Dental Care in Older Adults
NHS England Issues New Framework for Dental Care in Older Adults: What Patients Need to Know
As people live longer and retain more of their natural teeth, maintaining good oral health throughout later life is becoming increasingly important. Older adults may have more complex dental histories, existing restorations, medication-related oral health concerns, reduced mobility or difficulties with everyday oral hygiene.
Recognising these changing needs, NHS England has introduced a new framework for maintaining the oral health of the ageing population. The framework promotes a more personalised and prevention-focused approach to dental care, with treatment and support based on a person’s individual needs rather than age alone.
For older adults and their families in Edgware, Colindale, Burnt Oak and surrounding areas of North West London, understanding what this new approach means can help make dental care more appropriate, accessible and focused on maintaining oral health for longer.
What Is the New NHS England Framework for Dental Care in Older Adults?
The NHS England framework provides a structured approach to improving and maintaining oral health among an ageing population. It recognises that older adults have very different levels of independence, oral health needs and medical complexity.
The framework encourages dental services to consider factors such as:
- Oral health status
- Functional ability
- Frailty
- Dependency
- Medical complexity
- Communication needs
- Ability to maintain daily oral hygiene
- Access to dental services
- Individual treatment needs
The key message is simple: being older does not automatically mean that someone requires complex or specialist dental treatment.
Instead, the appropriate level of dental care should reflect the person’s individual circumstances and clinical complexity.
The framework was published by NHS England in June 2026 and subsequently updated in July 2026.
Why Has NHS England Introduced a New Approach to Older Adult Oral Health?
The UK’s ageing population is changing the demands placed on dental services.
According to NHS England, the population aged 65 and over has almost doubled over the past 40 years. The number of people aged 80 and over is also expected to double during the next 40 years, reaching more than six million.
At the same time, more people are reaching older age with their natural teeth.
The 2021 Adult Oral Health Survey found that 52% of adults aged 75 and over reported having 21 or more natural teeth.
Keeping natural teeth for longer is a positive development. However, it also means that dental services increasingly need to help older adults maintain teeth that may have fillings, crowns, bridges and other restorations accumulated over many years.
Ageing can also coincide with changes in mobility, dexterity, medication use, cognition and general health. These factors can make oral hygiene and access to dental care more challenging.
This is why the new framework focuses on individual need rather than age as the main determinant of dental care.
Does Age Determine the Type of Dental Care an Older Adult Needs?
No. Age alone should not determine the level of dental care a person receives.
Two people of the same age can have completely different oral and general health needs.
For example, one 75-year-old may be independent, medically well and able to maintain excellent oral hygiene. Another person of the same age may experience frailty, dementia, mobility limitations, multiple health conditions or difficulty managing daily oral care.
Their dental care requirements may therefore be very different.
The NHS England framework considers three broad groups.
Functionally Independent Older Adults
These individuals can generally manage their own daily activities and oral hygiene and can attend routine dental appointments.
They may require:
- Routine examinations
- Preventive dental care
- Professional hygiene support
- Fluoride advice
- Restorative treatment when required
- Ongoing monitoring
Frail Older Adults
Frailty can affect physical strength, mobility and independence. A frail person may need additional support to maintain oral hygiene or attend dental appointments.
Their dental care may require more personalised planning and closer coordination with carers or other healthcare professionals.
Functionally Dependent Older Adults
Some older adults may depend on family members, carers or healthcare professionals for everyday activities, including oral hygiene.
They may experience difficulties with:
- Tooth brushing
- Denture care
- Communication
- Travelling to a dental practice
- Understanding or communicating dental concerns
- Managing complex treatment plans
For these patients, dental care may need to be adapted around their functional and medical needs.
What Are the Three Levels of Dental Care?
One of the important features of the NHS England framework is a three-level approach to dental care.
Level 1: Routine Dental Care
Level 1 is appropriate for patients whose oral healthcare needs can generally be managed through routine dental services.
This may include:
- Regular dental examinations
- Preventive advice
- Oral hygiene support
- Routine fillings
- Maintenance of existing restorations
- Gum health monitoring
Level 2: Enhanced Dental Care
Some patients may require additional skills, facilities, adjustments or support because of their medical, physical, cognitive, communication or behavioural needs.
