Journal of the World Federation of Orthodontists 5 (2016) 1
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Elderly people, quality of life, and orthodontics
The chances of we humans living to an old age are on the rise, and we have reached the highest life expectancy ever, in one of society’s greatest achievements. This celebrated advance is the result of many actions: availability and quality of food, improved sanitation, and advances in health care promotion, disease prevention, and the entire range of health care services, from primary to palliative. Health care systems are struggling to manage the “golden wave” of elderly people with speciﬁc sets of diseases for which age is the main risk factor. The time has come to revolutionize today’s approaches to aging-related diseases as well as to improve quality of life (QoL) in old age. There is an increasing understanding that aging, far from being nature’s way of making space for the young, is a haphazard process of decline. Thus, it is our task to modulate this phenomenon. In fact, there is an imbalance between our growing longevity and our quality of life as we age, i.e., we have advanced much more in expanding the number of years that people live than in fostering the overall well-being of seniors. This happens because QoL does not depend solely on physical and mental health, but it is also linked to social interaction, built environment, leisure and entertainment. Therefore, a wide range of actions is needed to improve the QoL of older people, and this brings us to orthodontics. Orthodontics plays a potentially important role in improving the QoL of elderly individuals. The beneﬁts of orthodontic treatment for oral health-related QoL have been widely demonstrated [1e3]. However, most studies have focused on children and adolescents, even though some other studies have provided evidence that adults also beneﬁt from orthodontic treatment in this regard. An increasing number of seniors is seeking orthodontic treatment worldwide. They are looking for functional and aesthetic improvements, and we are technically prepared to meet their demands. The crucial issue is that common sense is totally prevailing over evidence in terms of what to do, and as a consequence many orthodontists do not know exactly how to properly perform such treatment. Orthodontic treatment modalities for elderly people are very often multi and interdisciplinary as they involve a combination and interaction of disciplines. Treatment time is usually reduced since
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both orthodontists and patients tend to opt for partial treatments. For instance, it is probably unwise to provide a comprehensive 3year treatment for an 85-year-old individual, but these very same people might see their QoL and oral health improve if they undergo a 3-month treatment. Our specialty has been historically associated with the treatment of children and teenagers, and this concept has gone a long way towards impairing the expansion of treatment beneﬁts to the seniors in our societies. How this association came into being is not completely understood, but this prejudice has deﬁnitely exerted a dramatic impact on the population. Orthodontists should be aware of this predicament and clinicians, researchers, and orthodontists associations should challenge this status quo, engaging our specialty into the efforts to improve elderly people QoL. The time has come to rethink the scope of orthodontics. For many years we were led to believe that our professional mission was to forge beautiful smiles. Evidence however supports the claim that our work transcends this noble yet limited purpose. We improve the patients’ breathing patterns; we improve function, enhance esthetics and self-esteem. In summary, the ultimate goal of orthodontics is to improve quality of life. We must strive to extend the beneﬁts of orthodontic treatment to older people, and ﬁght with all our might the deep-seated preconception that orthodontic treatment is strictly for youths.
References  de Couto Nascimento V, de Castro Ferreira Conti AC, de Almeida Cardoso M, Valarelli DP, de Almeida-Pedrin RR. Impact of orthodontic treatment on selfesteem and quality of life of adult patients requiring oral rehabilitation. Angle Orthod 2016 [Epub ahead of print].  Abreu LG, Melgaço CA, Abreu MH, Lages EM, Paiva SM. Parent-assessed quality of life among adolescents undergoing orthodontic treatment: a 12-month follow-up. Dental Press J Orthod 2015;20:94e100.  Zhou Y, Wang Y, Wang X, Volière G, Hu R. The impact of orthodontic treatment on the quality of life a systematic review. BMC Oral Health 2014;14:66.
Jorge Faber, DDS, MS, PhD, Editor-in-Chief Brasilia, Brazil