24 July 2023

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Integrating oral health into primary care for older adults

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Recently, there has been more attention and a call to action to integrate oral health into primary care settings. Census data suggest that there are 49.2 million older adults in the U.S., with 21 million with incomes below 200% of the federal poverty level. 

By 2030, nearly 74 million, or 20%, of the U.S. population will be older adults, with most retaining their natural dentition. This suggests an increased demand for oral health services, according to the authors. 

Preventive care visits to physician offices were 64.1% among adults ages 45 years and older - and 43% among those 65 years and older, less than 25% reported preventive dental visits among adults ages 55 and older. Close to 100% of adults aged 50 and older reported caries experience in their permanent teeth. In addition, between 46 to 60% have severe or moderate periodontitis. Untreated tooth decay and periodontitis are disproportionately found in minority and lower-income adults. Consequently, tooth loss is also significantly higher in non-Hispanic Blacks compared to other groups. 

Older adults have medical, physical frailty and cognitive issues that can challenge dental care access in this group. While causal relationships between oral and systemic diseases are still evolving and not yet fully established, there is unquestionably a bi-directional relationship between oral health, cardiovascular diseases and diabetes in older adults. 

Moreover, cardiovascular disease, respiratory disease and diabetes have all been associated with oral infections. Untreated oral infection leads to pain, overuse of emergency department services and even death. 

Nelson S, Kim EGR, Kaelber DC. "Integrating Oral Health into Primary Care: Perspectives for Older Adults. Journal of Dental Research." 2023;102(8):849-853. doi:10.1177/00220345231165011.