Oral Health Overview
Oral health, regardless of age, is integral to overall good health. It is an important, but often overlooked aspect of an older adult’s general health. Daily oral hygiene, the ability to access routine professional oral health services, and oral health education are all key factors that can improve the oral health of older Americans. According to the Centers for Disease Control and Prevention, 25 percent all people age 65 and older have no remaining teeth. Nearly one-third of older adults have untreated tooth decay. Severe gum disease is associated with chronic disease and severe health conditions such as diabetes, heart disease, stroke, and respiratory disease.
ACL's aging and disability networks are made up of local, state, and national organizations and committed advocates working to support older adults and people with disabilities. The network includes many programs and services that are offered at locations around local communities, such as senior centers, congregate meal sites, and community centers. The role of aging network providers who work with older adults and the communities where they reside may include the following.
- Identifying that an older adult may be facing dental issues
- Referring an older adult to resources
- Establishing oral health community partnerships
Related resources for the network, other providers, and older adults are below.
- 1. Identify the Problem and the Impact of Oral Health
Whether caring for natural teeth or dentures, daily oral hygiene can mean that older adults will be free of oral pain, maintain a well-balanced diet, and enjoy interpersonal relationships and a positive self-image. Without practicing good oral health, advancing age may put older adults at risk for a number of oral health problems, including:
- Dry Mouth
- Diminished sense of taste
- Root decay
- Gum disease
- Oral cancer
- Uneven jawbone caused by tooth loss
- Denture-induced tissue inflammation
- Overgrowth of fungus in the mouth, known as thrush
- Attrition (loss of teeth structure by mechanical forces
Oral health problems in older adults make it more difficult for them to consume a healthy diet. Physical factors directly affecting nutrition include:
- Changes in chewing ability
- Dry mouth, a common side effect of medicine untreated tooth decay
- Loose or missing teeth, dentures, or implants
- Poor-fitting bridges or dentures
The presence of chronic conditions can also result in dental problems. Approximately 85 percent of older adults have at least one chronic health condition, and 60 percent have at least two chronic conditions. People with chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) may be more likely to develop gum (periodontal) disease. Most older Americans, with or without chronic disease, take both prescription and over-the-counter drugs. Many of these medications can cause dry mouth which reduces saliva flow and increases the risk of cavities.
Additionally, people with chronic conditions are at a higher risk for experiencing mental health conditions. Having dental issues and/or chronic conditions can be a major source of stress and may complicate existing mental health conditions, such as depression. Programs like Healthy IDEAS (Identifying Depression Empowering Activities for Seniors), Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), Screening, Brief Intervention and Referral to Treatment (SBIRT), and Wellness Recovery Action Plan (WRAP) can be useful in managing mental health concerns or behavioral health conditions, such as substance use disorders.
Older adults with chronic disease can benefit from Chronic Disease Self-Management Education (CDSME) Programs. These community-based programs are specifically designed to enhance the self-management of chronic conditions. CDSME programs are also proven to maintain or improve health outcomes of older adults with chronic conditions, which may ultimately positively impact oral health. There are more than 30 CDSME programs. The most widely disseminated and available programs are the Self-Management Resource Center suite of programs.
- 2. Oral Health Tips & Tools for Providers and Consumers
- Diet, Nutrition and Oral Health
- Oral Health and Older Adults
- Relationship of Oral Health and Nutrition
- Resources to Help Maintain Good Oral Health
- CDC Infographic on Untreated Tooth Decay
- CDC Infographic on Tooth Loss
- CDC Infographic on Tooth Loss and Chronic Disease
- Oral Health, Mental Health, and Substance Use Treatment Toolkit (National Council for Mental Wellbeing)
- Trauma-Informed Care and Oral Health: Recommendations for Practitioners (Illinois ACEs Response Collaborative)
- 3. Helping Older Adults Access Affordable Dental Care
Good oral hygiene, a healthy lifestyle, and regular dental check-ups are essential steps to a healthy mouth. While it can be difficult to access typical health care settings, it can be even more challenging to access oral health care. Dental and oral procedures should not be delayed or avoided due to the inability to pay.
