America's seniors suffer a disproportionate burden of oral disease while having fewer resources for appropriate care -- and these issues will be exacerbated as the elderly population grows. Now, the dean of Columbia's dental school has issued a "call to action" on geriatric oral health and has outlined initiatives that he hopes other institutions will emulate in order to prevent a health crisis among the nation's aged.
Writing in the May issue of the American Journal of Public Health (AJPH), Ira B. Lamster, D.D.S., M.M.Sc., dean of Columbia University Medical Center's School of Dental and Oral Surgery, outlines ways to address this hidden health problem. His proposal covers dental education, provision of new dental services, changes in public policy, and prevention initiatives.
"The needs of the nation's seniors do not mesh with the availability of services," Lamster says. "While America's elderly population continues to grow, its dental needs have received little attention and almost no public health or public policy interventions."
The senior population is expected to increase rapidly -- to more than 350 million by 2030, when 20 percent of Americans will be 65 or older. "This is why we must take action now," Lamster says.
While a greater percentage of seniors retain their teeth than ever before, they still have significant oral health problems, which can reduce their quality of life and threaten their well-being. Multiple medications can reduce salivary flow and damage their teeth and gums, and years of exposure to oral bacteria and "wear and tear" lead to numerous oral problems.
"There is also strong evidence that poor oral health is a risk factor for potentially life-threatening systemic health problems," Lamster says. "Either the bacteria from gum infections or the body's response to the bacteria which occurs in the bloodstream can increase the development of the fatty plaques that cause heart attacks and strokes. Seniors in long-term care are especially at risk of fever and death from pneumonia, which results from the aspiration of these bacteria." Improved oral health has also been shown to help in the control of diabetes, and smoking and alcohol abuse cessation lessen the risk of developing mouth and throat cancer.
Lamster sees the issue as being especially critical for seniors in long-term care facilities, or nursing homes, as well as the homebound. "Access to dentists is just one of the many difficulties they encounter," he says. "Medicare does not provide coverage for routine dental services and a large percentage of nursing home residents are unable to pay for any dental care. Many are unable to care for themselves and nursing home staff are not trained to deal with their oral health needs. Clearly, there must be a response to the increasing oral health concerns of these seniors."