Chicago, IL—October 8, 2013 – The oral health of older Americans is in a state of decay, according to a new
national report released today by Oral Health America (OHA). A State of Decay, a state-by-state analysis of oral
healthcare delivery and public health factors impacting the oral health of older adults, reveals more than half of
the country received a “fair” or “poor” assessment when it comes to minimal standards affecting dental care
access for older adults. Florida and Arizona, areas with large older adult populations, rank in the bottom five
states due to a shortage of oral health coverage, a strained dental health work force, and deficiencies in
“While we are seeing improvements in certain areas of older adult dental care, there is still a lack of progress in
advancing the oral health of such a vulnerable population,” said Dr. Ira Lamster, Professor, Department of
Health Policy and Management, Columbia University, Mailman School of Public Health. “Older adults face
significant health challenges if their oral health is poor, and there is no coordinated program to help fund
A State of Decay gave a rating of “fair,” “poor,” “good,” or “excellent” based on state level data analyzing five
variables impacting older adult oral health: adult Medicaid dental benefits, inclusion of older adult strategies in
state oral health plans, edentulism (loss of teeth), dental health professional shortage areas, and community
The final evaluations in the report for each state are mixed, with several states performing well in some
variables, but still in need of improvement in other important areas. The top findings of this report that require
scrutiny and action are:
- Persistent lack of oral health coverage across much of the nation. Forty-two percent of states (21 states) provide either no dental benefits or provide only emergency coverage through adult Medicaid Dental Benefits.
- Strained dental health work force. Thirty-one states (62 percent) have high rates of Dental Health Provider Shortage Areas (HPSAs), meeting only 40 percent or less of dental provider needs.
- Tooth loss remains a signal of suboptimal oral health. Eight states had strikingly high rates of edentulism, with West Virginia notably having an adult population that is 33.8 percent edentate.
- Deficiencies in preventive programs. Thirteen states (26 percent) have upwards of 60 percent of their residents living in communities without water fluoridation (CWF), despite recognition for 68 years that this public health measure markedly reduces dental caries. Hawaii (89.2 percent) and New Jersey (86.5 percent) represent the highest rates of citizens unprotected by fluoridation, an unnecessary public peril.
Daily, 10,000 Americans retire and only 2 percent do so with a dental benefit plan. The State of Decay analysis
provides a tool for states to use in addressing shortfalls in oral health status, dental professional access sites,
dental benefits for low-income adults, and population-based prevention, all of which affect the oral health of
older adults, the fastest growing segment of the American population.
To help older adults and their caregivers address oral health needs and overcome many of the barriers to
accessing affordable dental care, OHA launched toothwisdom.org. The website is a first-of-its-kind online tool
that connects older adults to dental care and educates on the importance of maintaining oral health with age.
The American Dental Hygienists’ Association (ADHA) and Special Care Dentistry Association (SCDA) supported
OHA and the launch of the website by encouraging their members to provide meaningful articles for the
"Dental Hygienists have the opportunity to assist older Americans with the oral health challenges they may face
as they age,”" said Ann Battrell, Executive Director, American Dental Hygienists’ Association. "We’re all
committed to sharing the message that oral health matters and changing the common misperception that with
age comes a decline in oral health."
Few websites focus on oral and systemic health topics, and even fewer provide resources for older adult oral
health. Toothwisdom.org offers oral care resources by state – including direct links to dental care, caregiving
support, financial tools, social services, and transportation. It also shares the latest news and reliable health
information from dental experts across the country on relevant oral health issues, the importance of continuing
prevention with age, and the impact of oral health on overall health.
“My dental procedures have been very costly and I had to contact a social worker to help me understand my
bills. Dental care should be more available and affordable because we know poor dental care affects overall
health, which is particularly important for seniors," said senior Patricia Cosgrove, a client of The Carter Burden
Center for the Aging, Inc. “Toothwisdom.org can help me find a community health center so I can finally get an
affordable check-up and stay up-to-date on oral health information.”
A State of Decay and toothwisdom.org are part of Oral Health America’s Wisdom Tooth Project™, an initiative
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.
Links to the 2003 and 2013 editions of A State of Decay can be viewed on toothwisdom.org.