General Dentistry Faculty Co-Author Chapter on Geriatric Dentistry
Boston University Henry M. Goldman School of Dental Medicine (GSDM) alumna Lisa A. Thompson DMD 05 was the guest editor for the October issue of Dental Clinics of North America, a quarterly publication by Elsevier that provides updates on the latest trends in dental patient management and the newest advances in the dental profession. Each issue focuses on a single topic in dentistry and is presented under the direction of an experienced guest editor. The October 2014 issue focused on geriatric dentistry, and three GSDM faculty members co-authored a chapter entitled, “Oral Health Disparity in Older Adults: Dental Decay and Tooth Loss”.
The three contributing faculty members were: Professor in the Department of General Dentistry Dr. Paula K. Friedman; Clinical Assistant Professor in the Department of General Dentistry Dr. Steven L. Karpas; and Clinical Assistant Professor in the Department of General Dentistry Dr. Laura B. Kaufman.
The October issue highlighted that good oral health is increasingly recognized today as an integral part of the total health care picture, and that it helps ensure well-being. The Oral Health and Disparity in Older Adults chapter went a step further to discuss how poor oral health is considered a risk factor for poor overall health, and this is of concern for the geriatric population given numerous demographic and socioeconomic factors, complex medical and psychosocial conditions, inability to travel, and the limited number of dentists who are willing and able to provide dental care for those living in rural areas or in long term care facilities.
The chapter calls attention to a public health issue in geriatric dentistry because the baby boom generation is entering the later years of life and overall life expectancy has increased. According to co-author Dr. Laura B. Kaufman, many older adults—including those aged 70, 80, 90 and 100+—are keeping their natural dentition over their lifetime, with good oral health often an indicator of good systemic health. The chapter specifically mentions the benefits of retaining one’s natural dentition, however the retention of natural teeth into older age puts a greater number of teeth at risk for tooth decay and periodontal disease, because age-related issues may hamper oral hygiene efforts and the ability to access regular dental care.
To compound the issue, the chapter points out that there are limited numbers of dentists who are willing and able to provide dental care to residents in long term care facilities. Dentists may be reluctant to treat these elderly patients, citing pressures from private practice, including concerns about taking time from their practices to travel to long term care facilities. Other reasons for dentists’ reluctance to treat this patient cohort include the challenge of managing frail older adults with complicated physical and cognitive conditions, and the complexity of the work environment within the long term care facilities. Furthermore, many dentists perceive themselves as inadequately trained to treat long term care residents, also citing poor remuneration from private and public dental insurance plans and/or personal negative feelings in treating people with complex medical and psychosocial conditions.
Dental economics also come into play. The chapter calls attention to one of the greatest barriers to access to dental care for older adults—poverty. Older adults usually do not have private dental insurance. The authors cite very high costs for dental coverage. In fact, they mention that only 2 percent of Americans maintain a dental insurance plan into the retirement years. When lacking dental health insurance, accessing dental care becomes an out-of-pocket expense. And a lack of available funds for preventive and basic dental care may lead to a significant public health issue as more people live into their later years.
“Progress has been made in reducing dental caries and edentulism in older adults, but disparities continue to exist” said Assistant Dean of Students and Director of Geriatric Dental Medicine, Dr. Joseph Calabrese. “In addition to the impact of oral health on overall health, oral health also impacts quality of life.”
A downloadable copy of the October issue (with paid subscription) is available on the Dental Clinics of North America website.