Oral Health in Older People in Viet Nam: From Daily Mouth Care to Nutrition, Function and Dignity Across Care Settings
AGE-FRIENDLY CARE QUALITYLONG-TERM CARE QUALITY
AGE-FRIENDLY CARE QUALITY & LONG-TERM CARE QUALITY
Last reviewed: October 2026
An older person may begin eating less without anyone realizing that the problem starts in the mouth. A painful tooth makes them chew on one side. A loose denture makes meat, vegetables or fruit harder to manage. Dry mouth can turn swallowing into an effort. Someone living with dementia may not be able to explain dental pain at all; instead, they may become restless at meals, refuse food or resist personal care. What looks like “poor appetite” or simply “getting older” may therefore be an oral-health problem that has gone unnoticed.
Oral health is often treated as a separate dental issue, but for older people it is closely connected to nutrition, communication, comfort, social participation, self-confidence and functional ability. The World Health Organization recognizes oral health as integral to overall health and well-being, with the mouth and related structures supporting essential functions such as eating, breathing and speaking. Oral diseases can cause pain and functional limitation, but their effects often reach much further into everyday life.
For Viet Nam, this is becoming increasingly important as the population ages, more people live with multimorbidity and disability, and care increasingly extends across hospitals, rehabilitation services, homes, communities and long-term care settings. Oral health should follow the older person through that continuum. A clean, comfortable and functional mouth should not depend on whether someone happens to be at home, in hospital or living in a care facility.
Oral health is part of healthy aging, not an optional extra
Aging by itself does not mean that a person must lose their teeth, live with oral pain or accept difficulty chewing. Oral problems in later life often reflect an accumulation of exposures and unmet needs over many years: dental caries, periodontal disease, tooth loss, poorly fitting dentures, dry mouth, tobacco and alcohol exposure, reduced dexterity, cognitive impairment, limited preventive care and barriers to accessing treatment.
The effects extend well beyond teeth. Someone who cannot chew comfortably may gradually avoid foods that require more effort. An unstable denture may make a person reluctant to eat with others. Oral pain can disturb sleep and concentration. Persistent dry mouth can affect taste, speech, swallowing and denture tolerance. For an older person living with dementia, aphasia or another communication difficulty, pain may appear as agitation, altered behavior or refusal to eat rather than a straightforward complaint of toothache.
International policy increasingly reflects these connections. WHO's global oral-health strategy places oral health within primary health care, noncommunicable disease prevention and universal health coverage rather than treating dentistry as a separate service at the edge of the health system. The Bangkok Declaration, adopted at the first WHO Global Oral Health Meeting in 2024, reinforced the principle that there is no health without oral health.
This direction became even more relevant to Viet Nam in 2026. The WHO Western Pacific Regional Implementation Plan for the Global Strategy and Action Plan on Oral Health, published in March 2026, promotes stronger integration of essential oral health services into primary health care and universal health coverage while linking oral health with the broader noncommunicable disease agenda. On 5 October 2026, WHO also reported that Viet Nam was among 20 Asian countries and areas participating in a 100-Day Sprint to strengthen essential oral health benefits. Participating countries are developing and refining proposals for essential oral health benefit packages that could be incorporated into national universal health coverage arrangements.
That initiative needs to be interpreted carefully. The 100-Day Sprint is an ongoing technical implementation process. Participating countries have examined bottlenecks involving service delivery, workforce, access to essential medicines and health products, and health financing, and are refining proposed benefit-package arrangements. It does not mean that Viet Nam has already formally adopted a new national oral-health benefit package. What it does show is growing policy attention to oral health as part of mainstream health-system design rather than as an isolated dental service.
What does the evidence actually tell us about older people in Viet Nam?
The first point is methodological. Viet Nam does not currently have one contemporary prevalence figure that can accurately describe oral health among all older people across the country and across different care settings. Available studies use different populations, locations and methods, so their findings need to be interpreted within those settings rather than combined into a national prevalence estimate.
WHO's Viet Nam Oral Health Country Profile provides useful national context, although its disease estimates are not specific to older adults. Using 2019 estimates, untreated caries in permanent teeth affected 28.0% of people aged five years and above, severe periodontal disease 9.4% of people aged 15 years and above, and edentulism 4.2% of adults aged 20 years and above. These figures demonstrate a substantial population burden of oral disease, but they should not be presented as prevalence among Vietnamese older people.
