Filling the gap: A Delta Dental Q&A on the senior oral health care crisis in America

By Kenzie Ferguson, Vice President of Foundation and Corporate Social Responsibility for Delta Dental of California

I heard a heartbreaking story recently about a senior patient who was embarrassed by the poor state of her teeth. Because of her discomfort, she rarely smiled, was unable to chew food properly and even considered skipping her first family gathering since the COVID-19 pandemic. Unfortunately, this is not a standalone story. 

The alarming state of oral health for our nation’s older adult population was recently declared a public health emergency by the National Institutes of Health. In response, a coalition between Delta Dental, Washington DC-based Howard University College of Dentistry and federally qualified health center, Mary’s Center was recently announced to pilot solutions to this public health crisis. 

To shed more light on the challenges seniors face in maintaining their oral health, I moderated a Q&A session with Mary’s Center Family Physician Dr. Laura Blinkhorn and Delta Dental Chief Dental Officer Dr. Daniel Croley. We discussed how we’ve arrived at this point of crisis, why it’s important for oral health to be maintained as we age and what we can do to help.

1. Why is it important for older adults to maintain good oral health?

Dr. Croley: There’s a tremendous amount of evidence that connects oral and systemic health. So much so, that recent studies have linked oral diseases—in particular periodontal disease—with more than 60 systemic diseases. Some of those are heavy hitters in the older adult population such as diabetes, heart disease and stroke. So, it’s very important for us to maintain our oral health, knowing it’s all connected.

2. What are the challenges faced by seniors on fixed or low incomes in regard to access to oral health care?

Dr. Blinkhorn: People on a fixed income may be unable to afford healthy, nutritious meals, and often rely on food that is higher in sugar, putting them at higher risk for dental disease. And, for a variety of reasons, they’re unable to pay for preventive health care. So, often we are seeing people in our health care centers when they have a dental crisis, such as an abscess or gum disease. The goal is to try to back things up and get people good care before there’s a crisis. 

Dr. Croley: Another challenge is that as you age, dexterity changes, which can impact one’s ability to brush and floss. There are devices to help adapt your technique: floss threaders, floss picks, even irrigation flossing. Your hygienist or dentist can help you adapt to your own individual needs. 

3. Are older adults at greater risk for oral health problems?

Dr. Croley: 60% of older adults don’t have dental benefits. Most people’s dental insurance is delivered through their employer. When they retire, they say, ’Wait, where’s my dental insurance?’ There are options out there, but it goes back to the person having to find and purchase it themselves, and that adds a little bit more burden, especially when you’re on a fixed income. 

Dr. Blinkhorn: Often, older adults have several chronic medical conditions, such as diabetes, that can put them at higher risk for dental complications. They typically take medications, many of which cause dry mouth, which can lead to bacteria growth and cause dental disease. For older adults, oral health is often an area that’s neglected, especially if the care is expensive and it seems like something that can be skipped.

4. Often dentistry is seen as separate from overall health care. Is this a problem for older adults? 

Dr. Blinkhorn: Older adults often have many medical problems, and they can have multiple specialists. The burden of coordinating with these specialists and making sure the left hand knows what the right hand is doing is one of the great complexities of our health care system. 

I had a patient who started on a medication prescribed by another provider which treats osteoporosis. A side effect of that medication is a devastating disease, osteonecrosis of the jaw. Often the way we prevent that is with dental care prior to starting that medication. Unfortunately, since the patient didn’t have access to that, they suffered a devastating complication.

Dr Croley: Fortunately, it’s not all doom and gloom. I would say generally in the community there’s a recognition by both physicians and dentists for the need to connect. It happens more readily in a co-located clinic. It doesn’t need to happen with every patient from either side, but just sharing the data is very valuable so there is a picture of the whole person. 

5. Are there certain older adult communities who suffer more from poor oral health?

Dr. Blinkhorn: I think a lot of the conversations we’re having in our country about systemic factors leading to gross inequity and disproportionate burden of disease certainly apply to dental health in older adults. The untreated or unrecognized burden of chronic disease in certain populations can lead to dental and systemic disease. 

Among the older adults we serve at Mary’s Center, many of them are immigrants to the United States. They come from different health systems and may not have grown up with fluoride in their water or regular preventive dental care.

Dr. Croley: The beauty of where we are today is that we recognize the need to look at the discrepancies between populations. We need to pay attention to equity and focus on it through a whole person perspective.

6. What’s the benefit of integrating oral and medical care?

Dr. Croley: When you go to your dentist, they examine the entire head and neck area. If they identify the lymph nodes are inflamed and there’s no recognized reason, sometimes dentists are the ones saying, ‘You need to go have this checked out.’ So, there’s value systemically, both ways, for dental and medical care to be integrated. 

Dr. Blinkhorn: I’ve always had the good fortune of being co-located with a dentist team. It seems to be so fundamental to whole person care to be able to coordinate directly and to ask if you’ve seen a dentist, and if not, make your follow-up visit with me and then make sure to schedule a dentist visit as well. It’s so seamless.

7. How can we help improve oral health and overall health for those around us who are aging, including ourselves?

Dr Croley: First, take care of yourself. And as we age, we tend to revere the older adults around us, so we don’t think to check in. Having an honest conversation with our parents; ‘Hey, when was the last time you went to a dentist? Do you feel like you’re brushing your teeth effectively?’ A lot of people don’t want to have those kinds of conversations, but when you’re close with someone who is aging, be brave. You might help them reduce the risk of oral or even systemic disease.

Dr. Blinkhorn: One way is to make it easy so it’s not too burdensome a thing to do. Having a dentist and medical clinic co-located can make it easier for patients. Also, for older adults, sometimes it’s harder to brush your teeth and knowing there are tools and tricks to help with that is also important.  

8. In closing, what are your thoughts on the coalition between Delta Dental, Mary’s Center, and Howard University, and how we’ll work together to improve oral health for older adults?

Dr. Croley: I’m excited for the partnership because dentists and physicians are working together for the patient. We’re all in this together and I think the integration between systemic medicine and dentistry that Mary’s Center has created is going to give us a really great platform to prove to the world just how valuable that connection is.

Dr. Blinkhorn: I would add that our patients are deserving of excellent, respectful, evidence-based medical and dental care. It can make your life fuller and free from difficulty and pain if you participate in preventive care, and it’s our honor to partner with Delta Dental and Howard University in that goal.