Mouth Health of Older Americans in a State of Decay

A new report examining factors impacting the oral health of older Americans reveals the nation's oral health is in trouble. Published by Oral Health America (OHA), A State of Decay, Vol. III is a state-by-state report of the oral health of its 65+ population and the success or failure of states to address those needs. OHA found the lowest-performing states are found in the South and highest-performing throughout the East and the West coasts as well as the Midwest. The report underscores the important role policies and practices play in addressing barriers, particularly for vulnerable populations.

"While many Americans face obstacles when it comes to oral health, older adults are at an increased risk due to challenges with accessing care," says Dushanka Kleinman, a dentist and associate dean for research and academic affairs at the University of Maryland School of Public Health. "We have to develop solutions at the practice and policy level to address the barriers older Americans experience."

Older Americans are at risk for adverse oral health for a variety of reasons. Among the most prominent are a general decline in health, less access to oral health care and lack of dental benefits. The report serves as a resource for states to address shortfalls in oral health status, dental benefits for low income adults, and population-based prevention, all of which affect the oral health of older adults.

A State of Decay gave a rating of "poor," "fair," "good," or "excellent" based on state level data analyzing seven variables impacting older adult oral health: edentulism (loss of teeth), intake of fruit and vegetables, the availability of Medicaid dental benefits, Community Water Fluoridation, the status of the state's older adult Basic Screening Survey, and the existence and extent to which the State Oral Health Plan includes immediate or recent efforts to improve the oral health of older adults.

OHA identified variables for those ratings based on the latest understanding of what contributes to the condition of oral health among older Americans. Each state has been given two scores—an Individual Oral Health Score that measures individual-level factors that address the oral health of older adults such as edentulism and nutritional intake and a Public Policy Score, which measures factors that address what states are doing to address the oral health needs of older adults. These scores have been combined to give a total Composite Score.

The final evaluations for all 50 states revealed that 74%, or 37 states, earned a Composite Score of "fair" (30%) or "poor" (44%). Puerto Rico, Guam, and Washington D.C. were rated on some but not all of the variables and therefore not included in the Composite Scores.

All seven variables were combined in the Composite Score to provide an overall ranking. In order, the 10 states with the highest Composite Score are Connecticut, Rhode Island, Virginia, Minnesota, New York, Colorado, Florida, Maryland, North Dakota, and Wisconsin. The states with the lowest Composite Scores are Montana, Pennsylvania, Arkansas, Hawaii, South Carolina, Oklahoma, Louisiana, Tennessee, Alabama, and Mississippi (the least favorable).

The top findings of this report that illicit further scrutiny and action are the following:

• Tooth loss remains a signal of suboptimal oral health. Eight states had strikingly high rates of edentulism, with West Virginia notably having an older adult population that is 33.7% edentate.

•  Poor nutritional intake affects America's seniors. Twenty-one states (40%) have 40% or more older adults who do not eat at least one serving of fruit a day. Puerto Rico (51.3%), Arkansas (50.5%) and Oklahoma (50.4%) represent the highest rates with over one-half of older adults who are not eating at least one serving of fruit a day.

• Communities without fluoridated water create deficiencies in prevention. Eight states (16%) still have 50% or more residents living in communities unprotected by fluoridated water. Hawaii (89.2%) and New Jersey (85.4%) have the highest rates of residents living without fluoridated water.

• Inadequate surveillance of the oral health condition of older adults persists. Twenty-three states (45%) have never completed a Basic Screening Survey (BSS) of older adults and have no plan to do so. An older adult BSS is a surveillance of the oral health conditions of seniors in community and long term care settings. The BSS is, recognizes the need for community level oral health status and dental care access data.

• Persistent shortage of oral health coverage. Twenty states (40%) provide either no dental benefit or emergency coverage only through adult Medicaid dental benefits. Eighteen states provide limited coverage and 12 include comprehensive coverage.

• Critical lack of strategic planning to address the oral health of older adults. Thirty-five states (70%) lack a State Oral Health Plan that mentions older adults, with 13 states lacking any type of State Oral Health Plan.

"Access to oral health care for older Americans is a matter of social justice, with those living in poverty suffering the most from the lack of publicly funded benefits needed to improve their oral and overall health," says Caswell Evans, associate dean of prevention and public health sciences at the University of Illinois at Chicago School of Dentistry.

OHA developed six key practical recommendations to promote healthy aging and independence for this rapidly growing cohort of America's population.

• Support the Reauthorization of the Older Americans' Act, S.192, in the House of Representatives and the implementation of the oral health screenings provision.

• Support caregivers, often responsible for ensuring the oral health of their loved ones, through the passage of the RAISE Family Caregivers Act.

• Advocate for financially viable publicly-funded dental benefits.

• Sustain Community Water Fluoridation as an evidence-based public health practice that positively impacts oral health at the population level.

• Include specific language to ensure inclusion of provisions for older adults in every state's Oral Health Plan.

• Establish continuous surveillance of older adults' oral health by requiring states to conduct a BSS.

A State of Decay 2015 is the third in a series of reports from OHA surveying the state of oral health for older Americans. It is one of five programmatic strategies of OHA's Wisdom Tooth Project, a program designed to meet the oral health challenges of a burgeoning population of older adults with special needs, chronic disease complications and a growing inability to access and pay for dental services.

Source: Oral Health America