing oral health services, which is sporadic and mainly emergency-based.

Dental caries and the need for treatment among institutionalized elderly

The main purpose for the study was to determine the occurrence of untreated dental decay, and to assess the expressed demand for operative caries therapy among dentate institutionalized elderly in Denmark. The study population comprised all dentate elderly in eight nursing homes (n = 126) and in five hospital long-term care facilities (n = 75). In both groups of elderly 70% had untreated decay. The mean number of surfaces with untreated decay among the elderly in nursing homes (NH) and in hospital long-term care facilities (LTC) was respectively 9.7 and 7.5. The predominant factors influencing the occurrence of untreated decay were the use of dental services and the degree of helplessness. Regular use of dental services reduced the amount of untreated decay among the NH elderly, and the totally helpless LTC elderly had more decay than those able to manage alone. Half of the NH residents who had decay did not want treatment or were not able to express their demand for treatment due to poor mental or physical health. The realistic need for traditional operative filling therapy is discussed and it is concluded that the goal of an oral health care program for NH elderly should be to meet not only the demand for such treatment but also the need for emergency treatment and non-operative caries treatment.

[Knowledge, attitude and behavior of institutional staff with regard to oral health in nursing homes]

The purpose of the study was to describe the attitude and behavior of the institutional staff in two nursing homes in relation to the oral health problems and to the oral health care of the residents. A questionnaire was distributed to all staff with nursing responsibilities working day-time (n = 90), and 93% returned the questionnaires. The majority of the staff were female nursing assistants below 40 years of age. Only 17% said they had had sufficient training about oral health care, and many had problems assisting the elderly, especially the most helpless residents. It was a common problem to remove and replace dentures and many of the dentate elderly resisted assistance with toothbrushing by closing the mouth. In general the staff was aware of the many oral health problems of the elderly. The majority was of the opinion that oral health care service should be the responsibility of one dentist and of the municipality. Finally half of the staff expressed that the dentists working in the municipal clinics were as qualified as the private practitioners to take responsibility for providing oral health care to the elderly.

Oral mucosal lesions among institutionalized elderly in Denmark

The purpose of the study was to determine the prevalence of oral mucosal lesions among institutionalized elderly. The study population comprised 486 elderly from eight nursing homes, and 199 elderly from five hospital long-term care facilities in the eastern part of Denmark. Approximately half of the subjects exhibited one or more pathologic conditions of the oral mucosa. Denture related traumatic ulcerations were found in 3.9% of the nursing home residents, compared to 8.3% among the elderly in hospital long-term care. The most prevalent finding was denture stomatitis, which was manifest in about one third of the elderly. The prevalence was strongly influenced by the denture hygiene; 54% of the elderly with poor denture hygiene suffered from denture stomatitis, as compared to only 7% of those with clean dentures. The prevalence of denture stomatitis was also related to the usage of dentures at night and to the age of the dentures. The prevalence decreased significantly with increasing age, although the oldest age group did not have better denture hygiene, or more favorable wearing habits. It did not appear that sex, type of residency, degree of urbanization, denture conditions, or the use of anticholinergic drugs influenced the prevalence of denture stomatitis. The prevalence and severity of the disease can probably be reduced if the denture hygiene is improved and if the elderly only use their dentures during the daytime.(ABSTRACT TRUNCATED AT 250 WORDS)

Denture status and need for prosthodontic treatment among institutionalized elderly in Denmark

The purpose of the present study was to estimate the realistic need for prosthodontic treatment among institutionalized elderly in Denmark. The study population comprised 486 elderly in nursing homes and 199 in hospital long-term care facilities. The realistic need for treatment was estimated on the basis of the normative and the perceived needs, taking into account the general mental and physical state of each individual as assessed by the charge nurses. The investigation revealed that the majority of the elderly were markedly handicapped, two-thirds were unable to care for themselves, and 15% were in poor mental condition. Among the residents of nursing homes 67% had a normative need for prosthodontic treatment, e.g. new dentures, relining and/or corrections of occlusion, as compared to 71% of the elderly in hospital long-term care facilities. However, only 19% of the nursing home residents and 32% of the elderly in long-term care facilities has a realistic treatment need. The differences between the two groups of elderly are explained by differences in age and general health status. It can be concluded that the realistic need for prosthodontic treatment among institutionalized elderly in Denmark is far from being met, and that this problem can only be solved if given higher priority by the political decision-makers.

Dental caries experience among children with Down's syndrome

The purpose of this investigation was to determine dental caries experience among institutionalized and non-institutionalized mentally retarded children with Down's Syndrome (DS). Caries was furthermore assessed in a control group of mentally retarded individuals without DS. A total of 288 persons, 6-19 years old, were examined. The prevalence of caries free individuals was 40%. Institutionalized subjects had a lower caries prevalence than those living at home, probably as a result of differences in environment. Within all age groups, DS subjects had less caries but also fewer erupted permanent teeth than those without DS. In order to adjust for this difference, the DS subjects were compared with other mentally retarded individuals who were 1 year younger. After this correction, significantly lower caries prevalence was only found among the older age groups. When the results were analyzed on the basis of the number of teeth present and not on the number of tooth surfaces significant differences could not be found, even without the age correction. It is concluded that individuals with DS are susceptible to caries, though the prevalence of approximal caries is low, probably mainly due to the fact that DS subjects have more spacing.

Periodontal conditions in mentally retarded children

The purpose of this investigation was to evaluate the standard of oral hygiene and periodontal health among institutionalized and non-institutionalized mentally retarded children with and without Down's syndrome in relation to dental care and socioeconomic status. A total of 329 persons, 6-19 yr old, were examined. In general, oral hygiene and periodontal health were poor and most of the children had gingival bleeding. The best, as well as the poorest, oral hygiene and periodontal health was found among subjects living at home. Children with Down's syndrome had less plaque and calculus but, in spite of this, a tendency to more gingivitis than others. Individuals who had their teeth brushed every day under teacher supervision had better periodontal health than others. Furthermore this study indicates a relationship between socioeconomic status and periodontal conditions.

Prevalence of malocclusion in mentally retarded young adults

Occlusal anomalies were recorded in 218 mentally retarded young adults, aged 13-19 yr. Down's syndrome was diagnosed in 37 cases. Among the Down's syndrome individuals 41% had mandibular overjet, 54% mesial molar occlusion, 38% frontal open bite and 65% crossbite. Also, the mentally retarded subjects without Down's syndrome had markedly increased frequencies of some of the anomalies when compared to normal individuals. Thus, 27% had extreme maxillary overjet, 6% mandibular overjet, 17% mesial molar occlusion, 23% frontal open bite and 29% crossbite. Orthodontic dental service for the mentally retarded has been neglected for a long time. Though many factors may contraindicate treatment, it should in many cases be possible to improve the dental situation for this group, thereby helping these patients to a better oral function.