Massachusetts Medical Society: Pay Attention to the Oral Health of Your Elderly Patients

Pay Attention to the Oral Health of Your Elderly Patients

By MMS Committee on Oral Health

Multiple health issues are associated with poor oral health, especially among elderly patients. Despite the relative affluence of Americans, 70 percent of retirees do not have dental insurance — Medicare does not include dental benefits — and one in four adults age 60 and older no longer has any natural teeth.

The risks of poor oral health include heart disease, stroke, diabetes, hypertension, aspiration pneumonia, and sepsis, leading to medical complications and possible hospitalization. Missing teeth can affect nutrition, since people without teeth often lean toward soft, easily chewed foods.

Normal aging has an impact on the oral cavity, potentially affecting speech, mastication, swallowing, and digestion, as well as appearance. Elders may have decreased oral sensation, changes in taste sensitivity, decreased saliva and lingual strength, and mandibular/gum changes.

Despite these challenges, medical providers are well-positioned to support elderly patients’ oral health in several ways and should do the following:

  • Ask patients about oral health issues: Query them about pain, ability to chew, oral lesions, dry mouth, and dentures.
  • Determine patients’ routine oral care: Recommend that they brush twice daily and floss once a day, and store dentures in water overnight. Ask them whether they need assistance with oral care.
  • Examine the oral cavity: Have patients remove dentures. Look for food impaction, plaque, inflamed gums, decay, and lesions.
  • Limit anti-cholinergic medications: These can cause dry mouth and accelerate caries, so it’s worth limiting them if possible.
  • Make a dental referral: This is especially important if your patient has diabetes or acute oral needs. For those without MassHealth or private dental insurance, inform them of these options:
    • Dental hygiene and dental schools, which offer reduced fees for preventive and chronic needs.
    • Federally qualified health centers with dental practices, which offer graduated payments based on income.
    • The AARP, which offers dental insurance packages.
    • PACE (Program of All-inclusive Care for the Elderly), which is administered by MassHealth and Medicare and provides a wide array of medical, social, recreational, and other services to eligible seniors.
    • Dentists who offer payment plans or pro bono care on a case-by-case basis. Inquire about which dentists in the community do either or both.
  • Lend your voice and support to advocating for Medicare dental coverage: Watch for statewide efforts and learn more about national efforts by the Santa Fe Group and the Center for Medicare Advocacy. Act now to make a difference.
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