As the geriatric population continues to increase, dentists are changing their approach to dental care. Karen Becerra, DDS, CEO of Gary and Mary West Senior Dental Center in San Diego discussed the challenges and opportunities for dentists when treating seniors.
Question: What are the top barriers seniors face when accessing routine dental care?
Dr. Karen Becerra: Despite major advances in dentistry and the ability to prevent many oral healthcare issues, dental disease in seniors is one of the most significant and widespread public health problems in America, due to the costs of care and a lack of dental insurance.
Data shows that fewer than half of seniors visited a dentist in the previous year, and most of our patients are dual eligibles for both Medicare and Medicaid and can’t afford to pay for dental care. They have trouble finding dentists that will even accept Denti-Cal, California’s Medicaid program.
You’d be amazed at how many people don’t realize the Medicare coverage they get when they turn 65 has no coverage for dental care. Transportation is a major issue too, so our facility is co-located within a very popular senior wellness center in Downtown San Diego that sees almost a thousand clients a day.
Q: What are the biggest things dentists should consider when treating seniors?
KB: You need to think of a patient’s overall needs – from mental, social, medical and dental – so we are constantly consulting with physicians, families and social workers to address all of the patient’s needs. You have to customize the treatment plan based on the patient’s needs and circumstances. A 99 year old is going to get a different treatment plan than a 65 year old, because their ability to tolerate the stress of treatment varies. For example, a recent 99 year old woman had a broken tooth, that after careful consideration and discussion with her primary care physician, we decided it would be better to keep it in her mouth rather than extract it. If she had been 65, we most likely would have taken it out. While every case is different, we always try to keep in mind the patient’s broader health aspects when we consider their treatment.
Q: What are the most common dental issues seniors face?
KB: According to the CDC, about one-in-five people 65 and older have untreated tooth decay, and they may even experience new tooth decay at higher rates than children. Seniors are also more prone to issues like dry mouth, tooth loss and periodontal disease – the prevalence and severity of which increases with age.
In addition, oral cancer is seven times more common in people 65 years of age and older, as compared to younger adults, and more older adults die from oral cancer than from skin cancer in America. Research has also shown infections in the mouth may be associated with heart disease, stroke, diabetes, pneumonia and other health problems.
Q: How has dentistry for seniors changed over the past few years?
KB: As an industry, dentistry is always changing. New technologies and ways to treat patients and improve their experience to make them more comfortable with the dental process are always emerging. Fear is a big aspect of treating seniors, because many of them have had poor experiences in the past, so anything that can help alleviate that is helpful. For example, new high-resolution cameras let us show a patient what is happening in their mouths quickly and help us educate them on the importance of the issues in their mouth and how they need to take care of their teeth. With all of these changes, though, the basics remain the same for seniors and any other patient. If they don’t brush and improve their home care, we’re going to be limited on what I can do to help them, and the oral diseases will reoccur. Prevention stays the same regardless of how old you are.
Q: How does the Gary and Mary West Senior Dental Center approach care for seniors?
KB: We approach the patient as whole person, looking at their social, medical, mental and dental needs. The mission of the Gary and Mary West Senior Dental Center is to provide affordable, high-quality oral healthcare with comprehensive education, clinical, and wellness services for seniors in need, enabling them to live healthy and productive lives. The Senior Dental Center links high-quality and affordable oral healthcare with a suite of nutrition, case management and wellness services offered through the Gary and Mary West Senior Wellness Center, creating a one-of-a-kind, integrated community-based system of care for older adults. We’re focused on integrating medical and dental care for a seriously underserved population of low-income seniors so oral care isn’t an isolated silo.
Q: What are your thoughts about integrating medical care with dental care?
KB: I think it’s essential. You can’t be in good general health if you have poor oral health, and vice versa. Care has to be looked at holistically. This is a care model we’ve adopted at the Senior Dental Center, where seniors can access a variety of health and wellness services all under one roof. Health navigators are able to collect and share important health information among providers and social services professionals. Our initial intake looks at the whole person – from traditional healthcare indicators like medical, dental and psychological, but we also really focus on social issues like nutrition and housing, because if those basic needs aren’t met, patients aren’t going to be able to improve their healthcare.
Q: At the center, you do a Comprehensive Geriatric Assessment (CGA), how does that affect the care a patient receives?
KB: Every senior who comes to us with a dental issue first gets a Comprehensive Geriatric Assessment (CGA) where we evaluate overall health, dental and mental status, as well as functional ability and his or her living situation. This enables us to develop a coordinated care plan that encompasses dental, medical and supportive social services all together. The CGA allows us to understanding the holistic need of a patient so we can prioritize their needs and get them ready to be seated in one of the dental chairs. If at any point during the appointment, any social, medical or mental needs become evident, then we do a direct referral to the other social services co-located at the senior wellness center where we’re located, and we work with regularly.
Q: Do you expect any changes in access or insurance coverage for seniors over the next few years?
KB: Yes, we expect to see improvements in access as the community at large gets educated in the importance of addressing the oral-health needs of vulnerable seniors. We expect more collaboration, engagement and action from dentists and other health professionals, as well as engagement from community leaders, advocates, insurers and seniors themselves to help address these access issues. We believe the data we are collecting and analyzing at the Senior Dental Center will demonstrate the positive health outcomes and potential cost savings of providing dental care to seniors so that more communities will develop integrated models and more seniors have access to affordable coverage. As a non-profit, we’re always trying to raise funds to support these access efforts, so please visit www.seniordentalcenter.org to see how you can donate to support this cause so we can continue to shine a light on this issue to take all of our learnings and share them with others at the state and national level to proactively address this problem.
