Dental service trends for older US adults, 1998-2006.

This study of the Medicare Current Beneficiary Survey (MCBS) updates trends in utilization of dental services between 1998 and 2006 for community-dwelling U.S. adults of age 65 years and older. Bivariate comparisons were made between dependent variables (annual dental visits and types of dental procedures) and independent variables (age, gender, race, income, education, population density, marital status, U.S. Census Bureau regions, and self-reported health). The estimated percentage of community-dwelling Medicare beneficiaries with a dental visit for the years studied increased from 45.0% in 1998 to 46.3% in 2006. The age group of respondents who were 85 years and older had the greatest percentage increase in dental visits. Those reporting visits with preventive procedures increased from 87.8% to 91.2% whereas those reporting visits with nonpreventive procedures declined from 63.9% to 58.4%. The prevalence of dental visits continues to trend upward for this population of older adults. Increasing delivery of preventive services will likely impact the future mix of dental services as U.S. adults live longer.

Impact of dental care on oral health-related quality of life and treatment goals among elderly adults.

BACKGROUND: General dental care can effectively control disease and restore damaged tissue, yet little is known about its impact on patients' subjective oral health, namely treatment goals and oral health-related quality of life (OHRQoL). This study aimed to evaluate change in both aspects of subjective oral health among elderly adults receiving publicly-funded, general dental care. METHODS: We conducted a prospective, single-group intervention study of adults aged 75+ years receiving care through the South Australian Dental Service (SADS). Before receiving dental care, subjects completed the Oral Health Impact Profile (OHIP-14) questionnaire which evaluates OHRQoL. In this questionnaire, subjects rated the extent to which they had attained a self-nominated oral health goal. Dentists provided standard-of-care treatment and six months later the OHIP-14 and goal attainment questions were re-administered. RESULTS: Among the 253 adults studied, overall improvements in OHRQoL were observed (p < 0.05), although the effect was dependent on pre-treatment goal: mean OHIP-14 scores did not change significantly for subjects whose goal was less pain/discomfort while significant improvements were observed for subjects with other treatment goals. In contrast, mean goal attainment ratings improved significantly (P < 0.05), regardless of treatment goal categories. CONCLUSIONS: Dental care was associated with improvements in subjective oral health, although different patterns of improvement were observed for OHRQoL compared with goal attainment ratings.

Availability of domiciliary dental care for the elderly.

UNLABELLED: PURPOSES OF THE INVESTIGATION: To find out if local nursing/residential home managers are experiencing any problems in obtaining domiciliary dental care for residents. To assess the availability of local GDS and CDS dentists for domiciliary dental care for the elderly and the range of treatments offered. BASIC PROCEDURES: Self-completing postal questionnaires distributed to 148 dentists and 80 nursing/residential home nurse managers. MAIN FINDINGS: 71% of responding dentists undertook domiciliary visits but 43% of these were not accepting any new NHS domiciliary patients. Only 21% of those willing to visit would undertake any conservative treatment. Seventy per cent of nurse managers reported few problems in finding a NHS dentist, but the remaining 30% had found it difficult or impossible. Eighty-five per cent would find written guidelines helpful. PRINCIPAL CONCLUSIONS: The number of elderly patients keeping natural teeth is steadily increasing. The rate of dental caries in institutionalised patients is significantly higher than those living in their own homes. The number of dentists in the area of this study who are accepting new domiciliary patients is rapidly decreasing and only one in five will provide conservative treatment. This is a deteriorating situation, which merits further investigation on a national scale and subsequent planning to address it.

Spectrum of care treatment planning: application of the model in older adults.

A model for treatment planning is presented to help emphasize the most important elements of the clinical decision-making process for older adult patients. The patient's concerns and needs in the domains of function, symptoms, pathology, and esthetics are the central elements of the process. With sophisticated assessment methods and creative interventions, the dentist can work with each patient to identify and successfully address his or her needs and concerns. This model is applied to two clinical cases which illustrate the importance of considering innovative treatment plans, even when the patient is advanced in years.

Factors influencing the amount and type of dental services received by older adults in four municipalities in Ontario, Canada.

OBJECTIVES: The purpose of this study was to investigate the factors influencing the pattern (amount and types) of dental care provided to dental visitors participating in the baseline stage of the Ontario Study of the Oral Health of Older Adults. METHODS: We interviewed and examined older adults from four municipalities in Ontario and obtained dental service records for the previous two years for those reporting a dental visit. Individual services and their corresponding time and values were aggregated into categories. We compared the pattern of care for dentate and edentulous subjects, and by age, municipality of residence, and social, demographic and economic characteristics. RESULTS: The 473 subjects received 5,031 services, more than four hours of dental care per subject over the two years. The 29 edentulous subjects received about one-third the number of services compared with the dentate; however, there were no differences in relative time units (RTUs) or relative value units (RVUs). Among the dentate the amount of care (RVUs) varied by municipality of residence and by visiting behavior, but not by age, income, or other socioeconomic variables. CONCLUSIONS: Both dentate and edentulous visitors received over two hours of care per person per year. Dental care patterns were influenced by dental status, area of residence, and visiting behaviors.