This is known as enhanced dental care.
For example, a patient with significant mobility limitations or complex medical needs may require additional consideration when planning treatment.
Level 3: Specialist Dental Care
Patients with particularly complex needs may require specialist dental services.
This may involve more advanced clinical expertise or facilities that are not routinely available within general dental care.
Importantly, being an older adult does not automatically place someone into Level 2 or Level 3 care. The level of care should be determined by complexity and individual need.
What Is the BDA Case Mix Tool?
The NHS England framework recommends the use of the British Dental Association Case Mix Tool as a common approach to assessing the complexity of care required by older adults.
The tool considers different factors that may affect a person’s dental care needs, including:
- Communication
- Cooperation
- Medical status
- Access requirements
- Oral disease risk
Using a structured assessment can help dental teams better understand a person’s circumstances and determine what level of support may be appropriate.
For patients, this means that dental care planning can become more personalised instead of relying on age as a simple measure of complexity.
Why Can Dental Care Become More Complex With Age?
Ageing itself does not cause every dental problem. However, several factors that become more common later in life can influence oral health.
Tooth Decay
Older adults who retain their natural teeth can still develop cavities. Receding gums may expose root surfaces, which can be more vulnerable to decay.
Existing restorations may also need regular monitoring and maintenance.
Gum Disease
Gum disease can cause bleeding, inflammation and damage to the structures supporting the teeth.
If brushing and interdental cleaning become difficult because of reduced dexterity or mobility, maintaining gum health may require additional support.
Dry Mouth
Dry mouth, or xerostomia, is another important consideration.
Some medications and medical conditions can reduce saliva production. Because saliva contributes to natural protection of the mouth, reduced saliva can increase the risk of discomfort and dental decay.
Persistent dry mouth should be discussed with a dental or healthcare professional.
Multiple Medications
Older adults are more likely to take several medications for different health conditions.
Some medicines can affect oral health, particularly by contributing to dry mouth or other changes within the mouth.
Dental professionals should therefore be aware of a patient’s relevant medication history when assessing their oral health.
Reduced Dexterity
Conditions affecting the hands, movement or coordination can make everyday brushing and interdental cleaning more difficult.
In these circumstances, dental professionals can provide practical advice about adapting oral hygiene routines.
Cognitive Changes
People living with cognitive impairment or dementia may require additional assistance with oral hygiene, communication and dental appointments.
A personalised approach can help make dental care more manageable and comfortable.
Why Is Preventive Dental Care So Important for Older Adults?
Prevention is central to the NHS England framework.
Preventive dentistry aims to reduce the likelihood of oral health problems becoming severe enough to require complex treatment.
Depending on individual needs, preventive care may include:
- Regular dental examinations
- Fluoride-based prevention
- Effective tooth brushing
- Interdental cleaning
- Professional dental hygiene care
- Dietary advice
- Dry-mouth management
- Early detection of tooth decay
- Gum disease prevention and management
- Monitoring crowns, fillings and other restorations
Preventive care can be especially valuable when an older adult has other health or mobility challenges that could make extensive dental treatment more difficult.
Supporting Preventive Dental Care at The Tooth Sanctuary
For older adults in Edgware, Colindale, Burnt Oak and nearby areas, choosing a dental practice that takes a personalised approach can make ongoing preventive care easier to manage.
At The Tooth Sanctuary, patients can discuss their individual oral health needs and receive guidance based on their dental history, current oral health and long-term goals.
Regular dental care can help identify changes early, maintain existing teeth and restorations, and support better oral health as people age.
Can Older Adults Keep Their Natural Teeth?
Yes. Older age does not mean that tooth loss is inevitable.
With appropriate preventive care, many people can maintain their natural teeth well into later life.
The most important steps include:
- Brushing regularly with fluoride toothpaste.
- Cleaning between your teeth where appropriate.
- Attending dental examinations based on individual risk.
- Managing gum disease and tooth decay early.
- Maintaining existing fillings, crowns and other restorations.
- Discussing dry mouth or medication-related oral symptoms with a professional.
- Seeking advice promptly when changes in the mouth are noticed.
