Ways of Treating an Elderly Population

The US population is aging, and many elderly people will retain their natural teeth even though they grew up without the benefit of fluoridated water. Loss of bone due to periodontal disease, though managed, will result in exposed root surfaces and potential areas for decay. In addition, this population may have higher numbers of those who are uninsured and/or higher amounts of out-of-pocket or nonreimbursed expenses to maintain their oral health. Dental access for children who are uninsured is considered a priority, while access for those over 65 years of age is seldom discussed. In most states, Medicare doesnít cover recall hygiene visits, and in states where “routine” services are covered, the reimbursement to practitioners is so low, many do not accept it. 

It is clear that periodontal disease is now linked to systemic illness and diseases such as diabetes, cardiovascular disease, and others. The many medications taken by this population increase the risk for tooth loss due to xerostomia and reduced nutritional intake when chewing is difficult and food choices are limited. Caretakers can become responsible for washing, dressing, feeding, and tooth brushing their patients. Most nursing homes have limited dental equipment for examination of patients and for ongoing training of their caregivers. A reduced ability to pay for services and the need for continuing dental services increases the likelihood that clinicians will be treating more patients over 65 years of age, perhaps in nontraditional settings. 

There are 3 items of major importance that need to be recognized when working with this population: the impact of medications on salivary flow and decay; the deterioration of motor skills which are necessary to maintain good oral health due to age or disease; and dentures, when not being worn or when being cleaned, should be placed in a solution which will keep them bacteria-free.