Ten thousand Americans turn 65 every day, many of whom lose employee-funded health benefits when they retire. Increasingly, these retirees are electing to discontinue their investment in dental insurance. It is estimated that about 75% of Americans 65 or older do not have dental benefits, and Medicare does not cover routine dental services.
The decision to discontinue dental insurance is risky at best, as the absence of regular preventive dental care can have permanent, devastating effects on a senior’s overall health and well-being.
More than ever, it is the responsibility of dental providers to prepare ourselves to care for the unique issues that this aging population faces and to educate patients on the inherent connection between their oral and overall health, including the dangers of ignoring preventive dental care in the senior years.
Periodontal disease and systemic health
Researchers have long studied the connection between periodontal disease and a number of systemic health issues among seniors, and have linked periodontitis to serious health issues — even death — from diseases that typically strike seniors, such as stroke, aspiration pneumonia, latent prosthetic joint infection, as well as chronic conditions such as cardiovascular disease, renal disease, and diabetes.
Lack of dental care is a known cause of periodontal disease. Compounding this is the fact that hundreds of commonly prescribed medications for seniors — including antihypertensives, antidepressants, antihistamines, and common cold remedies — can reduce the volume of saliva, making the mouth more vulnerable to oral infections that can also spread to distant sites.
One example is bacterial endocarditis, an infection inside the heart caused by bacteria that normally develops in the oral cavity. Due to heart murmurs or other morphologic differences, about 5% of the population is at increased risk for these bacteria to attach to the heart valves and cause an infection. About 20% of individuals with bacterial endocarditis will perish because of this infection.
Similarly, it is critical that individuals with prosthetic joints are extra diligent about their oral health, because bacteria from the mouth can enter the bloodstream and cause latent prosthetic joint infections, one of the leading causes of arthroplasty failure. Additional surgery can be costly and is especially dangerous for geriatric patients.
Additionally, periodontitis shares a reciprocal relationship with diabetes, which now affects nearly 12 million Americans over the age of 65.
Individuals with diabetes are at a greater risk of periodontitis because they are more susceptible to infection. Conversely, research now shows that if periodontitis isn’t controlled or treated, it can become extremely difficult for diabetics to control their glucose levels, which puts them at increased risk for diabetic complications.
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Periodontal disease can be easily prevented if providers educate patients on the importance of routine dental care including regular cleanings. It is even more critical that diabetics understand the role that good home care and more frequent dental cleanings can play in their long-term health.
Detecting and treating oral cancer
Oropharyngeal (oral) cancer is one of the more common forms of cancer, and is one of the most devastating. It is also one of the most preventable.
In 2014, it is estimated that there will be 42,440 new cases of oropharyngeal cancer, approximately 8,390 of which will be fatal. Like many cancers, age is a primary risk factor. The median age for oral cancer diagnosis is 62, with the median age of death from oral cancer at 67.
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Those who survive are almost always left with a significantly impacted quality of life. Fifty-two percent of survivors end up disabled due to facial, head, or neck disfigurement. This physical impact can have far-reaching social ramifications including loss of speech, decreased ability to eat, social isolation, and depression.
Further, research conducted in 2011 by the Renaissance Dental Research and Data Institute showed that oral cancer is the most expensive cancer to treat in the United States. The cost of treatment can range from $100,000 to $250,000, dramatically increasing the likelihood of serious financial hardship including bankruptcy.
The pathology of oral cancer is such that it is a slow-growing cancer and can be caught during an oral examination. If caught in its early stages, the survival rate jumps from 60% to 83%. If caught in a precancerous stage, the risk of mortality can often be avoided altogether.
Dentists are trained to perform oral cancer screenings as part of a complete oral examination and it should be common practice among dental professionals to perform a screening at every visit. At a minimum, patients should be advised to request a screening at least once a year.
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Preventive care is key
Many debilitating oral health issues can be prevented by regular dental examinations.
Research has shown that patients are 50% more likely to schedule regular dental checkups when they have dental insurance, so it stands to reason that by forgoing dental benefits in retirement, patients are ignoring one of the most simple, yet potentially life-saving measures that regular dental screenings can provide.
As dental professionals, we are in a unique position to provide the education and care that our patients need to ensure long and happy lives well into their golden years.