Maintaining natural teeth can support comfortable eating, speaking and everyday quality of life.
Can Older Adults Have Dental Implants, Crowns or Other Restorative Treatments?
Older age alone does not rule out restorative dental treatment.
Depending on their individual circumstances, older adults may be suitable for treatments such as:
- Dental implants
- Crowns
- Bridges
- Dentures
- Restorative fillings
- Gum disease treatment
Suitability depends on factors such as oral health, gum condition, bone support, general health, medications, oral hygiene and the person’s ability to maintain the treatment.
A personalised dental assessment is therefore more important than simply looking at a patient’s age.
What Is Domiciliary Dental Care?
Domiciliary dental care refers to dental care provided in a person’s home or another setting outside a conventional dental practice.
It can be particularly relevant to people who experience significant difficulties accessing a dental practice because of factors such as:
- Frailty
- Severe mobility limitations
- Functional dependency
- Complex care needs
The NHS England framework encourages commissioners to consider domiciliary dental care when planning appropriate services.
However, being older does not automatically mean that a person needs home-based dentistry. The individual’s functional needs and circumstances should determine whether this type of care is appropriate.
How Can Family Members and Carers Support an Older Adult’s Oral Health?
Family members and carers can play an important role in helping older adults maintain good oral health.
Support may include:
- Encouraging regular tooth brushing
- Helping with denture care
- Supporting dental appointments
- Helping patients communicate symptoms
- Watching for changes in the mouth
- Reporting persistent pain or swelling
- Encouraging appropriate hydration
- Supporting regular preventive dental care
For people who are unable to maintain their oral hygiene independently, consistent assistance can make a meaningful difference.
Why Is Oral Health Part of Healthy Ageing?
Oral health is closely connected to everyday wellbeing.
Teeth and gums affect the ability to:
- Eat comfortably
- Chew food
- Speak clearly
- Smile confidently
- Maintain social interaction
- Enjoy everyday activities
For older adults, oral discomfort or untreated dental disease can affect quality of life and may make eating certain foods more difficult.
This is why maintaining oral health should be considered part of healthy ageing, rather than treated as an isolated dental concern.
Why Does the Framework Encourage Collaboration Between Healthcare Services?
Older adults may receive support from several different healthcare and social-care professionals.
The NHS England framework encourages greater collaboration between dental services and wider health and social-care systems.
This can involve:
- Dentists
- Dental hygienists and therapists
- Primary care
- Pharmacy
- Dietetic services
- Social care
- Care homes
- Local authorities
- Voluntary organisations
- Family and informal carers
Better communication between services can help ensure that oral health is not overlooked when an older adult is receiving care for other needs.
What Does the Framework Mean for Dental Professionals?
The framework also has implications for the dental workforce.
Dental teams may need greater knowledge and training in gerodontology, the area of dentistry concerned with the oral health needs of older adults.
This includes understanding how to care for patients experiencing:
- Frailty
- Dementia
- Multiple medical conditions
- Medication-related oral problems
- Reduced mobility
- Communication difficulties
- Complex restorative needs
- Functional dependency
The framework also supports dental professionals working effectively across their roles to strengthen preventive care and improve access for older adults.
Dental Care for Older Adults in Edgware, Colindale and Burnt Oak
For older adults, choosing a dental practice that understands individual needs can make routine dental care easier to manage.
The Tooth Sanctuary is located on Sheaveshill Avenue in Edgware, in the Colindale area of North West London, providing dental care for patients across different stages of life.
For families in Edgware, Colindale, Burnt Oak and nearby North West London communities, regular dental care can help identify oral health concerns early and support a personalised approach to long-term dental health.
The Tooth Sanctuary provides both NHS and private dental care, alongside a range of general, preventive, restorative and specialist dental services. Treatment planning can be tailored around the patient’s individual dental needs and circumstances.
How Can The Tooth Sanctuary Help Support Long-Term Oral Health?
Older adult dental care is not simply about treating a tooth when it becomes painful.
