Why Does Oral Health Seemingly Not Matter for Older Adults?
Why when older adults turn 65, retire and lose private dental coverage does their oral health no longer matter? With the rising cost of living, along with the loss of private dental insurance how can older adults continue to afford vital oral healthcare as they age? Neglected and poor oral health has a substantial impact on systemic health. In particular for older adults, poor oral health can be associated with several systemic conditions and may be exacerbated by multiple medications. Poor oral health can also cause a decline in nutritional intake, leading to increased disability and frailty.
Within Canada, healthcare is publicly funded. However, that public funding stops at the mouth. The vast majority of preventative and restorative oral care is funded through private insurance and out of pocket expenses. Private dental insurance is the primary determinant of receiving oral care. Without private insurance individuals of all ages are unable to afford costly care. This is especially true for older adults, who lose private insurance coverage often occurs when they retire, at a time in their life when oral care is crucial.
Prior to the past few decades, older adults often had no natural teeth. Restorative dentistry was very limited. Many adults had their teeth removed if any issues arose, and complete dentures were fabricated. The link between systemic health and oral health was not apparent, as it is today. While fabricating dentures is a solution for missing teeth, it is costly, results in inadequate patient satisfaction, as well as poor function. Poor oral function can lead to several issues including an inability to intake nutrients. This can drastically impact weight loss, frailty, and even mortality in older adults.
Poor oral health can be linked to poor diabetic control, coronary artery disease as well as other systemic conditions. Many older adults take multiple medications, which lead to several detrimental side effects. Many medications can cause gum inflammation, dry mouth, increase the risk of cavities, and oral sores. The effect of medications, systemic diseases, tooth loss, oral pain, and chewing problems can be contributing factors to frailty in older adults.
Older adults within Nova Scotia need public funding so they can have access to imperative oral care through a time in their lives that it is vital. The creation of a publicly funded program designed to provide them with access to costly preventative oral care within their communities can help to maintain optimal oral health, as well as systemic health, leading to decreased hospitalizations, and increased independence.
Having a provincial program similar to the NIHB (Non-Insured Health Benefits) could greatly improve oral health for older adults, and in return improve systemic health. The NIHB is a federal program that provides funding for dental services for First Nations & Inuit patients. The program currently covers routine dental exams, x-rays, preventative services (such as scaling and fluoride application), basic restorative costs, and dentures. With a program based upon the NIHB, older adults would be able to receive preventative care within their communities. With no additional cost to older adults, but all the benefits of having adequate oral healthcare.
Oral health professionals have been advocating for improved access to care for older adults, along with other vulnerable groups of the public for years. As a collective voice, the public needs to advocate for financial access to vital oral healthcare for older adults.
Amelia Wilson, Oral health advocate. RDH, BDH, Masters of Health Studies Candidate at Athabasca University.
References
American Dental Association. (2005). How Medications can affect your oral health. Journal of the American Dental Association 136(6). https://doi.org/10.14219/jada.archive.2005.0269
Azzolino, D., Passarelli, P., De Angelis, P., Piccirillo, G., D’Addona, A., & Cesari, M. (2019). Poor Oral Health as a Determinant of Malnutrition and Sarcopenia. Journal of Nutrients. 11(2898). https://doi.org/10.3390/nu11122898
Bakker, M., Vissink, A., Spoorenberg, S., Jager-Wittenaar, H., Wynia, K., & Visser, A. (2018). Are Edentulousness, Oral Health Problems and Poor Health-Related Quality with Malnutrition in Community-Dwelling Elderly (aged 75 Years and Over)? A Cross-Sectional Study. Journal of Nutrients. 10(1965). https://doi.org/10/3390/nu10121965
Canadian Dental Association. (2010). Position Paper on Access to Oral Health Care for Canadians. http://www.cda-adc.ca/_files/position_statements/accesstocarepaper.pdf
Estrada, I., Kunzel, C., Schrimshaw, E., Greenblatt, A., Metcalf, S., & Northridge, M. (2018). “Seniors Only Want Respect” Designing an Oral Health Program for Older Adults. Speciality Care Dentistry Association. 38(1). https://doi.org/10.1111/scd.12265
Government of Canada. (2021). Dental benefits guide: Non-insured health benefits program. https://www.sac-isc.gc.ca/eng/1579538771806/1579538804799#a11
Health Canada. (2010). Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey: 2007-2009. https://www.caphd.ca/sites/default/files/CHMS-E-tech.pdf
Hoeksema, A., Spoorenberg, S., Peters, L., Meijer, H., Raghoebar, G., Vissink, A, Wynia, K., & Visser, A. (2017). Elderly with Remaining Teeth Report Less Fraility and Better Quality of Life than Edentulous Elderly: A Cross-Sectional Study. Journal of Oral Diseases.(23). https://doi.org/10.1111/odi.12644
NSDA. (2021). Political parties commit to doing more to protect oral health of Nova Scotians. Nova Scotia Dental Association. Nova Scotia Dental Association. https://nsdental.org/whats-new/political-parties-commit-to-doing-more-to-protect-oral-health-of-nova-scotians/
Tavares, M., Lindefjeld Calabi, K., & San Martin, L. (2014). Systematic Diseases and Oral Health. Dental Clinics of North America. 58(4). https://doi.org/10.1016/j.cden.2014.07.005
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