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."
Columbia already has a number of programs in place to address these needs, and has plans for more. "We believe programs like our mobile dental clinic, which visits senior centers throughout Northern Manhattan , our five community-based practices and our Thelma C. Davidson Adair Center, which provides not just dental but medical care to seniors in Harlem , provide models that others might follow," says Lamster. "We continue to work toward expanding our dental services for seniors, with new geriatric clinics in development at Fort Washington Houses for the Elderly (the former Delafield Hospital at 165 th and Fort Washington) and the Isabella Geriatric Center (180 th and Audubon)." Lamster adds that he also plans new curriculum, research and policy initiatives that target geriatric oral health.
Lamster proposes a wide-ranging, coordinated national effort at all levels to address these problems, led by dental schools and involving groups such as the American Dental Association and American Dental Education Association; federal, state and local health authorities; and national organizations and foundations. Key to his proposal is a way to address the shortage of dental practitioners who are formally trained to meet the needs of elderly patients. Geriatric dentistry is not a recognized dental specialty, and there is no obvious source of support for training a new group of "gerodontologists." Geriatric dentistry should receive increased emphasis by the nation's dental schools, specifically in pre-doctoral dental curricula. Professional organization- and association-based responses to the challenge of providing oral health care services to the elderly need to be developed. In addition, he proposes:
• A national program for older Americans similar to the American Dental Association-sponsored "Give Kids a Smile," a program to provide free dental services to the nation's low-income children.
• On-site and off-site care activities for older populations at U.S. dental schools, which often focus their service programs on those who have difficulty accessing care.
• Effective and relatively inexpensive preventive procedures and protocols for the elderly who have problems accessing care, including application of topical fluoride varnishes and anti-infective (chlorhexidine) rinses or swabs.
• Collaboration with other health care providers who routinely treat the elderly, with a focus on increasing their awareness of potential oral health problems.