Geriatric Dentistry and Prevention: Research and Public Policy

Abstract

Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and as more teeth are retained by the elderly, the pattern of oral diseases and the treatment of dental conditions will be altered. Barriers to self-care and professional care must be removed, and prevention and early intervention strategies must be formulated to reduce the risk of oral diseases. Risk factors for oral diseases in the elderly can be reduced by personal home-care regimens, professionally provided preventive, diagnostic, and therapeutic care, changes in high-risk behavior, and a supportive environment. Generating new information about the prevention of oral diseases and conditions that have an impact on the elderly requires a substantial research effort. A research agenda for the elderly should include: epidemiologic studies of relevant oral diseases and related risk factors; investigations of patient and provider attitudes and behavior related to oral health; studies of the relationship between general health and oral health; development and testing of preventive and treatment strategies for conditions such as xerostomia, root caries, secondary caries, and gingival recession; and studies for the evaluation of the impact of the aging population on the dental delivery system. Public policy options to support geriatric oral health care and research are limited by the Government's pre-occupation with cost containment and the lack of visibility for dental programs. Many of the national health proposals for universal coverage and for elimination of financial barriers to health care do not include disease prevention or health promotion programs; dentistry is not mentioned even in those proposals that do include prevention. NIDR is gathering support for geriatric oral health research with its new initiative, entitled the "Research and Action Program to Improve the Oral Health of Older Americans and Other Adults at High Risk". Funding for this program may depend in part on changing national priorities and the dental profession's ability to become more intimately involved in the public debate regarding the future of the nation's health care system.