Issues in Financing Dental Care for the Elderly

Abstract

The elderly make up an increasingly larger segment of the patient population in dental practices. This article reviews recent epidemiologic, demographic, and health services research, and concludes that significant segments of the elderly are at high risk for oral disease and/or limited access to dental treatment, and consequently warrant classification as high-risk groups for policy considerations. It then proposes policy options to the dental community and public decision makers. Oral care can be viewed as having three components. Two basic components are the primary care component--which includes diagnostic, preventive restorative, and periodontal care--and the acute care component--i.e., the treatment of oral pain, trauma, and infection. The third, rehabilitative component, has to do with the restoration of oral function, including prosthodontics and cosmetic dentistry. Viewing dental care in this perspective may help link funding for dental primary care services with that for other primary health services, and link restoration of function and improvement of quality of life with similar health services, like hearing, vision, and social services. In addition, approaching dental care policy makers on several levels--i.e., federal, state, and local--will contribute to our ability as a profession, in the decades ahead, to meet the oral health needs of more elders: including the frail, those at high risk for oral disease, and those with limited access to care.

Social determinants of denture/bridge use: Japan gerontological evaluation study project cross-sectional study in older Japanese

“…Systemic ill health and functional limitations have been reported as barriers to seeking dental health care [25]. The results of the present study do not corroborate these findings.…”

Ethnic Disparities in Self-Reported Oral Health Status and Access to Care among Older Adults in NYC

“…Pairwise comparison results: 1 All groups significantly differ (pG0.01) except Black vs. White and Black vs. Hispanic. 2 The only significant differences are Whites vs. Hispanics (p=0.007) and Whites vs. Chinese (p=0.02).…”

“…However, many older adults experience significant barriers in obtaining necessary dental care, including a shortage of clinicians trained in the provision of oral care to older adults, a lack of perceived need for dental care, and a lack of insurance that covers dental care. [1][2][3][4][5] Consequently, older adults have the lowest rates of visiting a dentist compared with all other segments of the population: according to the Centers for Disease Control and Prevention, in 2006, 76% of children 2 to 17 and 62% of adults 18 to 64, compared to only 58% of adults 65 years and older, reported having had a dental visit during the previous year. 6 As is true for other age groups, among older adults, the burden of oral disease is most significantly borne by minorities, the poor, and immigrants.…”

“…Most elders lose employer-based dental insurance at retirement, Medicare does not cover routine dental care, and Medicaid provides only limited coverage in certain states. [1][2][3] New York is an exception as one of only 10 states to provide Medicaid coverage for adult oral healthcare, and the coverage is comprehensive. 24, 25 The availability of Medicaid coverage for dental services explains the relatively high rates of dental insurance reported in this low income group.…”

Dental restorations in adults in the UK in 1998 and implications for the future

“…Those reviewing care of the dentate elderly have suggested that linking dental primary care services with other primary health services like hearing and vision may support future national funding priorities. 8 This would put the maintenance and restoration of oral function into an overall context of improving quality of life. A further note of caution is needed as for some people, longevity will be at the cost of multiple drug regimes or polypharmacy.…”