2026 Hong Kong Complete Guide to Tooth Loss in Elderly Patients: Dr. Chan Si Yan Breaks Down the Multidisciplinary Dental Treatment Process

Many people mistakenly believe that dentistry is itself a specialty, but in reality, dentistry — much like general medicine — is further divided into distinct specialties based on the area of treatment. In this article, we examine a special case of tooth loss in an elderly patient submitted by a reader, and explore how multi-disciplinary dental treatment can address complex dental problems.

Mr. Yeung's Father: When Food Loses Its Joy

Mr. Yeung (pseudonym) sought consultation on behalf of his father, who had long been troubled by difficulties eating due to tooth loss. Mr. Yeung's father, now 68 years old, is a passionate food lover. Before retirement, his work took him around the world for decades, allowing him to savour countless culinary delights — a great source of joy in his life.

However, since retiring, his teeth have gradually become loose, likely due to age-related physical decline, and have been causing frequent pain. As a result, Mr. Yeung's father has been unable to chew most foods and has had to switch to bland, visually unappetising liquid meals. Initially, he would lose his temper over this, but over time, he stopped reacting with anger and instead became despondent and withdrawn, feeling that life had lost its meaning — a situation that deeply distressed his son.

Mr. Yeung shared that the whole family had encouraged his father to see a dentist as soon as possible to explore whether anything could be done. However, his father persistently refused, believing that tooth loss in old age is a natural and inevitable part of life, and that dentists would be unable to help — seeing it as a waste of both money and time. The devoted son did not give up, and a year ago brought his father to a dental emergency appointment, where a basic examination and pain relief treatment were carried out, but the underlying problem of being unable to chew remained unresolved.

Is Tooth Loss in the Elderly Beyond Treatment?

Like Mr. Yeung's father, many elderly patients face the problem of tooth loss — but does this necessarily mean nothing can be done? Dr. Chan Sze-Yan, Medical Director of the dental centre, along with her specialist colleagues — including Prosthodontics Specialist Dr. Tse Chi-Man, Periodontology Specialist Dr. Chow Wai-Wai, and Oral and Maxillofacial Surgery Specialist Dr. Lee Chi-Ying — will analyse the above case from a professional medical perspective.

Periodontology Specialist Dr. Chow Wai-Wai, Prosthodontics Specialist Dr. Tse Chi-Man, Oral and Maxillofacial Surgery Specialist Dr. Lee Chi-Ying, and Dental Centre Medical Director Dr. Chan Sze-Yan (from left)

Dr. Chan Sze-Yan noted that for an up-to-date diagnosis, Mr. Yeung's father should undergo a comprehensive 360-degree full-mouth scan. Based solely on the diagnostic records provided by the reader, however, his situation is indeed complex: many of his teeth have already been lost one by one due to periodontal disease, while the remaining teeth show signs of looseness and tooth decay, with several roots having decayed to the point of being retained within the jawbone.

Mr. Yeung's father presents with multiple significant dental problems simultaneously, including periodontal disease, tooth decay, and severe jawbone resorption. He also has a number of significant medical conditions, such as poorly controlled diabetes and the need for regular bone injection treatment (bisphosphonate therapy) due to osteoporosis — all of which make any form of dental treatment considerably more challenging.

Nevertheless, Dr. Chan emphasised that Mr. Yeung's father's case is not necessarily beyond treatment. Given the complexity of the case and the range of dental specialties involved, the patient may wish to consider a multi-disciplinary approach to dental care — that is, a comprehensive treatment plan formulated by the primary dental practitioner who is familiar with the patient's condition, with the treatment carried out collaboratively by general and specialist dentists with different areas of expertise. The primary dentist would coordinate the prosthodontist, periodontist, and oral and maxillofacial surgeon to address the various dental issues in an orderly sequence as set out in the treatment plan, and to adjust the plan as needed in response to the patient's evolving condition.

Photo provided by reader

Photo provided by reader

What Is "Multi-Disciplinary Dental Treatment"?

While "multi-disciplinary dental treatment" may not be widely known in Hong Kong, it has in recent years become an increasingly well-established treatment model in countries such as the United Kingdom and the United States, where it is referred to as "Multi-Disciplinary Dentistry".

The concept is based on the premise that dentistry encompasses a range of distinct specialties, each with its own specialist dentists who have accumulated extensive clinical experience in their respective fields. When a patient's condition spans more than one specialty, collaboration among specialists from different disciplines may offer a more effective means of addressing the root cause of the problem.

