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The low-down

The proportion of Americans over the age of 65 is rising, as is the proportion of dental patients in that age group. The percentage of edentulous patients is declining and we are seeing more patients who have retained their natural teeth well into their 70s. Because these older patients were not exposed to fluoride until later in life, they experienced significant restorative care earlier in life.

Restorative needs are typically more extensive and the older adult often has measurable whole mouth alveolar bone loss due to osteoclastic activation in response to periodontal pathogens. The increase in root surface exposure leads to decalcification and root caries are common.

Many states have adopted guidelines for dental care in nursing homes that utilize dental hygienists as oral health liaisons. State licensing boards have not made health liaisons mandatory at nursing home facilities, so this decreases the likelihood of services provided to these patients.³ Although there are no state mandatory healthcare providers for the elderly, there are a growing number of oral health practitioners that have offices set up in vans and carry dental equipment that is available to the facilities, such as Registered Dental Hygienists in Alternative Practice (RDHAP) in California.³

Poor access to dental care demands new interventions and models of delivery in services to the older adult population.⁷A cost-effective way to increase access to care in the long-term care environment would be to appoint a dental hygienist to the position of Oral Health Liaison.³ In successful models already in place, the common elements include involving the community in implementation and planning; building up existing health safety nets to link dental services; and changing the institutional policy to support the delivery of dental care as well as financing.⁷

In 2004, the number of uninsured individuals was 44 million—100 million had no dental insurance. As the numbers increase for those relying on Medicare and Medicaid, the budget cuts at the state and federal levels also continue to increase.⁷ Changes in healthcare policies as well as institutional changes must be made in order to care for the growing number of elderly people who will need oral health care in the future.

Water Pik’s “Boomers and Seniors: Living Longer, Living Healthier, Considerations for Dental Professionals,” continuing education course will help you understand the social impacts of aging and the diseases and conditions that affect this group. It will also examine how the above will affect dental practices. The course is offered free of charge. Visit professional.waterpik.com.

More than 10 years ago, Dr. Gordon Christensen stated that the dental hygienist had evolved into an important preventive arm of the dental profession. He went on to say the dental hygienist is a well educated professional and her or his responsibilities should not be limited to scaling and root-planing.

For various reasons, some within our control and others outside of it, we are not working up to the potential inherent in Dr. Christensen’s statement. We need to make our voices heard so we can put our skills to use.

Utilizing the dental hygienist for elder oral care would lower the cost of services for the dentist and allow hygienists to enhance their skills, becoming more capable and thorough while performing data collection and treatments.⁶ Allowing the dental hygienist to be the front line of caring for the underserved elderly populations would help close the gap in access to care problems that is increasing daily.

Rene Stephenson, RDH. BSDH, has been a clinical dental hygienist for 22 years. She served as the Texas Dental Hygienists’ Association vice-president , as well as in various council chairs. She was one of the 2007 finalists for the BreathRx Hygienist of the Year. For information about courses she presents, visit TexasEducationalConcepts.com.