Two important oral health care
concerns emerging in the United States are disparities in the oral
disease burden and the inability of certain segments of the
population to access oral health
care.[1] Older Americans are becoming a
larger segment of our population and suffer disproportionately from oral
diseases, with the problem being particularly acute for individuals
in long term care facilities. Population
projections for the United States indicate that the elderly will
constitute an increasing percentage of the population as we proceed
into the 21st century. In 2001, the
population of the United States was almost 278 million, and 12.6% of
the population was 65 years of age or older. By 2015, the population
is expected to increase to 312 million (3.08 million in 2010) and
14.7% of the population will be aged 65 years or older. In 2030, which is within the practice lives
of students currently enrolled in dental schools, the population
will have increased to more than 350 million, and 20% of the
population—1 of every 5 members of the US society—will be 65 years
of age or older. This large segment of
our population is further compounded by the elderly population continuing
to become increasingly diverse in terms of race, ethnicity, financial
resources, and living conditions.[2]
The challenges faced by both the
dental profession and the nation as a whole regarding provision of
oral health care services to older adults were the subject of a
recent report prepared by Oral Health America.[3]
All 50 states were surveyed to determine
the level of Medicaid coverage for dental services, and the report
concludes that financing oral health care services for the elderly will
be a major challenge to our future. Medicare
does not provide any coverage for dental
services, and only 1 of 5 Americans aged 75 years or older has any
type of private dental insurance. Given
our current economic circumstances it will be highly unlikely that our
government resources will be adequate to gear up for the impending problem of
oral health for the elderly.
The elderly suffer from chronic disorders that can directly
or indirectly affect oral health, including autoimmune disorders such
as pemphigus and pemphigoid.[4]
They generally require multiple medications, and common side effects
of the more than 500 medications used to treat their overall health
issues usually reduce salivary flow.[5]
Usually the reduction in saliva can
adversely affect their quality of life, the ability to chew, and lead to
significant problems of the teeth and their supporting structures.
The elderly may also have
difficulty performing routine oral hygiene procedures because of
physical limitations, such as Parkinson’s or rheumatoid arthritis. In addition, oral infection is now
recognized as a risk factor for a number of systemic diseases,
including cardiovascular diseases, cerebrovascular diseases, diabetes,
mellitus, and respiratory disorders. Also, it is important to note that
once people have lost their teeth and are using complete dentures, their oral health needs
do not decrease. Our jaws are not
static and may continue to resorb over time. Besides the continued resorption of bone,
improperly fitted dentures can adversely affect chewing, leading to
poor nutrition. In addition, those
without teeth remain susceptible to oral cancer, mucosal diseases,
and alterations in salivary gland function.
So for the vast majority of seniors who will reside in a long term
care facility, financing of oral health care services will be a
formidable challenge. Given that medicare
does not provide coverage for routine dental services including exams, and
in the absence of private insurance or personal resources, a large
portion of this group will not be able to afford any dental services
whatsoever, let alone the most appropriate treatments. Clearly, there must be a response to the
increasing oral health concerns of the elderly who present with
special needs, especially those who are homebound or living in long
term facilities burdened with
other chronic disorders.
While effective preventive measures exist for younger populations
(water fluoridation, dental sealants and parents), no preventive measures
have been devised to address the expected increase in oral health needs
of the aging population. And the need
for a coordinated effort to address the oral health care needs of
the elderly suggested by demographic trends and epidemiological data
necessitates our planning for what might be considered a crisis or at least a
paradigm shift in oral health care delivery for the elderly. Such a plan must consider contributions from
the dental profession, possibly through the efforts of the American Dental Association (ADA)
and its state and local associations; the dental schools, with
involvement of the American Dental Education Association; federal,
state, and local health authorities; and assistance from national
organizations and foundations that focus on health care. The dental profession has an opportunity to
take a leadership role in the delivery of health care services to
the seniors who have contributed so vitally to our society’s
well-being and who deserve to be treated with the best oral health
care we
have to offer.
Dr. Scheinfeld is a prosthodontist
specializing in geriatric care.
Novy Scheinfeld, DDS, PC
290 Carpenter Drive, 200A
Atlanta (Sandy Springs), GA 30328
404-256-3620
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[1] Oral Health in America: A Report of the
Surgeon General. Rockville, Md:
National Institute of Dental and Craniofacial Research; 2000.
[2] Wikipedia and 2010 Census.
[3] A
State of Decay: The Oral Health of Older Americans. Chicago, Ill: Oral
Health America; 2003:1–8.
[4] Stoopler ET, Sollecito TP, De Ross SS.
Desquamative gingivitis: early presenting system of mucocutaneous disease. Quintessence Int.2003;34:582–586.
[5] Fox PC, Eversole LR. Diseases of the
salivary glands. In: Silverman S, Eversole LR, Truelove EL, eds. Essentials of Oral Medicine. Ontario,
Canada: BC Decker; 2002:260–276.
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