Ed i to r ia l

Whether you’re a big fish, a little fish or an old and wise fish…

This is the start of exciting times in the life of

Gerodontology as from now we go up to four issues

per year with expansion into new areas of interest.

Last year we stated that this would include the

continuation of high quality research papers as well

as dental speciality reviews related to the care of

the older person, developments in patient care,

policy developments, gerontology review articles

and geriatric medicine review articles. You will also

see that there is an opportunity to relate develop-

ments in clinical progress which should allow

carers in the clinical scenario or elsewhere to pre-

sent their findings that have enhanced the oral care

of the older adult or improved their quality of life.

You will also see in the current issue that there is

an opportunity for research workers to present

short reports on their research activities. This is to

give an opening to report pilot studies, audit

reports, dissemination of good practice and inno-

vative approaches to clinical care.

It is fascinating to note the publication of an

article in this issue on the impact of the human

genome project on the treatment of the older adult.

The authors suggest that future dental services will

use highly sensitive diagnostic technology to

develop a personalized care programme for patients

to provide treatment with the greatest potential

benefits. The mapping of single nucleotide poly-

morphisms (SNPs) has accelerated complex disease

gene localisation, providing a tool to narrow the

linkage region by detecting multiple SNPs associ-

ated with the disease. This should enable a better

understanding of the mechanisms of disease pro-

cesses and facilitate the discovery of new and more

efficacious treatments, in this case for resorption of

the residual ridge. Who would have thought that

the genome project would have this sort of impact

in dentistry, let alone for the older patient?

From a clinical point of view we have also got to

realize that as older people retain teeth longer in

life, they will want to have a realistic ‘smile’. Not

something that is obviously artificial but something

that is commensurate with their biological age.

Unfortunately this is not always as easy as it would

appear because when some anterior teeth are lost it

is increasing difficult for the clinician to produce a

prosthetic replacement that matches the remaining

standing dentition. Research published in this issue

has shown that the majority of people older than

60 years do not wish a change in their appearance

and there is a need for customisation to promote a

‘natural’ appearance. This concern with appear-

ance is part and parcel of the fact that the current

over-60’s are the healthiest and most active on

record. They already provide health clubs, gyms

and keep-fit clubs with substantial business and

evidence would suggest that they use the facilities

and equipment for longer periods of time and there

is a decreased tendency for a fall off after the fes-

tival period than with the younger fitness fanatics.

A case in point concerns a patient of 84 years who

presented for dental treatment and enquired how

long the appointment would last. The reason for

this was that she did not want to miss her line-

dancing class which she had just started. The

operator was naturally impressed but was then

informed that the only reason for doing this was

the fact that she had stopped her keep fit classes to

allow ‘younger’ people to join!

Many people believe that it is no longer possible

to call someone old in their 60’s or early 70’s. In

future, each of us can expect to live longer and

experience health that is more or less free of

chronic illness. We will experience what clinicians

refer to as a ‘compression of morbidity’. In other

words, we will become older and older before

enduring, on average, shorter periods of ill health

before dying. At the same time there will be a move

to deliver more medical care and treatment at

home as health services attempt to reduce costs. It

is worth considering that in the UK, about 60% of

the National Health Service budget goes towards

care of the older adult and economists consider that

this is not sustainable in the future. Supporting the

growing phalanx of older adults represents the

most obvious and awkward challenge of the grey

revolution. By 2050, there will be far fewer young

people in developed countries to provide them with

wealth. Therefore those over 65 will either have to

play an increased role in making goods and run-

ning services compared with today or individual

productivity will have to rise amongst younger

workers to maintain a nation’s elderly. Until now

this latter process has compensated for the fact that

the average person is getting older and older.

However, whether this is able to continue is

another matter. This is also leading researchers to

try and redefine what is actually meant by an old

person. Perhaps there is a need to define this cohort

of people as young-elderly, elderly and older-

elderly. It is very apparent that there is a need for a

consensus of what these terms actually mean. An

� 2004 The Gerodontology Association, Gerodontology 2004; 21: 1–2 1

example of where this is beginning to apply is with

regard to the efficacy of drugs for this group of the

population. It is considered that specific drugs for

older adults should only be evaluated where the

median age is 82, by which time it is considered

fairly safe to assume that most of the physiological

changes of ageing will have set in. Pinpointing

when we start to age is actually a straightforward

process. It begins ‘in utero’. There, our cells divide,

grow and begin to accumulate the DNA damage

that will eventually lead to our deaths. Essentially

it is downhill from the word go. In the words of

Professor Tom Kirkwood, ‘‘It was once thought that

humans were programmed to die, but now we realize this

is not the case. Even in the last few minutes of life, a cell’s

repair mechanisms struggle to do their work.’’

It is therefore essential that research continues

into the ageing process and the care of the older

adult and Gerodontology will endeavour to play a

key role in providing a forum for the dissemination

of developments and understanding in this field.

James P. Newton

Editor

� 2004 The Gerodontology Association, Gerodontology 2004; 21: 1–2

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