Older-person-specific studies reveal important unmet needs in particular populations. A cross-sectional study of 258 people aged 65–74 years in Da Nang found that 48.4% reported brushing at least twice daily, 34% had never visited a dentist and 27.8% frequently experienced difficulty chewing. Untreated dental caries was found in 88.8% of participants; 21.0% had at least one tooth with a periodontal pocket of 6 mm or more, and 49.8% had at least one sextant with clinical attachment loss of 6 mm or more. These findings are important, but they describe one age group in one geographic setting and should not be generalized to the whole country.
A study of 791 residents of three government-administered long-term care facilities in Ho Chi Minh City found an especially high burden of untreated need. Most participants still had natural teeth, yet coronal and root caries were common. Among those with natural teeth, 26.2% had deep periodontal pockets and 96.5% required improvement in oral hygiene together with scaling. None of the completely edentulous participants had dentures, and substantial prosthodontic treatment needs were identified. These results again describe a specific institutional population rather than all Vietnamese older people, but they illustrate what can happen when oral health is not systematically integrated into long-term care.
More recent Vietnamese evidence points in the same direction. A 2024 cross-sectional study of 125 older people attending the Dental Department of 108 Military Central Hospital found tooth loss in 88.8% of participants; 83.8% had a prosthodontic treatment need. Because these participants had already presented to a dental department, the findings should not be interpreted as community prevalence. A small 2025 study involving 147 Vietnamese adults aged 20–90 years found that participants older than 75 had fewer natural and functional teeth and lower tongue pressure, oral motor performance and masticatory function than younger groups, alongside differences in food diversity. In 2026, a retrospective study based on 316 oral-health examination records from selected areas of Ha Nam Province reported gingivitis in 79.7% of the older people studied.
Each study has methodological and sampling limitations, but together they make a consistent point: oral disease, tooth loss and impaired oral function deserve much greater attention in older-person care in Viet Nam. The most defensible conclusion is not that Viet Nam has one established national rate of “poor oral health” among older people. It is that multiple Vietnamese studies have documented substantial oral-health needs in selected older populations, while contemporary nationally representative evidence covering community, hospital, home-care and long-term care settings remains limited.
Viet Nam now has a stronger foundation for daily mouth care
A significant development in 2026 is Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026, which issued professional guidance on caring for older people at home and in the community. Oral care is explicitly included within assistance with activities of daily living.
The guidance describes mouth care as helping keep the teeth and mouth clean, prevent oral diseases, improve appetite and confidence, and maintain an older person's ability to care for themselves. It covers people who have partial difficulty with mouth care as well as those who are too weak to perform it independently. Practical instructions address toothbrushing, tongue cleaning and removable dentures. Importantly from a person-centered perspective, the guidance also states that the person providing assistance should explain what will be done and obtain the older person's agreement.
Circular No. 34/2026/TT-BYT of 8 September 2026 creates a broader implementation pathway for this guidance. In its provisions on community care for older people, the Circular directs relevant training and guidance on self-care and caregiving skills to follow the professional guidance in Decision 1976/QĐ-BYT. The Ministry's population authority, provincial health departments, commune-level health stations and relevant community personnel therefore have roles in translating these materials into capacity-building and community-care activities.
Neither document should be described as a comprehensive national geriatric dentistry clinical guideline. Decision 1976 provides practical professional guidance for older-person care at home and in the community, while Circular 34 supports its use within a broader national health, population and development program. Diagnosis of dental disease, management of complex oral conditions, prosthodontic treatment and individualized high-risk prevention still require appropriately qualified dental professionals and clinical judgment.
Daily mouth care is basic care
The most sophisticated dental service cannot compensate for unreliable daily mouth care. For older people who retain natural teeth, twice-daily brushing with fluoride toothpaste remains one of the simplest foundations of prevention. WHO recommends encouraging twice-daily toothbrushing with toothpaste containing 1000–1500 ppm fluoride.
For people without natural teeth, oral care does not stop. The gums, tongue and other oral tissues still need appropriate cleaning and observation, and removable dentures require their own hygiene routine. Tooth loss changes the care required; it does not remove the need for mouth care.
