02/06/2026

TUESDAY | JUNE 2, 2026

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COMMENT by Dr Marini Ismail

I N 2021, Malaysia officially became an ageing nation, with 7% of the population aged 65 and above. By 2025, this figure had risen to 8%, representing around 2.7 million people. As this demographic grows, there is an urgent need for specialised healthcare strategies, particularly in dental care. Maintaining oral health in older adults can be challenging, especially for those living with dementia, Alzheimer’s disease or multiple chronic conditions. These individuals often require care from dentists trained in geriatric dentistry, who bring patience and experience in managing complex needs. Many older adults live in nursing homes, assisted living settings or at home with family support. As their ability to care for themselves declines, oral hygiene frequently deteriorates. Maintaining routine cleaning, monitoring for infections and practising basic oral hygiene are essential for older adults. However, providing this care can be difficult for caregivers, especially when individuals are fully dependent or have cognitive decline. In these cases, specialists in Special Care Dentistry can provide vital support through practical guidance and hands on training in daily oral care to ensure that oral hygiene is maintained safely and effectively. Dental care for older patients differs significantly from that of the general population. Their extensive medication use and complex medical histories must be carefully considered when planning treatment. In most cases, a conservative approach is preferred over more complex procedures. Factors such as how long a patient can remain comfortable in the dental chair, along with their physical and cognitive condition, must always be considered. In some situations, teeth that are broken may not cause immediate pain, making careful monitoring more appropriate than surgical intervention. Procedures such as tooth extraction carry risks, including swelling, delayed healing and bleeding, particularly in patients with conditions such as diabetes or those taking anticoagulant or cardiac medications. For older adults with complex medical conditions, invasive dental procedures must be approached with

Preventive care key to oral health in later life

caution. Consulting the patient’s physician is often necessary as temporarily stopping medications such as anticoagulants can carry serious risks, including stroke or heart complications. In many situations, the potential harm may outweigh the benefits of dental treatment, especially when the oral condition is not causing discomfort. Patients with Alzheimer’s disease or other forms of dementia require extra care as they may not be aware of numbness or other sensations after treatment. This can lead to accidental biting of the tongue or cheeks, causing injury and bleeding. Careful assessment of risks and benefits is therefore essential before carrying out any dental procedure in this group. A particularly important consideration in elderly dental care is the use of antiresorptive therapy, which is commonly prescribed for conditions such as osteoporosis, bone metastases or certain cancers. These medications, including bisphosphonates and other agents, work by slowing down bone resorption, thereby strengthening bone density and reducing fracture risk. However, they are also associated with a rare but serious condition known as medication-related osteonecrosis of the jaw or MRONJ. MRONJ occurs when the jawbone does not heal properly after minor trauma, such as a tooth extraction or denture irritation. This can result in exposed bone, pain, infection and difficulty in eating or speaking. The risk is higher in patients receiving high-dose intravenous therapy for cancer but it can also occur in those taking oral medications for osteoporosis, particularly after long term use. For this reason, referral to a specialist in Special Care Dentistry and dental assessment before starting antiresorptive therapy is strongly recommended.

“Identifying and treating

potential sources of

infection early can significantly reduce the likelihood of

Preventive care remains the foundation of oral health in later life. – MASRY CHE ANI/THESUN

to tooth loss. Regular dental care helps control inflammation, and maintaining good oral hygiene not only prevents pain and tooth loss but also supports overall health and well-being. Preventive care remains the foundation of oral health in later life. Dental check-ups are usually recommended every six months but people with complex health conditions or behavioural challenges may benefit from visits every three to four months. Studies have also suggested a connection between gum disease and the progression of Alzheimer’s disease, highlighting the broader importance of good oral hygiene. Identifying dental problems early, referring patients to specialists in Special Care Dentistry and emphasising preventive care can help older adults enjoy a healthy diet, maintain a stable weight and improve their overall quality of life. Dr Marini Ismail is specialist in Special Care Dentistry, Faculty of Dentistry UiTM Sg. Buloh. Comments: letters@thesundaily.com

Identifying and treating potential sources of infection early can significantly reduce the likelihood of complications. Once a patient has begun this medication, invasive dental procedures should be carefully evaluated and avoided where possible. Emphasis should instead be placed on preventive care, meticulous oral hygiene and conservative management strategies. Older adults often take multiple medications, including those for heart and blood pressure conditions. A common side effect of these drugs is dry mouth, which can increase the risk of tooth decay. Saliva plays an important role in the mouth’s natural self-cleansing process, washing away food particles and harmful bacteria. When saliva is reduced, teeth become more vulnerable to cavities and gum problems. People with diabetes are also more prone to gum disease as high blood sugar can make infections harder to control. Gum disease can cause teeth to become loose and if untreated may lead

complications. Once a patient has begun this medication, invasive dental procedures should be carefully evaluated and avoided where possible.

Education retains its importance in the Malaysian landscape for parents, students and stakeholders. The changes are fast paced with new developments in new fields of study such as cybersecurity, data protection, augmented and virtual reality, machine learning in education, digital education and artificial Intelligence. Leading the way are universities, who are invited to showcase their latest programmes, curriculum and content in our Education Focus for 2026.

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