Reappraising prosthodontic treatment goals for older, partially dentate people: Part II. Case for a sustainable dentition?

The second of this two-part series, on the theme of estimating prosthodontic treatment needs and goals for older, partially dentate people, examines the roles of patient-perceived functional impairment, treatment outcome and changing demographic profiles in influencing these goals. In contradistinction with the lack of compelling evidence for the basis of the traditional, morphologically-driven prosthodontic treatment strategy, the evidence that the assessment of treatment need should take greater account of individuals' felt oral functional concerns, and thereby assuming a more problem-oriented, outcomes-based approach to prosthodontic decision-making, is gaining strength. Furthermore, the current blueprint guiding prosthodontic planning and procedures cannot be exempt from the far-reaching changes in society brought about by new economic and social realities, and will need to transform itself in the light of new evidence. How these realities translate in a developing country context is not certain, but it is known that inequalities in access to, and the provision of healthcare are related to socio-economic factors, be they prevailing or of residual nature from past structural conditions. Such conditions adversely affect peoples' health status and add urgency to the pursuit of viable and appropriate management strategies. In the context of a reappraisal of current prosthodontic paradigms, the shortened dental arch concept is presented as a potentially compelling strategy for the appropriate management of the ageing, partially dentate patients in South Africa, whose access to healthcare is inequitable. Since dental and oral health status is variable, the management strategy highlighted here should be seen as one, albeit an important one, within a range of available options.