A long-term approach can involve:
- Assessing current oral health
- Identifying risk factors
- Preventing future dental disease
- Monitoring existing restorations
- Managing gum health
- Addressing tooth loss
- Discussing suitable restorative options
- Supporting patients who may feel anxious about dental treatment
- Developing an appropriate maintenance plan
For patients in Edgware, Colindale, Burnt Oak and North West London, speaking with a dental professional can help determine what type and frequency of dental care is appropriate for their individual needs.
What Should Older Adults Do to Protect Their Oral Health?
A few consistent habits can make a significant difference:
Brush twice daily: Use fluoride toothpaste and follow your dentist’s recommendations.
Clean between your teeth: Interdental cleaning can help remove plaque from areas a toothbrush cannot reach.
Attend regular dental appointments: Your dentist can recommend an appropriate recall interval based on your individual risk.
Don’t ignore symptoms: Pain, swelling, bleeding, loose teeth, persistent ulcers or changes in the mouth should be assessed.
Tell your dentist about medication: Particularly if you experience persistent dry mouth or other changes.
Look after dentures: Keep dentures clean and have them assessed if they become uncomfortable or loose.
Ask for help when needed: If brushing or attending appointments becomes difficult, discuss this with your dental team or carer.
The Future of Dental Care for Older Adults
The new NHS England framework reflects an important shift in how oral health in later life is considered.
The focus is moving away from viewing older adults simply as one age group and towards understanding individual function, dependency, clinical complexity and preventive needs.
This approach recognises an important reality: two people of the same age may have completely different dental requirements.
One person may need only routine preventive care. Another may need enhanced support because of frailty, medical complexity or reduced independence. A smaller group may require specialist dental services.
Personalised assessment can help ensure that each person receives care that is appropriate to their circumstances.
Conclusion: Better Dental Care Starts With Individual Needs
The new NHS England framework highlights the importance of adapting dental care to the needs of an ageing population.
As more people retain their natural teeth into later life, prevention, early intervention and long-term maintenance become increasingly important.
Most importantly, age should not be used as the only measure of dental complexity. Functional ability, dependency, medical circumstances, oral health and individual needs all matter when determining appropriate care.
For older adults and their families in Edgware, Colindale, Burnt Oak and North West London, maintaining regular dental care can be an important part of healthy ageing.
At The Tooth Sanctuary, an individualised approach can help patients understand their oral health needs and explore appropriate options for maintaining a healthy, comfortable and functional smile throughout later life.
Some of the Most Asked Question
The framework provides a structured approach to maintaining oral health in an ageing population. It focuses on prevention, personalised care, dependency and clinical complexity rather than age alone.
No. Age alone does not determine whether someone needs specialist dental care. The complexity of their oral health, medical circumstances, functional ability and dependency should be considered.
Common concerns can include tooth decay, gum disease, dry mouth, tooth wear, root-surface decay, tooth loss and difficulties maintaining oral hygiene.
Dry mouth can be associated with certain medications and medical conditions. Reduced saliva can increase the risk of dental decay and oral discomfort.
In suitable cases, older adults may be able to have dental implants. A dentist needs to assess oral health, gum condition, bone support, general health, medications and the patient's ability to maintain oral hygiene.
Gerodontology is the area of dentistry focused on the oral health needs of older adults, including people experiencing frailty, medical complexity, cognitive changes or functional dependency.
Domiciliary dental care is dental care provided outside a conventional dental practice, such as in a patient's home. It may be considered for people who have significant difficulty accessing a dental practice.
Carers can help with daily oral hygiene, denture care, arranging dental appointments and identifying changes such as pain, swelling, bleeding or difficulty eating.
There is no single interval that is suitable for everyone. The recommended frequency depends on oral health, dental history, medical circumstances and individual risk.
No. Ageing does not automatically cause tooth loss. Good oral hygiene, preventive dental care and early treatment can help many people retain their natural teeth for longer.
The Tooth Sanctuary is located on Sheaveshill Avenue in Edgware, in the Colindale area of North West London. Older adults from Edgware, Colindale, Burnt Oak and surrounding areas can discuss their individual oral health needs with the dental team.
Disclaimer
This article is intended for general information and educational purposes only. It does not replace professional dental advice, diagnosis or treatment. Dental needs vary between individuals, particularly among older adults with medical conditions or complex care needs. If you have concerns about your oral health, please consult a qualified dental professional for personalised advice.