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 healthcare. 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.
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. 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. 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. 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 home bound 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 healthcare 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
ZoAnna Bock, MS, DMD
Hanna Orland, DMD
290 Carpenter Drive, 200A
Atlanta (Sandy Springs), GA 30328
3781 Chamblee Dunwoody Road
Chamblee, GA 30341
 Oral Health in America: A Report of the Surgeon General. Rockville, Md: National Institute of Dental and Craniofacial Research; 2000.
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 A State of Decay: The Oral Health of Older Americans. Chicago, Ill: Oral Health America; 2003:1–8.
 Stoopler ET, Sollecito TP, De Ross SS. Desquamative gingivitis: early presenting system of mucocutaneous disease. Quintessence Int.2003;34:582–586.
 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.