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Ada Anderson tried to prepare her 80-year-old mother for her dental visit. She gave her medication to quell her anxiety, and they rehearsed opening her mouth wide.
But at the dental clinic, Violeta Anderson refused to cooperate. Ada Anderson tried calming her mother by singing and rubbing her leg. Then she tried bribing her with crackers.
“It’s important,” Ada Anderson told her mother, who has dementia. “We have to know what’s happening with your teeth so you don’t hurt.”
In the end, dentistry professor Roseann Mulligan and her students at the University of Southern California dental school were able to get one X-ray during the two-hour visit. They couldn’t do a clinical exam. Mulligan, who specializes in geriatric care, suggested that Anderson be partially sedated next time.
Good dental hygiene is important to overall health, and chronic illnesses and medications can worsen oral health. Yet providing dental care to seniors such as Violeta Anderson is fraught with challenges. According to the American Dental Association, a fifth of people age 75 and older haven’t seen a dentist in the past five years.
Many older patients are resistant because of fear or years of neglect – or they have impaired cognitive skills and don’t understand the need. Others are not mobile enough to get to a dental office.
“There are layers upon layers that can make it very difficult,” said Susan Hyde, division chair of oral epidemiology and dental public health at University of California at San Francisco School of Dentistry.
Older patients also may have arthritis or a history of strokes. “They can’t take care of their own teeth and are prone to tooth decay and subject to pain,” Hyde said. “It becomes very complicated.”
Even for patients eager for care, paying for it can be a problem.
Medicare, which covers medical care for people 65 and older, doesn’t include routine dental care, and many seniors lose coverage through other insurance plans when they retire. Medicaid, the insurance program for low-income Americans, doesn’t require states to provide it to adults. Only 15 states offer a comprehensive dental benefit to Medicaid recipients, according to the nonprofit Center for Health Care Strategies. California recently reinstated fuller dental services for adults, and Virginia and DC offer limited dental services.
Nursing homes are required to do a dental screening and help residents with oral hygiene, but dentists say that doesn’t always happen.
“You have people who have maintained their oral health their entire lives, only to see it go down the tubes in six to eight months,” said Judith Jones, a professor at Boston University’s dental school and elder-care spokeswoman for the American Dental Association.
Poor oral hygiene and care can lead to infection, the inability to eat and a loss of dignity, Jones said. And the bacteria that cause gum disease can increase the risk of coronary heart disease, aneurysms and other health problems, research shows.
Some efforts are underway to ensure that all elderly patients get access to high-quality dental care, though dentists say it won’t be easy. The Senate has proposed including oral-health screenings in its re-authorization of the Older Americans Act, which helps pay for nutrition and social services for low-income seniors. This spring two bills were introduced in Congress that would expand coverage to adults without dental insurance.