Local Area Agencies on Aging (AAAs) may partner and/or establish relationships with dental schools, faith-based organizations, non-profits, social service organizations and others to help provide dental care and/or assistance for older adults in need. These organizations may offer community outreach, like free dental days, provide transportation to and from care sites, and/or assistance with financial aid, etc. Here are two examples of partnerships in action:
Through partnership and/or establishing working relationships resources can be available to help older adults overcome barriers to accessing affordable oral health care. Overall dental health is dependent on a healthy oral cavity.
The following list provides options to help overcome barriers to accessing and paying for dental and oral health care.
- Dental Schools – Dental schools can be a good source of quality, low-cost dental care. Most schools have clinics where dental students gain experience by providing care to patients for a reduced fee. Experienced, licensed dentists closely supervise the students. Contact a dental school in the local –area for more information.
- Dental Hygiene Schools Dental hygiene schools may also offer supervised, low-cost preventive dental care from students training to be dental hygienists. To locate dental hygiene schools, go to the American Dental Hygienists’ Association website.
- Community Health Clinics (CHCs) – The Health Resources and Services Administration (HRSA) funds CHCs that care for older adults when they cannot pay for health care services on their own. The majority of CHCs provide dental services. Federally funded health centers offer oral health care and can scale payment based on an individual’s income. Locate a health center.
- Faith-Based Community Organization – Some faith-based organizations also provide access to health and dental care for those in need. One example is Mission of Mercy, an independent nonprofit, faith-based community organization that provides free dental care to the uninsured and underinsured in several locations around the country.
- Wisdom Tooth Project – Serves seniors and their caregivers by teaching about oral health in aging, and connecting individuals with affordable dental clinics. For more information on the Wisdom Tooth Project, click here.
- State and Local Resources – Your state or local health department may know of programs in your area that offer free or low-cost dental care. Contact a health department office to learn more.
- Medicare – Medicare is a federal health insurance program that serves people 65 and older as well as people of any age with disabilities. Medicare only covers dental services related to specific medical conditions or treatments, and it does not cover dentures or most routine care like check-ups, cleanings, or fillings. Visit Medicare Dental Services, or call 1–800–MEDICARE (1–800–633–4227), to learn more.
- Medicaid – Medicaid is a state-run program that provides medical benefits – and in some cases dental benefits – to eligible people and families. Most states provide limited dental services for adults, while some offer comprehensive services. Visit Medicaid & You for more information.
- Veterans Administration - Dental care eligibility and veteran dental care benefits are based on a number of factors. All veterans are encouraged to contact their nearest VA to find out if they qualify for dental care benefits. Dental care is offered to eligible veterans at more than 200 locations around the country, including Alaska and Puerto Rico. Find a nearby VA Dental Clinic by city, state, or postal code. To see if you qualify for dental care benefits, please read the Veterans Dental Benefits and Eligibility section on the VA Dentistry homepage.
- 4. Community-Based Oral Health Partnerships
The purpose of community-based programs is to help underserved populations of older adults receive the oral health care they need to live an overall healthier life. Below are examples to replicate or adapt to meet a specific need in your community.
Innovative and Promising Practices
Innovations in Nutrition Programs and Services (INNU) grantees have and successfully educated older adults about nutrition using innovative and promising practices. For example, 2017 INNU grantee Live ON NY partnered with several organizations to provide therapeutic meals modified to align with dental and oral function and promote oral health and dental care.
The Friends of Calvert County Seniors (FCCS) Dental Program provides dental services to older adults with low incomes living in Calvert County, Maryland. This program provides access to and pays for older adults’ dental care, covering up to $2,000 in dental expenses. The FCCS Dental Program also provides other medical services, such as hearing assistance, prescriptions, emergency care, and eye care.
The Gary and Mary West Senior Dental Center is located in San Diego, California. The Dental Center will launch in spring 2016 and is co-located with the Gary and Mary West Senior Wellness Center. The program provides comprehensive dental services that include screenings, cleanings, fluoride treatments, sealants, x-rays, fillings, extractions, crowns, bridges, dentures, scaling, oral surgery, root canals, referrals, care coordination, and patient education. The center specifically targets low-income older adults.
