The aging population and oral disease prevention: Are dental hygienists ready?


Many of us have heard about people living longer and retaining their natural teeth. That sounds like a good thing, right? Of course it is, but are we ready for these people in the operating room? Are we ready to provide them with the best preventative measures? How comfortable are we with treating our frail, elderly patients?

Life expectancy for women increased from an average of 68 to 81 years, and for men from an average of 76 to 76 years. In fact, it is expected that by 2034, the number of senior Americans will exceed the number of children in the United States for the first time. As of 2018, the number of people aged 65 and above was 52.4 million, and this number is expected to climb to 80 million by 2040, accounting for 21% of the total population.1 This is important! Are we ready?

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Meeting the dental needs of an aging population

Steps Dental Hygienists Can Take

Whether we visit patients in other settings, such as long-term care facilities, or have them come into our offices, we are seeing an increase in older patients. Their common oral health challenges are reduced oral home care, which results in increased plaque and tartar buildup; xerostomia; root caries; and recurrent decay around existing restorations. They also face challenges unrelated to oral health, such as changes in mobility, increased daily medication use (which may have side effects), mild to moderate memory loss, dependence on caregivers, and lack of dental insurance.

Have you ever had a patient tell you, “I'm retiring next month, so I need all my dental work done before then”? There's a reason they say that. When someone turns 65, they become eligible for Medicare. Most Medicare plans do not offer dental coverage, and many seniors live on limited income such as Social Security or disability.2 As a result, one of the most at-risk populations faces many challenges and may not have dental insurance and have limited financial means to address oral health issues. It is estimated that more than 17 million seniors live below 200 percent of the federal poverty level.3

I learned from first hand experience

My interest in this population comes from my days in public health and providing dental care in nursing homes. I was hired by a Federally Qualified Health Center (FQHC) to start a school-based sealant program, which has been my experience for the past five years. It was January 2020, and the coronavirus pandemic forced me to change my plans. I found myself working in nursing homes with patients I had little experience treating.

This showed me a lot, mainly the struggle these patients face. It also taught me that we have to look at this population with a different mindset, a precautionary mindset. Many of these patients already have significant dental needs, but we have many opportunities to help prevent future disease.

We need to make our treatment and prevention services affordable. Some options include regular caries treatment and preventive applications of silver diamine fluoride (SDF), provision of fluoride varnishes, recommendations for twice daily use of 5000 ppm toothpaste, and dry mouth relief recommendations that provide a neutral pH. We have to research the products and services we offer because not all products are created equal, especially dry mouth products.

I hope I have raised awareness of this high-risk group. Many older adults are at risk for future dental disease, and we have the power to change that trajectory. As dental hygienists, education and prevention are at the core of our practice. This group needs us to be creative and innovative with the choices we offer. If we wait until decay begins under a crown or bridge, or Class V lesions begin, it will be too late.

We must beat the disease. This is where preventive application of SDF, increased exposure to fluoride, and increased exposure to xylitol through recommended dry mouth products can be very beneficial. Aging is a challenge and we have the ability to help patients prevent future disease and improve their quality of life!

refer to

1. Seniors are expected to outnumber children for the first time in U.S. history. U.S. Census Bureau. March 13, 2018. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

2. Medical insurance dental insurance. Centers for Medicare and Medicaid Services. 2023. https://www.cms.gov/medicare/coverage/dental

3. Know the facts about financial security for seniors. National Council on Aging. 2023. https://www.ncoa.org/article/get-the-facts-on-economic-security-for-seniors



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