Modern Hygienist - September 2008 - (Page 19)

AGING | patients The low-down has been paid to the need for comprehensive healthcare for uninsured children and younger adults, but little information has been published about the percentage of elderly without health insurance.2 Even though the number of older adults without insurance is small, their healthcare needs are substantial.2 Bear in mind that in most states, Medicare does not cover routine dental services. In states where Medicare does cover an annual “cleaning,” the reimbursement is very low, and most dentists do not want to get involved in treating patients with Medicare.3 The person without private insurance or the personal resources to have dental care most likely will go without oral healthcare.1 PROBLEMATIZING PERSONAL CARE Oral infection now is recognized as a risk factor for a number of systemic diseases such as diabetes, respiratory disorders, cardiovascular and cerebrovascular diseases. The elderly often take multiple medications that can reduce saliva flow, reduce the efficiency of chewing, and lead to dental problems that affect the supporting teeth and their structure.1 The mouth is the gateway to the digestive system, and when chewing becomes difficult, nutritional problems are sure to follow.4 Many older adults are able to live independently, while others live in long-term care facilities.4 In either setting, nearly 45% of people over the age of 85 require assistance in daily activities such as bathing, dressing, feeding, toileting and oral healthcare. 1 ,5 Because more elderly patients have preserved their natural teeth, there is an increase in oral disease due to the increased debilities that come with age.5 Dental equipment is a major expense for a long-term care facility and few dental treatment rooms are available in nursing homes. Most exams can be done in wheelchairs or Geri chairs when the basic tools necessary for evaluation and screening are available, and many nursing care facilities have sterilization equipment and suction machines that can be used by dental hygienists. Those who have an interest in treating the elderly patient should take continuing education courses on the care and treatment of geriatric patients, and take into consideration that some residents may be difficult to treat.3 The proportion of Americans over the age of 65 is rising, as is the proportion of dental patients in that age group. The percentage of edentulous patients is declining and we are seeing more patients who have retained their natural teeth well into their 70s. Because these older patients were not exposed to ﬂuoride until later in life, they experienced signiﬁcant restorative care earlier in life. Restorative needs are typically more extensive and the older adult often has measurable whole mouth alveolar bone loss due to osteoclastic activation in response to periodontal pathogens. The increase in root surface exposure leads to decalciﬁcation and root caries are common. CONSIDERING SOLUTIONS Many states have adopted guidelines for dental care in nursing homes that utilize dental hygienists as oral health liaisons. State licensing boards have not made health liaisons mandatory at nursing home facilities, so this decreases the likelihood of services provided to these patients. 3 Although there are no state mandatory healthcare providers for the elderly, there are a growing number of oral health practitioners that have offices set up in vans and carry dental equipment that is available to the facilities, such as Registered Dental Hygienists in Alternative Practice (RDHAP) in California.3 Poor access to dental care demands new in- webexclusive For important tips on priorities in geriatric care and a special report on working with patients who have Alzheimer’s, visit www. modernhygienist.com. Utilizing the dental hygienist for elder oral care would lower the cost of services for the dentist and allow hygienists to enhance their skills. September 2008 | modern hygienist 19 http://www.modernhygienist.com http://www.modernhygienist.com

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Modern Hygienist - September 2008 Contents Editor's Letter Letters Modern Solutions Access Denied Kids First: Creating Comfort Worn Out? Voice of a VIP Hands-on Hygiene: Magnification In Focus Digital Persuasion That "Other" Female Cancer Ad Index Classifieds Moonlighting

Modern Hygienist - September 2008

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