Health-Related Social and Ethical Considerations towards the Utilization of Dental Medical Services by Seniors: Influencing and Protective Factors, Vulnerability, Resilience and Sense of Coherence.

The aim is to analyze protective and modifying factors (e.g., vulnerability, resilience, sense of coherence) in relation to the utilization of dental services by seniors at different levels of the healthcare system. Terminological imprecision in the use and transfer of existing terms (sense of coherence, resilience, salutogenesis) to gerodontology is clarified. Factors influencing a reduced utilization (static/dynamic factors) can occur isolated or in combination and, thus, model the risk of a reduced utilization of dental services (influencing-factor mechanism). Protective factors of utilization include patient-specific factors for self-motivation and factors that promote oral-health-related resilience. Resistance forces that counteract can be identified as oral-health-related resilience factors. Achieving social and individual appreciation and establishing a prevention-oriented approach to utilization will be increasingly challenging, since the population is becoming older and access is not equal in terms of opportunity. Resistance forces need to be strengthened in an ethical context. Studies should increasingly present resilience processes, determinants and modes of action at the various interfaces in the healthcare system, which can ensure sustainable medical care in old age. The concepts conveyed here are generally valid and able to point out inequalities and ageism in access to dental services.