Oral health is a fundamental aspect of general well-being, and its relevance is intensified in the context of people over 60. Due to the aging population and increasing life expectancy in many countries, oral health in people over 60 is a topic of increasing relevance today.

Increasing life expectancy has allowed many people to live beyond their productive years, bringing several social, economic, and psychological challenges. As the population ages, significant health challenges also arise.

It is, therefore, imperative to design and implement holistic educational intervention strategies that not only inform but also empower this population group, their caregivers, and the community. The aim of this research was to analyse the historical context, perspectives, contemporary relevance, and broader societal and cultural implications of oral health strategies.

In recent decades, there have been significant changes in the perception and explanation of the causes of health problems(1,2), so the analysis of the relationship between the socioeconomic structures of the population and the process of obtaining health, well-being, and quality is not new.(3)

Oral health care has evolved throughout history. In ancient times, dental health was largely ignored, and people often lost teeth at an early age.

However, with the advancement of medicine and stomatology, attitudes towards oral health began to change. In the context of the older population, over the last decades of the 20th century and early 21st century, there has been a marked increase in the preservation of natural teeth in developed countries.

This is mainly due to advances in diagnosing and treating oral diseases. However, despite these improvements, many older adults still face significant oral health challenges.

A study conducted by the World Health Organization (4) (WHO) in 2021 revealed that approximately 30 % of people over 65 have untreated dental problems. This fact highlights the need to allocate more resources to the oral health of older people to ensure their physical well-being and quality of life.

If you want to see how a country is changing, there is no better way than to observe its demographic dynamics. This process forces us to rethink how society is organized to respond to the necessary care these changes entail, which involves specific policies to address each element of these dynamics.

In 2030, one in six people worldwide will be 60 or older. By that time, the global population of people aged 60 and over will have risen from 1 billion in 2020 to 1,4 billion. By 2050, the global population of people aged 60 and over will have doubled (2,1 billion). The subregions of Central America and the Caribbean have countries experiencing rapid population aging.(5)

According to the WHO, this will be the Decade of Healthy Ageing 2021-2030, approved at the 73rd World Health Assembly (2020), the highest decision-making body of the World Health Organisation made up of all the member states, as the institution in charge of determining the policies that guide the organization's global health.(6)

The Decade for Healthy Ageing 2021-2030 pursues the objective of promoting healthy aging as a cross-cutting strategy for all the Sustainable Development Goals (SDGs) and calls for the collaboration of governments, international organizations, civil society, professionals, academic institutions, the media, and the private sector, to improve the quality of life of older people, their families and the communities they live in.(6)

Cuba, according to estimates, 2025 will be the most aging country in the Latin American region, and by 2050, it will become one of the most aging countries in the world with more than 11 million inhabitants and 19 % aged 60 years and over; it is estimated that by that date, this population will exceed 34 %, which will increase the risk of disability and the social cost derived from this circumstance.(7)

In the next 50 years, Cuba will be the most aged country in the Third World and is currently the third oldest in Latin America, which is related to the increase in life expectancy, the decrease in fertility below replacement level, the negative migratory balance and the reduction in infant mortality, all of which has affected not only the size and growth rate of the population but also its structure by age groups.(7)

This is why aging is one of Cuba's most significant challenges. For this reason, the public policies the nation has been promoting for more than 60 years need to be improved, and proactive policies that are more effective than the traditional ones need to be implemented to result in better benefits and, therefore, a better quality of life.(8)

Oral diseases are highly prevalent. Globally, 3.5 billion people suffer from oral diseases, which are closely related to non-communicable diseases and, therefore, generate to considerable health, social, and economic burden.(9) Although improvements are being seen in some countries, the burden of poor oral health remains, especially among the most vulnerable in society.

The economic burden of poor oral health and the direct and indirect costs of oral diseases globally amount to US$545 billion (10), placing them among the most costly health areas. In addition to pain and discomfort, oral health problems result in a lack of well-being and quality of life.

Poor oral health hurts the quality of life and healthy aging, both physically and mentally, and is highly associated with cardiovascular diseases, diabetes, cancers, and pneumonia,(11) reflecting significant inequalities between countries, particularly affecting vulnerable people and at-risk groups.

The risk factors that oral diseases share with other NCDs, such as tobacco use, harmful alcohol consumption, high intake of free sugars, or poor hygiene, are one reason for the need to integrate oral health strategies into national NCD policies, with articulated inter-ministerial and inter-sectoral work, from a comprehensive perspective covering the whole life cycle of a human being, including old age.

