by By Laura Thill
The country’s aging population is changing the way dentists and hygienists must care for their patients.
Your patients aren’t getting any younger. Baby boomers today are between the ages of 52 and 70 – 46 million of whom are 65 and older, according to the U.S. Census Bureau. By 2060, this number is expected to grow to over 98 million, with 19.7 million projected to be 85 or older, and people in this age group will comprise nearly one in four U.S. residents.
In addition to a number of health challenges, elderly patients face obstacles blocking their access to healthcare providers, including lack of physical mobility and financial constrains. Often, their medications compromise their oral health, while impaired dexterity prevents them from completing basic tasks, such as brushing their teeth.
The good news is that the dental industry has been evolving to accommodate the country’s aging patient population. “More dental schools are opening in the United States, and [more] international dentists are entering the workforce to meet the needs of the aging population,” says Paul Kim, DDS, clinical partner in the GEDC Northeast region. Additionally, the efficiency of the DSO model will permit greater access for elderly patients in rural areas, he notes. “And, more [insurance] plans will be accepted, allowing greater population access.”
Slow down
There’s no question that maintaining an efficient patient flow is crucial to running a dental practice. At the same time, practitioners face a greater need than ever before to budget extra time for their elderly patients. “The biggest difference I see when dealing with the older adult population is the need to slow down,” says Kristin Rose, RDH, BS, Enhanced Hygiene. “One of the most crucial aspects of our job, which often gets overlooked, is [taking time to carefully] review the patient’s medical history. Updating medical histories of the older adult patient is crucial for diagnosis, treatment planning, treatment and prognosis.” Hygienists, who generally are responsible for taking the patient’s history, should “slow down and take the time to collaborate with those necessary, and provide ample time for the patient to ensure that a thorough medical history is recorded and reviewed.”
A comprehensive periodontal and caries risk assessment should accompany the medical history, she continues. “[Hygienists should] slow down and record the bleeding points, recession, furcations and mobility when [completing their] periodontal charting.” They should also take time to review caries risk factors, such as medications, health issues, diet, exposed roots, xerostomia, oral hygiene and a past history of caries, she adds. “Slowing down and taking the time to properly access [each] patient each time will provide the hygienist and dentist with valuable information, [which can] help assist them in comprehensively treating their patient.”
In fact, dental caregivers should make it a point to ensure their elderly patients are comfortable in the dental chair, Rose notes. “Some older adults find it difficult to sit for extended periods in the dental chair, or they may object to being placed in a supine position; others have difficulties with support and balance,” she says. “Pillows, rolled towels or other aids may help provide additional support during treatment. Having an office that can accommodate wheelchairs will also be beneficial as we continue to treat more elderly adults.”
Training your hygienists and staff
From compromised dexterity to various health issues, dentists and hygienists must be watchful of a number of challenges facing their elderly patients. “Assessing your patient’s dexterity is key,” says Rose. “Because of the possibility of actively declining skills, every dental hygiene visit should include an assessment of the patient’s manual dexterity. As reliance on others grows, [the hygienist should] include the caregiver in homecare instructions, [providing] specific suggestions as to how the caregiver can supplement the patient’s abilities and daily efforts. One of my favorite ways to review oral hygiene instruction is to demonstrate the use of the toothbrush, floss, interdental aides, bridge threaders, etc. Many older adult patients also find it helpful to have written instructions or an instruction sheet.”
In addition, oral health care aids – including spin and sonic brushes, water flossers and more – are available to assist dexterity-compromised patients, notes Kim, adding that it’s important to help patients understand that “we are not selling them a product, but prescribing what is best for their care.” Indeed, it’s important to educate patients about oral care products available to assist with and promote good oral health, he points out. “Hygienists are trying to present what is best for the patients’ care and this is where oral care products come into play in order to continue the care at home.”