The practical approach should be individualized. A fully independent older person may need little more than appropriate preventive advice and access to suitable supplies. Someone with arthritis, tremor or weakness may benefit from a toothbrush that is easier to grip or from an electric toothbrush. A person recovering from stroke may suddenly lose the hand function required for a task they performed independently for decades. Someone with advanced frailty or dementia may need substantial assistance.
The aim should be to preserve independence wherever possible. If someone can brush most of their mouth but needs help reaching certain areas, support that remaining ability rather than automatically taking over the entire task. Age-friendly care is not simply about getting the task completed; it is also about maintaining function, autonomy and participation.
Daily mouth care also creates an opportunity to notice change. A family caregiver or care worker does not need to diagnose oral disease to recognize a broken tooth, bleeding gums, swelling, an ulcer, an unstable denture, persistent red or white changes, new pain or a sudden tendency to chew on only one side. Recognition followed by appropriate assessment is often more valuable than trying to put a diagnostic label on the problem.
Dentures restore function, but they also require care
Dentures can help restore appearance, communication and chewing, but they should not disappear from the care plan simply because someone has worn them for years. Plaque and food debris accumulate on removable dentures, the tissues beneath them still require care, and fit can change as oral tissues and underlying bone change over time.
International care-home guidance supports daily denture care and removal of removable dentures overnight unless there is a clinical reason for different advice. A denture that once fitted well can become unstable. Repeated ulcers, movement during chewing, pain or an inability to manage ordinary food should not simply be accepted as an inevitable part of aging.
Nor should the long-term solution automatically be to blend or soften all food while leaving the underlying oral problem unassessed. Texture modification may sometimes be clinically necessary, particularly where swallowing is impaired, but it should not become a substitute for dental evaluation when chewing difficulty is caused by pain, tooth loss or a poorly fitting denture.
Evidence published in 2026 helps clarify what prosthodontic rehabilitation can realistically achieve in edentulous older adults. A systematic review of 15 studies found that prosthodontic rehabilitation consistently improved masticatory function and oral-health-related quality of life. Nutritional improvements were more modest, with stronger effects when denture provision or other prosthodontic rehabilitation was combined with dietary counseling. Evidence that prosthodontic treatment alone improves broader systemic outcomes such as frailty, morbidity or mortality remains limited.
This distinction matters. A well-made denture can restore chewing ability, but it may not automatically restore a balanced diet if the person has already adapted to a restricted range of foods or also has dysphagia, depression, cognitive impairment, poor appetite or other causes of nutritional risk. Dental rehabilitation and nutritional support often need to work together.
Oral function and nutrition should be assessed together
Counting teeth tells only part of the story. The more useful questions are often functional: Can this person chew comfortably? Can they manage the textures required for an adequate diet? Is eating painful or tiring? Has food variety narrowed? Has there been unintended weight loss? Has swallowing changed?
A 2025 umbrella review synthesizing 16 systematic reviews found that functional oral problems were more consistently associated with malnutrition than simple structural indicators. Masticatory dysfunction and edentulism without dentures were associated with greater malnutrition risk, whereas the presence of dental prostheses alone did not show a significant association. Much of the underlying evidence is observational, so these findings should not be interpreted as proving that one oral problem directly causes malnutrition in every individual.
The practical implication is nevertheless useful: a change in eating should prompt a look at the mouth, and an oral-health problem should prompt a look at nutrition.
An older person who suddenly stops eating meat, vegetables or fruit may not simply have “poor appetite.” Someone losing weight while struggling with an unstable denture may need more than nutritional supplements. Conversely, dental treatment alone may not be enough if poor intake also reflects dysphagia, acute or chronic illness, depression, cognitive decline or treatment burden.
Oral health and nutrition therefore fit naturally into an integrated pathway involving dentistry, medicine, nursing and nutrition and, when swallowing difficulties are suspected, professionals with appropriate expertise in swallowing assessment and rehabilitation.
Dry mouth should not be dismissed as “just aging”
Dry mouth is common enough in older populations that it can easily be normalized, yet it deserves attention. Older people frequently live with multimorbidity and take multiple medicines, and many medications can contribute to xerostomia or reduced salivary function.
A 2026 systematic review and meta-analysis focused on adults aged 75 years and older found that polypharmacy was significantly associated with dry mouth, with a pooled odds ratio of 2.05. A greater medication burden was also consistently linked with dry mouth and hyposalivation. The evidence does not mean that medication count alone explains every case; specific drug effects and the person's wider clinical context also matter.