Dental specialty classifications

Learn more: 3 Key Factors Affecting Private Dental Fees That You Should Know

The Treatment Process of "Multi-Disciplinary Dental Treatment"

Dr. Chan explained that using Mr. Yeung's father's case as an example, after the primary dentist formulates an initial treatment plan, it is passed to the prosthodontist for a more detailed assessment. Based on the treatment requirements, the prosthodontist determines which teeth can be preserved to serve as future support for the dentures, and which decayed teeth need to be extracted to prevent further damage to surrounding teeth.

The periodontist then takes over to thoroughly eliminate the periodontal bacteria in the mouth and stabilise the patient's oral condition. This step is critical because if the periodontal disease and tooth decay are left unaddressed and dentures are fitted directly, the remaining teeth will not be able to provide stable support, rendering the dentures ineffective.

Furthermore, because Mr. Yeung's father has been receiving regular bone injections over an extended period, any oral wound or trauma carries a risk of complications such as osteonecrosis and tissue necrosis. For this reason, an oral and maxillofacial surgeon may need to be involved in the extraction of the decayed teeth. Finally, the prosthodontist would custom-fabricate the most suitable set of dentures for the patient.

Example of role allocation within a "multi-disciplinary dental treatment" team

Dentures Are Not the Only Option

Prosthodontics Specialist Dr. Tse added that in addition to dentures, Mr. Yeung's father may also consider dental implants. He noted that the dentist would recommend different treatment options based on the patient's overall health and oral condition, and would determine which teeth may need to be extracted earlier so as not to compromise the durability and aesthetics of future restorations.

Based on past experience, many elderly patients are concerned about their physical condition and prefer to avoid extensive surgical procedures. In such cases, dentists generally favour more conservative approaches, such as removable dentures (dentures that can be taken in and out by the patient), rather than placing implants at multiple sites — an approach that is also more cost-effective.

Removable dentures

Where conditions permit, some teeth — though structurally fragile — may still be retained through root canal treatment (commonly known as root canal treatment) combined with magnetic attachments, allowing them to serve as support and anchorage for removable dentures. This significantly enhances the patient's comfort when wearing the dentures. In addition, by preserving the tooth roots, this approach helps reduce alveolar bone resorption — making future dental implant placement simpler and quicker should the patient wish to pursue that option later.

Magnetic attachment device used to secure dentures

Periodontal Disease Treatment Is Indispensable

As mentioned above, periodontal disease treatment is an essential component of the overall treatment. The patient must first have the periodontal bacteria eliminated from the mouth in order to create a healthy oral environment that is conducive to subsequent denture fabrication.

Periodontology Specialist Dr. Chow noted that in more severe cases of periodontal disease, the dentist will generally make every effort to salvage the remaining teeth so that they can effectively support future dental prostheses. The dentist will first perform deep cleaning to remove calculus and periodontal bacteria that have accumulated on the tooth roots over many years, and will also take time to educate the patient on self-care and oral hygiene techniques. Where the patient's health permits, minor surgical procedures — such as tissue repair and bone or gum augmentation — may also be performed on loose teeth to improve their stability.

She cautioned, however, that as periodontal disease is a chronic condition, treatment cannot be completed overnight. Even after treatment, several months of follow-up appointments will be required to stabilise the condition.

As mentioned above, periodontal disease treatment is an essential component of the overall treatment. The patient must first have the periodontal bacteria eliminated from the mouth in order to create a healthy oral environment that is conducive to subsequent denture fabrication.

Periodontology Specialist Dr. Chow noted that in more severe cases of periodontal disease, the dentist will generally make every effort to salvage the remaining teeth so that they can effectively support future dental prostheses. The dentist will first perform deep cleaning to remove calculus and periodontal bacteria that have accumulated on the tooth roots over many years, and will also take time to educate the patient on self-care and oral hygiene techniques. Where the patient's health permits, minor surgical procedures — such as tissue repair and bone or gum augmentation — may also be performed on loose teeth to improve their stability.

She cautioned, however, that as periodontal disease is a chronic condition, treatment cannot be completed overnight. Even after treatment, several months of follow-up appointments will be required to stabilise the condition.

When Is the Involvement of an Oral and Maxillofacial Surgeon Required for Extractions?

Within the multi-disciplinary dental team, the oral and maxillofacial surgeon is responsible for extracting decayed teeth. However, Oral and Maxillofacial Surgery Specialist Dr. Lee pointed out that tooth extraction is not exclusively within their domain — general dentists are also capable of performing extractions, depending on the circumstances.

She explained that Mr. Yeung's father's case is particularly complex due to his ongoing bone injection treatment, which increases the risk of difficult-to-manage complications such as osteonecrosis during tooth extraction. As a precaution, patients in similar situations often request that extractions be performed by an oral and maxillofacial surgeon