Inside Dental Assisting
Aging Populations and the need for dentistry
Key opinion leaders in oral healthcare share ideas on the impending challenges for dental practices
According to the United States Census Bureau, the geriatric population (ie, persons 65 years old and over) increased by a factor of 11, from 3.1 million in 1900 to 34.6 million in 1994 and is expected to be 82 million by 2050, says Joe Lancellotti, the founder and chief information officer of DoctorsMarketing.com. In 2011, the first baby boomers reached the age of 65. This group, which was born between 1946 and 1964, represents about 20% of the population, and they have more teeth in their mouth per person than any previous geriatric segment in history, he says.
“Like many industrial nations of the world, demography informs destiny, and we are observing the emergence of an ever larger number of men and women over the age of 65 years,” notes Harold Slavkin, DDS, the former dean of the University of Southern California School of Dentistry. “In the United States, the cohort over 80 years of age is rapidly increasing in size.”
According to Gordon Christensen, DDS, MSD, PhD, co-founder of Clinical Research Associates (now Clinicians Report), this age range of patients will need a significant portion of the dentistry of the future. Therefore, dental healthcare workers need to significantly increase their education and training for addressing the special needs of aging or geriatric patients, Slavkin says.
Identifying the Need
Key opinion leaders in oral healthcare believe that the aging population is becoming an urgent issue in America. For this reason, many organizations around the country are hosting conferences designed to increase awareness, education, and appreciation for these patients.
“Compared to previous generations, the edentulous rate in this group is lower and continues to drop as more adults enter senior status,” Lancellotti says. “In the past, the majority of older adults had minimal or no teeth, so this group seldom called the dentist for dental care and, therefore, were not part of the dentist’s revenue plan.”
This is no longer the case. Today’s aging population grew up learning about fluoride and preventive dentistry. They were educated about a wide variety of dental services to maintain oral health, replace fillings, and improve the appearance of their smiles, Lancellotti says.
“Many of these people will be living with chronic diseases and conditions that are highly complex and very often require not one but multiple medications that can have profound impact on how one can or cannot approach dental treatment,” comments Lawrence Tabak, DDS, PhD, former director of the National Institute of Dental and Craniofacial Research (NIDCR). “The dental profession will need to become increasingly more knowledgeable about chronic diseases and conditions and the pharmacology intended to treat those diseases and conditions. We’ll also have to develop better approaches to treating patients in this age category, even down to the level of restorative materials.”
Exploring New Approaches
Tabak elaborates that as individuals age, oral healthcare workers often are not dealing with actual carious lesions, but rather complex secondary decay, multiple restorations, and superimposed periodontal disease. A new generation of materials that provide more options will be required, he adds.
“New, better preventive procedures for the aging population need to be developed,” Christensen emphasizes. “Additionally, new, better techniques for restoring mature adult teeth also need to be developed.”
“The baby boomers have arrived at a certain phase in their lives, and with this comes the need to use certain types of materials that are more resistant to root caries,” observes David Garber, DMD, a member of Team Atlanta. “Abfraction lesions become more common, along with incisal and occlusal wear.”
Christensen notes that less-expensive esthetic procedures are needed for mature patients who cannot afford some of the higher-cost treatments.
“Because of the economic situations, many of these cases will be handled on a piecemeal basis using newer materials or older materials in slightly different ways in order to handle ongoing problems as they arise, rather than attempting to do either quadrant dentistry or full-mouth dentistry,” Garber advises. “Many will be direct as opposed to indirect restorations, and hopefully we’ll see a return to minimally invasive restorative dentistry, as opposed to automatically preparing teeth for crowns.”
Investment in Health
Now that people are living longer, they have an expectation that the dentistry will last longer, and that is not always the case for some patients, explains John Kois, DMD, MSD, founder of the Kois Center. As more scientific knowledge emerges, dentists are finding more concerns with other systemic diseases that they hadn’t realized also have an impact on dental health, and where dental health has an impact on overall health. Therefore, the treatments clinicians offer their patients cannot just be restorative treatments using a handpiece, but those created by developing an entire wellness philosophy with patients so they can take care of themselves, Kois emphasizes.
“Clinical practice has absolutely changed from a reparative model to a wellness model, and the wellness model is even more critical in aging or geriatric patients because they have many other shared risk factors that complicate the dental treatment, whether it’s a systemic disease or an old condition that affects the survival probability of the restoration,” Kois notes. “From the dentist’s point of view, aging or geriatric patients offer many more significant challenges in trying to help them maintain either their existing dentition or to create suitable replacements so that they maintain their quality of life.”
According to Roger Levin, DDS, CEO of Levin Group, Inc, although geriatric dentistry is not an ADA-designated specialty, dentists will need to manage and treat their senior patients differently. There will be a lot of breakdowns, cavities, and crowns and bridges, and they’ll want implants and cosmetic dentistry, he says. There are more complications, and sometimes more time involved, and there are pharmaceutical tie-ins with drug interactions that dentists need to be aware of, Levin adds.
“They are still the wealthiest segment of the population with the means to afford treatment,” Levin believes. “As long as dentists manage the physical limitations of their elderly patients, I think geriatric dentistry can become an increasingly important part of our profession.”
Fred Joyal, CEO and co-founder of 1-800-DENTIST, says that while implants are rightly becoming more and more popular, dentures aren’t going anywhere and, in fact, are a gateway to implants until the cost comes down. The majority of people probably won’t ever be able to afford implants, he says.
“It’s important that dentists make sure their older patients know exactly what the practice offers and the benefits of all the options,” Joyal says. “And if they don’t know how to do implants, they should learn how.”
Joyal adds that older patients, like all patients, refer their friends. Therefore, he suggests that dentists invest in the best technology to make dental visits as comfortable and pain-free as possible for aging and elderly patients. They’ll remember when dentistry wasn’t so comfortable, and they’ll tell their friends about it, he says.
“The percentage of older adults in the population is more relevant than ever before for the dentist and his/her future planning,” Lancellotti says. “This is definitely a growth area for dental services. The challenge will be how to educate, communicate, and market specifically to this group—while making the office easily accessible and able to meet their physical needs.”