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Another Challenge Of Old Age: Keeping Your Teeth

One, introduced in February by Sen. Bernie Sanders, the Vermont Democrat running for president, would extend dental coverage to all Medicare and Medicaid recipients, increase funding for oral health services at health clinics and create an oral health professional student loan program. The other, introduced in January by Rep. Robin Kelly (D, Illinois), would allow organizations to get federal grants to improve oral health education and expand outreach programs to under-served communities, including the elderly and disabled.

Mulligan, the USC professor, said coverage for dental care is just as necessary as it is for it is for medical care. But Violeta Anderson, who has diabetes and high blood pressure, doesn’t have dental insurance. She gets treatment because she is lucky enough to have a daughter who can pay for it.

The Center for Oral Health, a California-based nonprofit, is conducting a two-year assessment in California to determine the extent of dental problems among seniors. Preliminary results show that 38 percent of residents of California’s long-term-care facilities don’t have any of their original teeth. Nearly half of those with at least one tooth had untreated decay. And about 1 in 7 needed urgent care.

“The system is not currently equipped to deal with this huge wave of individuals,” said Theresa Anselmo, who is overseeing the assessment for the nonprofit. “How do you keep these folks healthy as they age, given it becomes a luxury to afford even basic dental care?”

More dentists need to be trained in how to treat elderly patients, experts say. The American Dental Association recently started offering online training, and dental schools are also making an effort to train students. Mulligan, for example, recently founded an online master’s degree program for dentists interested in geriatric care.

Nazanin Sharifi, a Los Angeles area dentist who is in the program, said she wanted to specialize after caring for her father, who had Alzheimer’s. “I saw how he suffered,” she said. “He didn’t know how to brush his teethor even say he was in pain.”

In San Francisco, all dental students at the University of the Pacific’s dental school spend time at On Lok Lifeways, an organization that serves elderly people who would otherwise need nursing home

One morning in October, Elisa Chavez, a professor at the school, supervised two students as they treated patients. Chavez said that until they do a rotation in geriatric dental care, many of her students haven’t thought about the specific challenges. “When you have patients who have lots of medical issues, it can be intimidating,” she said.

The patients who visited the On Lok dental clinic that day all had some form of dementia. They spoke three different languages – Korean, Tagalog and Cantonese. All had missing teeth and health problems, including diabetes, a history of strokes, high blood pressure and kidney disease.

One 95-year-old patient had to be told several different ways to close his mouth so the team could take X-rays. Another, 82, had bone loss and signs of an infection but refused X-rays and a cleaning.

It’s a similar story at the University of the Pacific dental school. Paul Subar, a professor there, said some elderly patients may need to come five or six times before dentists can do a procedure.

But the patience can pay off. Just ask Anthony Vanderhorst. After nearly a year of care, Vanderhorst, with a history of liver disease, a stroke and deteriorating teeth, recently walked out sporting a new set a dentures.

The 64-year old, who doesn’t have dental insurance, told Subar that he was happy to look normal and play the trumpet again. And he was grateful for treatment he otherwise could not afford.

“The school was my only alternative,” Vanderhorst said, “or else I wouldn’t have any teeth in my mouth.”

By Anna Gorman, Kaiser Health News


Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation. Photo by m01229 via Flickr.

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