May 2004, Vol 94, No. 5 | American Journal of Public Health 698
© 2004 American Public Health Association
Oral Health Care for the Elderly: More Than Just Dentures
Kavita Ahluwalia, DDS, MPH
School of Dental and Oral Surgery, Columbia University, New York, NY
As a dentist and a recent immigrant to the United States, I find the policy debates around health care access, quality, and financing refreshingly open. We have done a tremendous job in preventing oral diseases, exemplified by water fluoridation being heralded by the Centers for Disease Control and Prevention as one of the nation’s 10 great public health achievements of the 20th century—but that we have failed, as a society, to provide quality and accessible dental care for our elderly is shortsighted at best, heartbreaking at worst.
Perhaps our antipathy to providing such care stems from pre–fluoride era realities when adults routinely lost all or most of their teeth by midlife. Although the majority of seniors today have retained most of their teeth, there are grave disparities in oral disease burden, access to oral health care, and oral health–related quality of life by race/ethnicity, social class, and medical and functional comorbidities. Partly because of improved tooth retention and partly because access to care is problematic, we are witnessing increased rates of dental diseases in seniors. This situation is likely to get worse as both absolute numbers and the proportion of older adults in the United States increase over the next several decades (see the lead editorial by guest editor Ira Lamster).
The treatment, management, and prevention of oral diseases in seniors will improve not only the conditions of their mouths, but also their overall health and well-being. Recent data indicate that periodontal diseases are associated with chronic diseases such as cardiovascular disease, cerebrovascular diseases, and diabetes. In addition, oral cancer—which is primarily seen in adults older than 60 years—can be physically, emotionally, and economically devastating. The sobering projections on the "graying of America" notwithstanding, the most compelling reason to improve the oral health and health care of our seniors is apparent when a human face, complete with mouth, is affixed to the problem. Oral diseases and dysfunction can be extremely painful, and they have an acute impact on quality of life, affecting chewing, eating, speaking, and social interactions. In no segment of society are these domains of health more critical than in the elderly, for it is in this population that deficits in quality of life are most devastating.
Despite the economic challenges facing the nation, there are concrete steps we can take to improve oral health and oral health care for our seniors. First, the financing and provision of oral health care must be integrated with the mechanisms used to ensure overall health and well-being for the elderly. Second, because seniors are more likely to visit a physician than a dentist, it is imperative that primary care providers and geriatricians be educated about the medical, functional, emotional, and social consequences of oral diseases and dysfunction and that they provide regular screening and preventive education for dental diseases.
Third, the daily caretakers of homebound and institutionalized elderly—nurses, home care workers, and nurses’ aides—need improved oral health care education and training. Fourth, quality assurance measures used by organizations that provide care for seniors ought to address oral health and function. Finally, the dental community must recognize that the management of oral diseases in the elderly poses specific challenges; it is vital that we generate new options for providing improved oral health care to seniors, including making geriatric dentistry a recognized specialty of dentistry.
Copyright © 2004 by the American Public Health Association
