How much reduction of the dental arch is functionally acceptable for the ageing patient?

Dental care should be aimed at the preservation of a natural functioning dentition for life, within the available resources. In general, preference should be given to dentitions comprising complete dental arches or 14 occluding pairs of teeth. However, in many subjects--such as the elderly--this goal might be neither attainable nor necessary. In these cases, dental care should be aimed at preserving the strategic parts of the dental arch, which are the front and premolar regions (the so-called ultimate occlusal preservation target). Clinical observation as well as research findings indicate that elderly people can function at an acceptable level with a reduced dentition consisting of 10 or even fewer occluding pairs. The minimum size of a functional dental arch differs between individuals and depends on local and systemic factors. Important indicators are the age, the (periodontal) quality of the remaining dentition, the spatial relationship between the lower and upper teeth, the occlusal activity and the adaptive capacity. Dental health care systems should implement guidelines to concentrate the available resources primarily on the strategic regions of the dental arch, especially in high-risk groups. These guidelines should be based on research results. The main objective of this paper is to contribute to defining an acceptable oral status for elderly subjects.