Changes in Older Adults' Oral Health and Disparities: 1999 to 2004 and 2011 to 2016.

OBJECTIVES: To examine changes in tooth loss and untreated tooth decay among older low-income and higher-income US adults and whether disparities have persisted. DESIGN: Sequential cross-sectional study using nationally representative data. SETTING: The 1999 to 2004 and 2011 to 2016 National Health and Nutrition Examination Survey. PARTICIPANTS: Noninstitutionalized US adults, aged 65 years and older (N = 3539 for 1999-2004, and N = 3514 for 2011-2016). MEASUREMENTS: Differences in prevalence of tooth loss (having 19 teeth or fewer, 8 teeth or fewer, and no teeth) and untreated decay and mean number of decayed and missing teeth (DMT) between low- and high-income adults 65 years and older in each survey and changes between surveys. Adjusted prevalence and count outcomes were estimated with logistic and negative binomial regression models, respectively. Models controlled for sociodemographic characteristics and smoking status. Reported findings are significant at P < .05. RESULTS: In 2011 to 2016, unadjusted prevalence of having 19 teeth or fewer, 8 teeth or fewer, no teeth, and untreated decay among low-income adults 65 years and older was 50.6%, 42.0%, 28.6%, and 28.6%, respectively. Multivariate analyses indicated that although most tooth loss measures improved between surveys for both income groups, tooth loss among low-income adults remained at almost twice that among higher-income adults. The disparity in untreated decay prevalence in 2011 to 2016, 15.2 percentage points (26.1% vs 10.9% for low vs high income) was twice that in 1999 to 2004, 8.5 percentage points (22.9% vs 14.4% for low vs high income). DMT decreased for both groups, with lower-income adults having about five more affected teeth in both surveys. CONCLUSION: Tooth loss is decreasing, but differential access to restorative care by income appears to have increased.

Burden of oral disease among older adults and implications for public health priorities.

Dental disease is largely preventable. Many older adults, however, experience poor oral health. National data for older adults show racial/ethnic and income disparities in untreated dental disease and oral health-related quality of life. Persons reporting poor versus good health also report lower oral health-related quality of life. On the basis of these findings, suggested public health priorities include better integrating oral health into medical care, implementing community programs to promote healthy behaviors and improve access to preventive services, developing a comprehensive strategy to address the oral health needs of the homebound and long-term-care residents, and assessing the feasibility of ensuring a safety net that covers preventive and basic restorative services to eliminate pain and infection.