Saliva lubricates oral tissues, supports speech and swallowing, contributes to taste and helps protect teeth and mucosa. Persistent dryness can therefore cause discomfort, difficulty eating dry foods, altered taste, reduced denture tolerance and greater susceptibility to dental caries and other oral problems.
Medication-related dry mouth illustrates why oral health cannot be managed in isolation. A dentist may identify the oral consequences, but prescribed medicines should not simply be stopped because they are suspected of contributing to dryness. A physician or pharmacist may need to review whether the medication regimen can safely be adjusted while dental and oral-care strategies address symptoms and complications.
Even simple advice about hydration needs to fit the person. Someone with a medical indication for fluid restriction should not simply be told to drink more. Likewise, repeated use of sugar-containing sweets or drinks to relieve dryness can increase caries risk. The response needs to reflect the person's overall health rather than treating the mouth as a separate system.
Cognitive impairment changes how mouth care needs to be delivered
Dementia creates particular challenges because oral disease may become difficult to express long before it becomes difficult to feel. A person may forget how to brush, fail to recognize the toothbrush, become frightened when someone approaches their mouth or be unable to describe toothache clearly. New agitation, sleep disturbance, refusal to eat or repeated touching of the face may have many possible explanations, but oral pain should be among the possibilities considered.
Resistance to mouth care should not automatically be labeled “non-compliance.” Pain, fear, sensory sensitivity, communication difficulty, unfamiliar caregivers, previous experiences and the manner in which assistance is offered may all contribute. Slowing down, explaining what is happening, using familiar routines, protecting privacy and allowing the person to perform whatever part they still can may make the difference between cooperation and distress.
Mouth care is intimate personal care. Dementia or dependency does not make a person's dignity or preferences irrelevant. Decision 1976/QĐ-BYT appropriately requires explanation and agreement when assistance with mouth care is provided. Where an older person cannot meaningfully make or communicate a care decision, involvement of an appropriate representative or family member should follow applicable law and professional guidance, while the older person should still be involved as far as reasonably possible.
For long-term care services, competency therefore means more than knowing how to use a toothbrush. Staff need to recognize possible oral pain, adapt communication, safely assist a dependent person, manage dentures appropriately and know when a change requires dental or medical assessment.
Oral health, swallowing and respiratory safety intersect, but claims should remain evidence-based
Older people with dysphagia, neurological disease, severe frailty or high dependency may have difficulty clearing secretions and oral debris. Oral and pharyngeal microorganisms can be aspirated into the lower respiratory tract, making the relationship between oral hygiene and respiratory risk biologically plausible and clinically relevant, particularly in long-term care.
Poor oral health has been associated with aspiration and nursing-home-acquired pneumonia, but association should not be turned into the claim that good mouth care by itself prevents pneumonia. A Cochrane review of oral-care interventions in nursing homes found insufficient evidence to determine whether professional oral care reliably reduces the incidence of nursing-home-acquired pneumonia. Low-certainty evidence from some studies suggested a possible reduction in pneumonia-associated mortality, but the overall evidence remained inconclusive and the optimal oral-care protocol could not be established.
The practical conclusion is therefore balanced. Good oral care remains important for cleanliness, comfort, dental-disease prevention and dignity and is particularly relevant for people at risk of aspiration. It should, however, form one part of a broader swallowing and respiratory-safety strategy rather than being promoted as a stand-alone pneumonia-prevention intervention.
This also applies to people receiving enteral tube feeding. The fact that food no longer passes through the mouth does not eliminate oral secretions, plaque, discomfort or oral pathology. Mouth care remains necessary.
Hospitalization can rapidly disrupt oral health
An older person who managed their own oral care before admission may become dependent within a few days of acute illness. Stroke may impair hand function and swallowing. Delirium may interfere with cooperation. Acute illness, reduced intake, mouth breathing and medications can contribute to oral dryness. Dentures may be removed and misplaced. Eating patterns change, and oral care can quietly fall behind more visible acute clinical priorities.
Hospitals therefore need to ask more than whether a patient “has teeth.” Can the person perform their own mouth care? Do they wear dentures, and are those dentures available and fitting? Is there oral pain or visible pathology? Has chewing or swallowing changed? Does the person now need assistance that they did not require before admission?
