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Our Aging Population and Oral Health Challenges
The Importance of Oral Health in Geriatric Primary Care
(MacEntee, M. I., Müller, F., & Wyatt, C., 2011)
The importance of oral health cannot be over emphasized. Oral health is not separate from general health, maintaining oral health is definitely challenging and diverse in old age. Multiple studies acknowledge mouth health to overall health and well-being. 17  Oral health continues to take a back seat to general health even though this connection has been clearly established. Addressing poor oral health is critical among older Americans. The lack of routine dental care can contribute to respiratory infections and other systemic diseases, particularly important when considering the health of vulnerable patients, and older adults. Oral problems frequently affect the “elderly” (people aged 65+) population. Missing teeth, dry mouth (xerostomia), and mastication limitations, contribute to inadequate nutrition that may contribute to an accelerated physical and mental degeneration. Loose painful  teeth or ill-fitting dentures result in a reduced desire or ability to eat. 17 Dental caries have been attributed to the reduced salivary flow  from diminished function of salivary glands. 6,21,17,27  Elderly are susceptible to various pathological conditions such as Candidal infections, periodontal disease, and a decreased rate of wound healing. 7,24,25 Considering the magnitude of this ‘silver tsunami’ - oral health promotion and prevention will need to be addressed.  Family physicians, nurses, physician assistants,  and other members of the primary care team are in the perfect position to address oral health, integration and coordination between medicine and dentistry is critical. Accommodating this very large segment of the American population with multiple co-morbidities, taking multiple medications with disastrous side effect, including those for high blood pressure, high cholesterol, pain, anxiety and depression, Parkinson disease, and Alzheimer disease . . . . 6-14 will be critical and will require effective two-way communication between primary care and dental professionals.
Oral Health Challenges Facing Older Adults
Access to dental care is one of the greatest challenges facing older adults. Access to dental coverage is limited. Not addressed by the Affordable Care Act (ACA). Private insurance is costly, Medicaid is limited with few providers accepting it, and Medicare does not provide coverage for routine dental care. Dental insurance is a primary indicator of whether or not an individual visits the dentist. Close to 70 percent of older Americans do not have dental insurance. 13,16,18   Although efforts have been made to address the shortage of oral healthcare providers by the Health Resources and Services Administration (HRSA) supporting Federally Qualified Health Centers (FQHCs). Dental Health Professional Shortages Areas continue to experience unmet needs. 12,13,16,18
Barriers to Accessing Oral Health for Older Adults
Poverty 12,13,16,26 Lack of insurance coverage 12,13,16,26 70% of older adults lack dental insurance Medicare does not cover preventive and outpatient dental treatment Poor reimbursement by Medicaid (few providers accept it) Availability of access to oral health services 12,13,16,26 Limited number of professionals trained in geriatric dentistry 12,13,16,20,26 Inadequate funding Lack of dental professionals interested in this population Caregivers do not see oral health as a priority Lack of mobility/transportation 12,13,16,26 Individual health perceptions & values 12,13,16,26 Disability 12,13,16,26 Institutionalization 12,13,16,26
“Poor oral hygiene is a long-term care facility’s most expensive and life impacting problem. It is silent and usually goes unrecognized. Providing mobile hygiene services could dramatically reduce the costs of hospitalizations related to diabetes, heart attacks, strokes, pneumonia, and other life threatening diseases.”   - Charles C. Whitney, MD, President, and Founder of 3rd Era Dentistry. Next Page