Another oral health challenge in older people is malnutrition. Oral health has a direct impact on nutrition. Older people who experience pain or discomfort in the oral cavity may avoid certain foods, resulting in an inadequate diet and other health problems. Studies have shown that missing teeth and ill-fitting dentures can limit the intake of healthy foods essential for overall well-being.(12)

Access to dental care can be a significant challenge for many older adults. Factors such as lack of material resources, lack of transportation, and physical limitations may be barriers. Even worse, in the authors' view, is that in some cases, preventive care is not sought or provided, which may aggravate existing health problems.

Moreover, tooth loss can have a considerable psychological impact on older people. Self-esteem, body image, and social interactions may be affected. In addition, certain mental health conditions may be present in those facing serious dental problems, creating a negative cycle between oral health and emotional health.

The use of new oral health promotion strategies is an important key to maintaining and improving oral health status in older adults. These strategies emphasize oral health as well as older adults' life characteristics and quality of life.

Prevention is key to maintaining oral health in older adults. Awareness campaigns, oral hygiene promotion, and access to regular dental check-ups are essential. Public health institutions should focus on strategies that include three fundamental aspects: education, access to dental services, and promoting a healthy diet.

Educational intervention strategies for older adults should be based on fundamental pillars (6):

Community education programmes. Community education programmes are essential to addressing the oral health of older adults. Such initiatives may include workshops, lectures, and information campaigns focusing on various aspects related to risk factors associated with the development of diseases affecting the stomatognathic apparatus. Customization of content for this group is crucial to making the information relevant and effective.

- Training of health care providers and caregivers. An effective strategy involves training healthcare providers and caregivers about oral health, including primary healthcare physicians, nurses, other professionals, and caregivers. This enables a comprehensive approach and consultation or referral to specialists when necessary. Training should focus on the relationship between oral health and systemic diseases to communicate the importance of oral care to older adult patients.

- Use of technology and digital information. Technology has changed the way education is provided. Through the development of apps and online platforms, accessible oral health information is possible for older people. This may include tutorials or reminders. In addition, social media and educational videos can attract the attention of this demographic, facilitating learning and adoption of healthy habits.

Interventions in care settings. Another key strategy is implementing intervention programs within nursing homes and day centers. By including routines in daily care, good oral health can be encouraged. This can consist of supervised brushing and access to appropriate oral hygiene products adapted to the physical needs of the older adult population.

- Nutrition and oral health awareness. The link between nutrition and oral health is undeniable, so it is crucial that educational interventions also include information on how diet can affect oral health. Raising awareness among older adults about the importance of a balanced diet would be vital.

When analyzed from a health (Public Health) perspective, promoting oral health in older adults can reduce the burden of dental disease and its impact on general health. Oral health is related to systemic diseases such as diabetes and cardiovascular diseases.(11) Therefore, improving oral health education can positively affect long-term health.

Socially, older people with oral problems can experience a significant impact on their quality of life, including affecting their self-esteem and ability to interact with others. Missing teeth can lead to problems with eating and nutrition, contributing to a deterioration in general health. Therefore, educational interventions should also focus on the social and emotional aspects that affect this growing population group.

From an economic perspective, investing in oral health education can result in significant savings in the long term. Preventing dental disease reduces the need for costly treatment and can reduce the economic burden on public health systems and families. Promoting oral health through education can be a cost-effective strategy that benefits society.

It is crucial to consider possible counterarguments related to educational interventions. Some may argue that older adults may be reluctant to adopt new practices due to a lack of understanding of technology or information. However, in the authors' view, this can be an opportunity to personalize the educational approach, using traditional methods adapted to the comfort of each older adult. In addition, it is essential to include family members in education, providing a supportive environment that encourages the adoption of healthy habits in families.

The oral health of older adults is not only an individual health issue but has broader implications. Their quality of life influences their independence and ability to participate in society. Promoting good oral health translates into a more active and engaged older population.

Currently, efforts to improve the oral health of older adults should focus on health education for these patients. Therefore, it is essential to address various factors in the design of educational programs, ensuring that all older people have access to the information and resources necessary to care for their oral health.

The topic's contemporary relevance lies in the growing population of the over-60s and the need to ensure that their well-being is a public health priority. The development and implementation of effective and accessible strategies for oral health education would be essential, and it is always advisable to adapt these strategies, taking into account the changing needs of the older population and innovations in education and health care.

Oral health is a right that should be accessible to all, regardless of age. According to Montano et al.(13), medical science professionals' disease-focused approach should, therefore, be changed to a preventive approach based on health, health education, and self-care.

Oral health education intervention strategies for the over-60s are crucial to improving their oral health and quality of life. Through community-based programs, training of healthcare providers and caregivers, the use of technology, and an emphasis on nutrition, significant improvements in the well-being of this population can be achieved. By addressing diverse health, social, economic, and economic perspectives and considering possible counterarguments, it is clear that educational interventions must be comprehensive and adaptive. Maintaining a proactive and preventive approach will improve the oral health of older people and, thus, their well-being and quality of life in society.