More articles on dentists:
In-network dentist availability satisfaction declines: 3 key statistics
5 states with highest, lowest annual salaries for orthodontists
New Jersey dentist to repay $250k to Medicaid for alleged improper billing: 5 things to know
Question: What are the top barriers seniors face when accessing routine dental care?
Dr. Karen Becerra: Despite major advances in dentistry and the ability to prevent many oral healthcare issues, dental disease in seniors is one of the most significant and widespread public health problems in America, due to the costs of care and a lack of dental insurance.
Data shows that fewer than half of seniors visited a dentist in the previous year, and most of our patients are dual eligibles for both Medicare and Medicaid and can’t afford to pay for dental care. They have trouble finding dentists that will even accept Denti-Cal, California’s Medicaid program.
You’d be amazed at how many people don’t realize the Medicare coverage they get when they turn 65 has no coverage for dental care. Transportation is a major issue too, so our facility is co-located within a very popular senior wellness center in Downtown San Diego that sees almost a thousand clients a day.
Q: What are the biggest things dentists should consider when treating seniors?
KB: You need to think of a patient’s overall needs – from mental, social, medical and dental – so we are constantly consulting with physicians, families and social workers to address all of the patient’s needs. You have to customize the treatment plan based on the patient’s needs and circumstances. A 99 year old is going to get a different treatment plan than a 65 year old, because their ability to tolerate the stress of treatment varies. For example, a recent 99 year old woman had a broken tooth, that after careful consideration and discussion with her primary care physician, we decided it would be better to keep it in her mouth rather than extract it. If she had been 65, we most likely would have taken it out. While every case is different, we always try to keep in mind the patient’s broader health aspects when we consider their treatment.
Q: What are the most common dental issues seniors face?
KB: According to the CDC, about one-in-five people 65 and older have untreated tooth decay, and they may even experience new tooth decay at higher rates than children. Seniors are also more prone to issues like dry mouth, tooth loss and periodontal disease – the prevalence and severity of which increases with age.
In addition, oral cancer is seven times more common in people 65 years of age and older, as compared to younger adults, and more older adults die from oral cancer than from skin cancer in America. Research has also shown infections in the mouth may be associated with heart disease, stroke, diabetes, pneumonia and other health problems.
Q: How has dentistry for seniors changed over the past few years?
KB: As an industry, dentistry is always changing. New technologies and ways to treat patients and improve their experience to make them more comfortable with the dental process are always emerging. Fear is a big aspect of treating seniors, because many of them have had poor experiences in the past, so anything that can help alleviate that is helpful. For example, new high-resolution cameras let us show a patient what is happening in their mouths quickly and help us educate them on the importance of the issues in their mouth and how they need to take care of their teeth. With all of these changes, though, the basics remain the same for seniors and any other patient. If they don’t brush and improve their home care, we’re going to be limited on what I can do to help them, and the oral diseases will reoccur. Prevention stays the same regardless of how old you are.
Q: How does the Gary and Mary West Senior Dental Center approach care for seniors?
KB: We approach the patient as whole person, looking at their social, medical, mental and dental needs. The mission of the Gary and Mary West Senior Dental Center is to provide affordable, high-quality oral healthcare with comprehensive education, clinical, and wellness services for seniors in need, enabling them to live healthy and productive lives. The Senior Dental Center links high-quality and affordable oral healthcare with a suite of nutrition, case management and wellness services offered through the Gary and Mary West Senior Wellness Center, creating a one-of-a-kind, integrated community-based system of care for older adults. We’re focused on integrating medical and dental care for a seriously underserved population of low-income seniors so oral care isn’t an isolated silo.
Q: What are your thoughts about integrating medical care with dental care?
KB: I think it’s essential. You can’t be in good general health if you have poor oral health, and vice versa. Care has to be looked at holistically. This is a care model we’ve adopted at the Senior Dental Center, where seniors can access a variety of health and wellness services all under one roof. Health navigators are able to collect and share important health information among providers and social services professionals. Our initial intake looks at the whole person – from traditional healthcare indicators like medical, dental and psychological, but we also really focus on social issues like nutrition and housing, because if those basic needs aren’t met, patients aren’t going to be able to improve their healthcare.
Q: At the center, you do a Comprehensive Geriatric Assessment (CGA), how does that affect the care a patient receives?
KB: Every senior who comes to us with a dental issue first gets a Comprehensive Geriatric Assessment (CGA) where we evaluate overall health, dental and mental status, as well as functional ability and his or her living situation. This enables us to develop a coordinated care plan that encompasses dental, medical and supportive social services all together. The CGA allows us to understanding the holistic need of a patient so we can prioritize their needs and get them ready to be seated in one of the dental chairs. If at any point during the appointment, any social, medical or mental needs become evident, then we do a direct referral to the other social services co-located at the senior wellness center where we’re located, and we work with regularly.
Q: Do you expect any changes in access or insurance coverage for seniors over the next few years?
KB: Yes, we expect to see improvements in access as the community at large gets educated in the importance of addressing the oral-health needs of vulnerable seniors. We expect more collaboration, engagement and action from dentists and other health professionals, as well as engagement from community leaders, advocates, insurers and seniors themselves to help address these access issues. We believe the data we are collecting and analyzing at the Senior Dental Center will demonstrate the positive health outcomes and potential cost savings of providing dental care to seniors so that more communities will develop integrated models and more seniors have access to affordable coverage. As a non-profit, we’re always trying to raise funds to support these access efforts, so please visit www.seniordentalcenter.org to see how you can donate to support this cause so we can continue to shine a light on this issue to take all of our learnings and share them with others at the state and national level to proactively address this problem.
More articles on dentists:
In-network dentist availability satisfaction declines: 3 key statistics
5 states with highest, lowest annual salaries for orthodontists
New Jersey dentist to repay $250k to Medicaid for alleged improper billing: 5 things to know