• 11/13/2004
  • E.J. Mundell
  • USA Today

A generation or two ago, dentures were common among the elderly, even the middle-aged. Fortunately, public health initiatives over the past 50 years have changed attitudes and hygiene practices, and a majority of today’s Baby Boomers are growing older with the teeth they had as teenagers. But will the nation’s dentists be able to care for them as they continue to age?

“By about 2030, an enormous amount of people — 20% of the population —will be 65 years of age or older. Those numbers are going to be overwhelming, and I don’t think dentists right now are very well-equipped to deal with them,” said Dr. Ira Lamster, dean of the Columbia University School of Dental and Oral Surgery, in New York City.

In an article published earlier this year in the American Journal of Public Health, Lamster warned of a “looming crisis” in geriatric dentistry. “The country’s been successful, and rightly so, in convincing people that teeth can last a lifetime,” he said. On the other hand, aging teeth and gums have special health-care needs.

“What are teeth? They are biomechanical devices for crushing and grinding food,” explained dentist and American Dental Association spokesman Dr. Richard Price. “But any machine is going to wear or break. As you get older, gums recede. In some populations, tooth decay among senior citizens is twice that of teenagers.”

Some of the contributing factors to poor oral health in old age include:

A lifetime of tooth repair using fillings, bridges and crowns. “Every time you do that you lose some of the natural tooth,” Lamster said. Cavity-causing bacteria tend to settle around crowns, fillings or other restorations, spurring decay.

Reduced saliva flow as a side effect of medication. “Saliva is the most important weapon the body has in terms of protection against dental diseases,” Lamster said. “When saliva dries up, it’s very common to see patients with a rapid, rampant form of tooth decay.”

The “dental-care-is-for-the-young” syndrome. “A myth among older people is that you simply don’t have to go to the dentist — not true,” said Price. Even people with dentures should see a dentist to check for signs of oral cancer, which increases in risk with age.

Restricted mobility. The oral care of elderly who are either house-bound, disabled or in long-term care facilities is of particular concern to Lamster. “My mother was in a long-term care facility, and I saw her difficulty in accessing dental services,” he said. With a rapidly aging population, “How are we going to manage that treatment?” he said. “Who’s going to pay for it? These are unresolved issues.”

Lack of oral care insurance coverage. Medicare typically doesn’t pay for dental care, leaving many elderly “limited resources to pay for those services,” Lamster pointed out. Both Lamster and Price stressed that oral health isn’t just about teeth and gums.

“There has been a lot of literature that has related oral infections, in particular, to a raised risk of certain systemic diseases, including cardiovascular and cerebrovascular diseases, respiratory disease, as well as diabetes,” Lamster said. Poor oral health can be an indicator of other, potentially lethal problems, so older persons who don’t get regular dental checkups may miss more serious diagnoses.

According to Lamster, much more needs to be done to better train today’s dentists and dental students when it comes to geriatric oral health. “It’s the responsibility of the entire profession to address this need,” Lamster said. “It’s going to be a tremendous challenge, both in paying for it and delivering the services.”