Janet A. Yellowitz

Oral health status of older rural adults in the United States

BACKGROUND Little is known about the oral health care of older rural residents. The authors describe oral health indicators for the older adult population by place of residence in the United States. METHODS The authors analyzed data from the Third National Health and Nutrition Examination Survey and the 1995, 1997 and 1998 National Health Interview Surveys. Oral health indicators included perceived oral health (self-reported dental status and unmet dental needs) and dental status (untreated caries; decayed, missing and filled permanent teeth, or DMFT; and edentulism). Dental care utilization and access were measured by number of dental visits, frequency of dental visits and dental insurance status. RESULTS Older rural adults were more likely than their urban counterparts to be uninsured for dental care (72.1 percent versus 66.1 percent, respectively) and were less likely to report dental visits in the past year (46.9 percent versus 58.4 percent, respectively). A higher proportion of rural residents than urban residents were edentulous (36.7 percent versus 28.2 percent, respectively) and reported poor dental status (50.7 percent versus 42.2 percent, respectively). There were no differences in unmet dental needs, percentage of people with untreated caries or in mean DMFT by place of residence. CONCLUSIONS Older rural residents inadequately utilize dental care and have less favorable oral health indicators than do older urban residents. CLINICAL IMPLICATIONS This article shows the need for more dental practitioners in rural areas. With the low density of dentists per person and the high need for care, rural America offers an excellent opportunity for oral health professionals to provide much needed services.

ELDER'S ORAL HEALTH CRISIS

UNLABELLED Dentistry must prepare to meet the challenges of providing oral health services to the increasing numbers of medically compromised and cognitively impaired older adults whose care is often complicated by functional, behavioral, and situational factors. BACKGROUND With the unprecedented aging of the population, oral health care providers will be treating a greater number of older adults than in the past. There will also be a larger frail and vulnerable cohort with physical and/or cognitive conditions, disabilities and limited financial resources. The elderly suffer disproportionately from oral disease and limited access to oral health care. Many older adults are either unwilling or unable to receive routine care, putting them at greater risk for general and oral complications. Some present with extensive oral disease, the cumulative effects of disease throughout their lifetime, an even more complicated situation when frail elders are homebound or in long-term care institutions. To care optimally for this aging cohort, oral health professionals need to be knowledgeable about the many conditions, disabilities and age-related changes associated with aging. METHODS Literature review and discussion of the key research studies describing demographic and societal changes leading to the current multifactorial oral health care crisis impacting older adults. The authors draw upon the evidence and their experience in geriatric patient care to provide information relevant to todays oral health care practitioners treating older adults. CONCLUSION Oral health services are an essential component of primary geriatric health care. The growing population of older and impaired adults requires practitioners who are sensitive to the myriad of functional, behavioral and situational factors that impact this aged cohort. Adequate access to quality oral health care for the aged is a salient public health issue that will require political and psychobiomedical interprofessional collaboration to adequately address.

Oral cancer examinations among smokers and moderate-heavy drinkers, United States, 2008.

OBJECTIVES Smoking and moderate-heavy alcohol consumption are primary risk factors for oral cancer. This report uses national data to test whether adults with these risk factors received oral cancer examinations (OCEs) at a rate consistent with their risk. METHODS Data from the 2008 National Health Interview Survey (NHIS) were used for this analysis. The main outcome variables described lifetime receipt of extraoral or intraoral OCEs. Other variables described health-care visits, as well as the timing of, reasons for, and type of practitioner providing the most recent OCE. Descriptor variables were smoking and drinking status. Covariates included several sociodemographic factors. Weighted bivariate and multivariable analyses were conducted using SUDAAN software. RESULTS According to the 2008 NHIS, about 34 percent of adults aged 40 years or older reported receiving either an extraoral or intraoral examination during their lifetime. Current smokers were no more likely to have received an OCE than were never smokers, controlling for relevant covariates. Moderate-heavy drinkers and light drinkers were significantly more likely to have received an OCE than were lifetime abstainers. CONCLUSIONS Current smokers did not receive OCEs at a rate consistent with their increased risk, whereas moderate-heavy drinkers did. One explanation for this finding is that medical and dental visit behaviors indirectly influenced OCE rates. Dentition status played an important role, as having teeth is strongly associated with dental visit behaviors. Health-care practitioners are encouraged to consider the smoking and drinking statuses of their patients when they conduct routine physical examinations of the head and neck.

Access, Place of Residence and Interdisciplinary Opportunities

Healthy People (2000) stated, ‘Having adequate access to medical and dental care can reduce morbidity and mortality, preserve function and enhance overall quality of life’.) This statement is particularly relevant to older adults as their oral health has improved over the past 50 years, and their utilization of dental services has increased (Vargas, Kamarow, & Yellowitz, 2001). )Older adults have an increasing need for care; however, barriers to care increase with age, and many elders do not receive care on a routine basis (Stanton and Rutherford 2003). The Surgeon General’s report on oral health identified the elderly among the populations most vulnerable to poor dental care (U.S. DHHS, 2000).) Ensuring that older adults receive routine oral health care is critical, as basic oral health services are essential components of primary health care (Dolan & Atchison, 1993) and having routine preventive care is associated with good oral health. Although there are no studies to support it, the U.S. Public Health Service recommends annual oral examinations for all adults (United States Public Health Service, 1994). Yet many older adults only seek care when they are in pain or discomfort, which predisposes them to poor oral health. More of the today’s elderly are retaining their natural teeth, with fewer adults experiencing total tooth loss (edentulism). In 2003–2004, one-quarter of noninstitutionalized adults 65 years of age and older were edentulous compared to 33 percent in 1993 (Lethbridge-Cejku, Rose, & Vickerie, 2004). Although there was no gender difference in the rate of edentulism, there were large differences in the prevalence of edentulism by socioeconomic status. Persons with family incomes below the poverty line were almost twice as likely to be edentulous as those with incomes at or above the poverty level. In addition, edentulism was higher among Black persons than among White persons (Kramarow, Lentzner, Rooks, Weeks, & Saydah, 1999).