# Ageing, multimorbidity and polypharmacy shape prosthodontic case-mix in undergraduate clinics: a 9-year retrospective cohort study of 1,205 patients in Germany

## TL;DR

This study shows that older patients with multiple health conditions and many medications are common in university prosthodontic clinics, affecting treatment choices.

## Contribution

The study provides new insights into how aging, multimorbidity, and polypharmacy influence prosthodontic treatment patterns in undergraduate clinics.

## Key findings

- Patients in prosthodontic clinics are predominantly older with high rates of cardiovascular diseases and polypharmacy.
- Combined fixed-removable prosthodontics is the most common treatment, influenced by age and tooth count.
- Higher age and more missing/decayed teeth increase the likelihood of removable prosthodontic treatment.

## Abstract

Demographic ageing and increasing multimorbidity are transforming prosthodontic care, with growing demands related to medical complexity, polypharmacy, and long-term maintenance. It remains unclear to what extent these changing care realities are already reflected in undergraduate prosthodontic teaching clinics. This study aimed to characterize the age profile, systemic health, oral health, and prosthodontic treatment patterns of patients treated in an undergraduate prosthodontic clinic over nine years (2011–2019).

This retrospective observational study included 1,205 consecutive patients treated in undergraduate prosthodontic courses at a German university dental center. Demographics, comorbidities, medication use, number of remaining teeth, Decayed-Missing-Filled-Teeth-(DMFT) Index and periodontal indices were extracted from electronic records. Prosthodontic treatment was categorized as fixed, removable, or combined (fixed–removable). Descriptive statistics, chi-square tests, and regression models were applied.

The cohort (45% women) had a mean age of 60.7 (± 12.3) years; mean age varied over the study period without a consistent linear trend. The most frequent comorbidities were cardiovascular diseases (42.3%), allergies (29.4%), and bleeding disorder/anticoagulation (19.1%). Polypharmacy (≥ 5 medications) increased from 6.8% (2011) to 18.6% (2019) and was more common at higher age. Patients had on average 16.8 (± 8.3) teeth at baseline and 14.5 (± 9.2) after treatment; baseline DMFT was 24.3 (± 6.8) and increased with age. Overall, 37.5% received fixed, 13.2% removable, and 49.3% combined prosthodontics. In multivariable analyses, higher age and higher baseline DMFT increased the odds of removable (vs. fixed) treatment, whereas more remaining teeth favored fixed treatment.

Undergraduate prosthodontic clinics predominantly manage older, multimorbid, and often polymedicated patients. Treatment patterns are primarily explained by baseline oral and systemic conditions, underscoring the need for training in risk-adapted planning, medication-related risk management, and maintenance-oriented care.

The online version contains supplementary material available at 10.1186/s12903-026-07977-5.