When acute illness turns someone who was previously independent into someone who needs help with mouth care, that is a functional change. It should be recognized as such.
Discharge is another vulnerable moment. Families may receive detailed instructions about medications and follow-up appointments but little information about the fact that the person now needs help brushing, has an unstable denture or has begun avoiding food because chewing hurts. Relevant oral-health needs should therefore travel with the person through discharge and transfer alongside medications, mobility, nutrition, continence and other functional information.
Home care needs to be effective and realistic
Family members remain an important source of day-to-day support for many older people in Viet Nam, which makes practical caregiver capability especially important. Decision 1976/QĐ-BYT is useful precisely because it brings mouth care into ordinary home and community care rather than leaving it entirely to periodic dental visits.
But giving a family instructions is not the same as ensuring that care is feasible. A daughter caring for a parent after stroke may understand that teeth should be brushed but struggle to position the person safely. An older spouse may lack the hand strength needed to provide effective assistance. A person living with dementia may accept mouth care from one familiar caregiver and resist another. Even simple equipment can be difficult to use when caregivers have never been shown how.
A realistic plan starts by asking what the older person can still do, what help is actually available and whether the person providing that help has been shown how to do it safely. Caregivers should also know which changes they can manage themselves and which require professional assessment.
Preserving the person's own role matters here just as much as it does in hospital or long-term care. Whenever possible, mouth care should remain something the older person participates in rather than something that is automatically “done to” them.
Long-term care needs an oral-health system, not occasional dental campaigns
Long-term care creates a different challenge because oral care has to remain reliable every day over months or years. WHO's 2024 Long-term care for older people: package for universal health coverage explicitly includes oral diseases among the health-care needs that long-term care systems should be able to assess and manage. It identifies routine oral-health assessment, daily oral hygiene including brushing with fluoride toothpaste, preventive interventions and referral to oral-health professionals when needed as relevant components of care. Importantly, the WHO package is primarily a tool for governments and policy-makers planning long-term care systems; it is not a bedside clinical guideline or step-by-step operating procedure.
A visiting dental campaign can identify disease and provide useful treatment, but it cannot substitute for a functioning daily care system. If oral health is not assessed when a person enters a service, no one clearly knows who requires assistance, dentures are not routinely cleaned, basic supplies are unavailable, staff cannot recognize deterioration or referrals repeatedly fail, oral health can worsen between dental visits.
NICE guidance for care homes supports oral-health assessment, individualized mouth-care planning, assistance according to need and preference, twice-daily toothbrushing for people with natural teeth, daily denture care, staff training and access to dental services. More recent implementation research reinforces an important lesson: education can improve staff knowledge and attitudes, but education alone does not reliably produce better oral-health outcomes. Materials, routines, supervision, organizational support and access to dental expertise also matter.
For a Vietnamese long-term care service, the quality questions therefore go well beyond “Did a dentist visit this year?” Was oral health assessed when the resident entered the service? Is there an individualized plan? Does the team know who needs partial or complete assistance? Are natural teeth, dentures, oral tissues and functional problems considered? Are changes documented and escalated? Is there a workable referral pathway? Are oral-health needs communicated during hospital transfer and return? Can the organization demonstrate that staff are competent to deliver the care expected of them?
These are not merely dental questions. They are questions of quality governance.
Prevention becomes more important as care becomes more complex
There is sometimes an assumption that preventive dentistry matters less in advanced age because someone has already “reached old age.” In practice, prevention may become even more valuable as treatment becomes harder to deliver.
A frail person may find travel to a dental clinic exhausting. Cognitive impairment may make lengthy or complex procedures stressful. Multimorbidity, anticoagulant therapy, respiratory disease, polypharmacy or limited tolerance for long appointments can complicate treatment. Preventing new disease or identifying it early may therefore avoid a much greater treatment burden later.
WHO's 2026 guideline on environmentally friendly and less invasive oral health care for preventing and managing dental caries is relevant here, although it is not a geriatric dentistry guideline. It promotes prevention first, minimally invasive care, shared decision-making and effective mercury-free approaches to caries prevention and management. For older people, these principles support care that seeks meaningful oral and functional benefit while also considering frailty, treatment burden, preferences and goals of care.
