Oral Health Disparities, Barriers Exist for America's Elders
Lester, Arlene, Henderson, Gaylyn, Taylor, Jacqueline, Aging Today
For three decades, the government's Healthy People series has provided science-hased, 10-year national objectives for improving the health of all Americans. Healthy People 2020 continues in this tradition, with established Leading Health Indicators that communicate high-priority health issues and necessary actions to address them.
Oral health is a Healthy People 2020 Leading Health Indicator. Poor oral health can limit food choices and the enjoyment derived from eating. It can affect verbal communication; facial esthetics; selfexpression and self-esteem; social contact; and intimacy. Disparities in untreated dental disease may also contribute to disparities in oral health-related quality of life and unnecessary oral pain.
Prevention and control of oral disease, particularly for poor, underserved and vulnerable populations, is a priority for the U.S. Department of Health & Human Services (HHS), the Office of Minority Health and the HHS Oral Health Coordinating Committee.
Causes, Risks of Poor Oral Health
In spite of the decades-long improvements in oral health in America's population subgroups, significant disparities are still found in elder populations. For example, dental caries (tooth decay) is largely preventable and has decreased in the past four decades. In older adults, however, dental caries represent the most prevalent chronic disease and can lead to tooth loss.
Periodontal disease is the most common cause of tooth loss among elders, and is more likely to affect African American and Hispanic elders. Adults older than age 65 have an average of 19 remaining natural teeth, and lower-income, less-educated African American elders have even fewer. Given that at least 20 natural teeth are considered necessary for efficient chewing, and that removable dentures are 30 percent to 40 percent less efficient than chewing with natural teeth, tooth loss among elders is a red flag indicating poor oral health and lack of access to dental care.
Older adults who have tooth loss are also more likely to gravitate toward easierto-chew foods like potpies, stews, soups, bakery items, ice cream and cheeses. Many of these foods are rich in saturated fats and cholesterol: eating them can cause weight gain and obesity, and may interfere with managing existing diabetes and cardiovascular disease among elders. Given the prevalence of obesity across all racial and ethnic groups, tooth loss may contribute additional burden to prevention and control of obesity- related diseases among elders from these groups.
Oral cancer is of grave concern among elders, too. Approximately 30,000 Americans are diagnosed annually with this largely preventable cancer, with African American males having the highest incidence rate in the United States, compared with women and other racialethnic groups. Oral cancer rates increase with age, accelerating after age 50 and peaking between ages 60 and 70.
Other age-associated factors also increase the burden of oral disease: taking medications that treat age-related chronic conditions- tricyclic antidepressants, antipsychotics, beta blockers and antihistamines- can induce dry mouth, which means there is not enough saliva present to protect teeth against dental caries and tooth decay.
Disparities and Barriers to Care
Disparities also exist in the use of dental services among elders. Older adults from racial-ethnic minority groups are more likely to report lower perceived need for dental care than do other elders, citing lack of teeth and cost as primary reasons.
A 2008 Medical Expenditure Survey from the HHS Agency for Healthcare Research and Quality (drc. …