The First Baptist Church-Pharmacy, Medical and Dental Clinic is located in Vicksburg, Mississippi. Volunteer providers (dentists, doctors, nurses, and social workers) staff the clinic one evening per month and offer free services on a first-come, first-serve basis until the clinic runs out of supplies. Dental services include screenings, x-rays, extractions, and referrals. The clinic only accepts individuals without insurance.
The University of Texas Health Science Center San Antonio (UTHSCSA) Dental School provides dental care at a reduced price. Supervised dental students provide the following services: screenings, fillings, extractions, crowns, bridges, dentures, and referrals. The clinic does not have eligibility requirements for new clients; however, dental needs must match the services offered at the clinic in order to receive care. The services offered are determined by the types of skills dental students are learning at the time. UTHSCSA offers general dentistry care specially tailored for older patients who have a more difficult time being seen in a private practice office due to cognitive decline, functional limitations, or those with complex medical or medication histories. No referral is needed for seniors seeking treatment in our geriatric dentistry clinic. However, because our provider availability is limited, be aware that our clinic has limited hours of service.
Mission of Mercy is a nonprofit, faith-based community organization that provides free health care to individuals who are economically disadvantaged and have difficulty accessing services. The program’s mission is to restore dignity and provide free health care, dental care, and prescription medications to those without insurance, as well as to low-income and homeless populations. The Maryland/Pennsylvania service location, profiled here, is the only Mission of Mercy service location that offers dental services in addition to medical services. The program partners with churches in the service area and a mobile van visits these locations. Health and dental services are provided on the van by a volunteer team of licensed medical and dental professionals.
One-time oral health services events can also be effective in helping older adults receive the oral health services they need. Insurance should be confirmed for event-based models. For example, volunteers providing dental and other oral health services typically carry their own malpractice and professional liability insurance. The event coordinator usually provides special event liability insurance, which covers bodily injury and property damage claims.
If you are an aging network provider and want to share your oral health program or event, please reach out to us at email@example.com.
- 5. Tips to Implementing a Community-Based Older Adult Oral Health Program
This section provides key tips for starting a community-based oral health program for older adults. Eight key steps are recommended for implementation.
- Conduct a Needs Assessment: Assessing the specific oral health needs of older adults in your community is a vital first step to implementation.
- Develop a Vision, Mission, and Goals: Developing your program’s vision, mission, and goals helps ensure that staff and community partners are working toward a common objective.
- Design the Program: As you define your program’s scope, you might choose to replicate, or copy, an existing program; adapt an existing program; or design an entirely new program.
- Establish Partnerships: Collaborating with a variety of organizations can help strengthen the planning process for a community-based oral health program for older adults and can expand the program’s impact.
- Finance the Program: Obtaining funding is an important step to starting your program and sustaining it over the long term.
- Implement the Program: You must consider several key steps as you proceed from planning and preparation to program operations and services delivery.
- Evaluate the Program: During the early planning stages of your program, before you start serving older adults, developing an evaluation plan that reflects your program’s vision and mission is imperative.
- Ensure Sustainability: Sharing your program results with partners, funders, and other community stakeholders is fundamental to maintaining existing relationships, attracting support and buy-in from your community, and thereby ensuring your program’s long-term sustainability.
- 6. Webinars
Oral Health and Nutrition: Alignment with the Healthy People 2030 Oral Health Objectives (Dec 2021)
This webinar discusses the importance of oral health status among older adults as it relates to nutrition, and how it aligns with Healthy People 2030 objectives.
- 7. Archive
Older Adults and Oral Health: Inspiring Community-Based Partnerships for Healthy Mouths Webinar (May 15, 2013)
This webinar explores the oral health status of older adults in the U.S., provides useful resources, and highlights two innovative community approaches to improving oral health access for older adults.
Who’s Leading the Leading Health Indicators? (August 20, 2012)