Besides evaluating patients’ dexterity, dentists and hygienists should be mindful of the various health issues that potentially impact their dental hygiene, including root sensitivity; gum disease/tooth loss; denture-induced stomatitus/fungal buildup from loose-fitting dentures; and xerostomia, or dry mouth due to reduced saliva flow (a side effect of various medications or radiation treatment to the head/neck area.) “Any medical condition or medication that contributes to xerostomia, or a change in saliva consistency, will impact the oral flora, [leading to] an inability to remove plaque and food stuff from the dentition,” says Kim. “This will negatively impact both hard and soft tissues.”
“The older adult population, coupled with all of the discoveries surrounding links between oral health and systemic health, make it increasingly important for the dental provider to be prepared,” says Rose. “Ongoing research suggests that periodontal bacteria entering the bloodstream may be linked to conditions such as respiratory disease, diabetes, heart disease, increased risk of stroke and osteoporosis. Studies further suggest that periodontal bacteria can pose a threat to people whose health is already compromised by these conditions.
“Comprehensive dental care becomes increasingly important to help improve our older adult patients’ quality of life and outlook,” she continues. “Thinking ahead and being prevention-focused will help [dentists and hygienists] minimize root sensitivity and caries with proper fluoride treatments. Treating perio at its earliest stages will help keep the gums healthy and minimize other health conditions. If a patient has reduced salivary flow, make sure they are receiving proper calcium phosphates. Many fluoride treatments and even prescription fluoride toothpaste are now available with calcium phosphates to help simplify the amount of products being prescribed to those with reduced salivary flow.”
The DSO’s role
Dental service organizations today are working harder than ever to provide their dental members with the necessary training and resources to permit them to care for elderly patients. “We take education and training seriously in the DSO space,” Kim points out. “At GEDC, we have established Great Expressions Dental Centers University, which is comprised of classroom teachings, online courses and online communications to keep team members up to date on the best methods and technologies to treat patients,” he says. “We have been developing more courses geared towards elderly patients.”
“We also have an online learning site, which offers over 600 hours of online education,” Kim continues. “Our seasoned clinicians provide support – ranging from treatment technique to office flow, scheduling guidance and staff support – to all of our providers. Our front desk staff often helps the elderly with patient ride logistics, and coordinates with facilities and families to schedule appointments.” The more knowledgeable dentists, hygienists and office managers are regarding caring for their elderly patients, the better, he adds.
Recently, Kim began work on a cooperative care agreement with elderly care institutions and healthcare systems, which will enable GEDC to visit the elderly care facilities and service the elderly, without forcing them to leave their area of comfort. “There is a myth that just because one is a senior citizen, he or she does not use technology,” he says. “The elderly are an active population in their retirement years and are using text and emails. We communicate with the elderly in ways they prefer, in order to get them in for their next checkup and take that extra step when they need assistance with such things as ride logistics, coordination with family and visits to their location (e.g. retirement home).”
“[Dental providers and hygienists] need to focus not only on problems that may exist today, but ways they can prevent future dental health issues,” says Rose. “As the focus shifts from what is wrong today to stopping future disease, we can ensure that our older adult population will have less emergency visits to the dentist and an overall healthier quality of life.”
Making care affordable
Older adults comprise one of the fastest growing segments of the American population, yet only a small fraction of retirees receive dental coverage through a prior employer, according to Paul Kim, DDS, clinical partner in the GEDC Northeast region. Dental service organizations, which are structured to reduce costs through operational efficiency, can help make dental care affordable to older patients, while ensuring they continue to receive quality care, he points out.
“Additionally, GEDC accepts almost all insurances, further reducing the barrier for patients,” says Kim. “GEDC also partners with Careington to offer its own discount dental plan, making care even more affordable for those without insurance. Patients who don’t have dental insurance or partake in a government sponsored program can sign up to receive dental care at substantially reduced fees – often by as much as 35 to 60 percent.
Dental practices should look into offering these types of services – as well as Medicare and Medicaid coverage – to their elderly patients, Kim points out. Doing so will motivate patients to continue with regular checkups and comply with treatment plans, ensuring their oral health throughout their later years.