That should not be confused with undertreatment because someone is old. Chronological age alone is not a reason to deny appropriate dental care. A healthy 75-year-old may reasonably receive comprehensive restorative or prosthodontic treatment. Another person of the same age with severe frailty, advanced dementia and limited tolerance for complex intervention may have different priorities, with greater emphasis on comfort, pain relief, prevention, infection management and maintaining useful function.
Age-friendly care means making that distinction according to the individual rather than according to the number on their birth certificate.
Oral health needs clear escalation pathways
Daily caregivers do not need to become dentists, but they do need to know what should not wait. New or persistent oral pain, facial or oral swelling, difficulty opening the mouth, trauma, a broken or very mobile tooth, unexplained bleeding, repeated injury from a denture, a persistent ulcer or other abnormal oral lesion, unexplained numbness, or a significant new problem with chewing or swallowing should prompt professional assessment. Fever accompanied by spreading facial or oral swelling may require urgent dental or medical attention.
Oral cancer also deserves vigilance in later life because relevant exposures accumulate over time. Tobacco and alcohol are important shared risk factors for oral cancer and other noncommunicable diseases. A persistent or otherwise suspicious oral lesion should not repeatedly be attributed to denture irritation or “old age” without appropriate assessment.
A well-designed system therefore distinguishes between daily mouth care, routine preventive dental care, timely assessment of new problems and urgent escalation. Treating all four as though they are the same thing can lead either to unnecessary referral or, more seriously, delayed treatment.
A practical oral-health quality framework for Viet Nam
A useful pathway is:
assessment → individualized mouth-care plan → daily support → professional dental care when needed → reassessment → continuity across settings.
Assessment should look beyond the number of teeth. It should consider pain, natural teeth, dentures, oral cleanliness, gums and mucosa, dry mouth, chewing, swallowing, nutritional effects, the person's ability to care for their own mouth and whether another person needs to assist.
The care plan should make clear what the older person can do independently and where support is needed. Daily care should reliably include appropriate toothbrushing with fluoride toothpaste, denture and oral-tissue care where relevant and observation for change. Nutrition and hydration should be reviewed when oral problems interfere with intake. Persistent dry mouth or suspected medication-related oral effects may justify medication review by an appropriate clinician, but caregivers should not alter prescribed treatment independently.
Dental services should provide prevention, diagnosis, treatment and rehabilitation according to the person's needs, function and preferences. Hospitals, rehabilitation services, home care and long-term care should communicate relevant oral problems, dentures, assistance requirements, eating or swallowing concerns and follow-up needs during transitions.
Organizations should also measure more than the number of dental consultations. Useful quality measures may include completion of oral-health assessment, individualized care plans for people who need assistance, staff competency, availability of suitable oral-care supplies, timely response to identified problems, completion of dental referrals and documentation of oral-health needs during transfers.
A system is functioning when oral problems are recognized and acted upon before they become crises.
From a clean mouth to function and dignity
For an older person, good oral health is not fundamentally about achieving a perfect dental chart. It is about being able to eat without avoidable pain, enjoy familiar foods, speak comfortably, smile without embarrassment, interact with other people and maintain control over an intimate part of personal care.
For families, good oral care means having enough knowledge and support to help without being expected to diagnose or manage complex dental disease alone. For hospitals, it means recognizing when illness has changed a person's ability to care for their mouth. For home and community services, it means incorporating mouth care into ordinary older-person care. For long-term care organizations, it means building reliable systems rather than depending on individual staff goodwill.
Viet Nam now has a stronger practical foundation through Decision 1976/QĐ-BYT, implementation mechanisms under Circular 34/2026/TT-BYT and the country's participation in a wider regional effort to integrate essential oral health services into primary health care and universal health coverage. These developments do not mean that the gaps in access, workforce, financing or quality have been solved. They do mean that oral health can increasingly be understood as part of the architecture of healthy aging, integrated care and long-term care quality.
The question should therefore not simply be “Were this older person's teeth brushed today?”
A more meaningful question is:
“Is this person's mouth healthy and comfortable enough to support eating, communication, function, confidence and dignity, and does the care system continue to protect those things wherever the person receives care?”
That is the difference between mouth hygiene as a task and oral health as part of high-quality, age-friendly care.
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