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Monday, September 27, 2004 - Page updated at 12:00 AM

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Many seniors go without dental care

Seattle Times staff reporter

Dental-health tips


Daily care is key to preserving oral health. That means brushing and flossing but also eating right and keeping good track of conditions in the mouth.

Dry mouth a condition typically caused by taking multiple medications or undergoing radiation can promote plaque on the teeth that turns to tartar. People with dry mouth often suck on hard candy, which causes decay. Instead, keep the mouth hydrated.

Check regularly for white and red patches in the mouth, which could be a precursor to cancer.

If arthritic hands make flossing and brushing difficult, experts recommend an electric toothbrush.

Ruby Peebles always had good teeth. So good, she can't recall ever having a filling.

But circumstances that often come with growing older caused her dental health to slip.

Her husband retired and so their employer-paid dental insurance stopped. Then he died and she moved across the country to be near her daughters. During the tough transition, finding a new dentist wasn't a priority.

Last year, she finally quit working at age 76. Her already-low income plummeted to Social Security and a small pension, and she really couldn't afford to pay a dentist.

To make matters worse, the vivacious grandmother grew a little lazy.

"I'd been so fortunate not to have bad teeth, I got careless," Peebles admitted. "During my careless time, I'd eat a snack and go straight to bed without cleaning my teeth."

Over two years, it all added up to a mouth sensitive to hot and cold; a painful, badly infected tooth; and a first-ever cavity.

Poor nutrition. Lax self-care. Medication side effects. Less physical resilience.

Such factors make older adults inclined to tooth decay and gum disease. Oral cancer also strikes seniors most. And new research links chronic mouth infections to heart disease, stroke and problems with diabetes.

Yet for all kinds of reasons — no insurance, ignorance, isolation — millions of older adults fail to get the oral-health care that could improve their lives and perhaps even extend them. Too many wait until it really hurts to see a dentist. By then, it may be hard to chew or even speak clearly.

Such suffering has prompted a national call to find new ways to treat older people's oral health.

It's part of a much bigger challenge to prepare for longer-lived baby boomers who soon will start to retire and lose their employee dental insurance. At the same time, many dentists also will start to retire and dental schools aren't expected to produce enough replacement graduates.

Searching for solutions

The Seattle-area research, dental and social-service communities are part of the push to expand care and find new solutions.

• Projects are under way to help homebound disabled elders and those who use long-term care services.

• The state this year quadrupled to $300,000 the money available to pay for licensing fees and insurance for dentists and other licensed health-care providers who want to give free care. Also, a new law this year allows providers to deliver that free care in private settings and still be insured.

• The state dental association will more aggressively market its long-standing program that lets low-income patients sign up for a 25 percent discount with about 400 participating dentists.

• Volunteer dentists and hygienists are screening and treating patients of all ages in mobile dental vans in multiple counties. The Northwest Medical Teams project next year is expected to add a van to meet the huge need in King County.

Still, experts in the Puget Sound area report older adults' need for oral-health care is greater than ever.

"The acuity of patients we're seeing is increasing," said Kathleen Moore, coordinator of Evergreen Hospital's dental-access program. "We see people who've had quality dental care in the past who can no longer afford it. They've let things go until it becomes an emergency situation."

Medicare, the nation's health-insurance program for people 65 and older, does not cover dental care. The very poor get some basic dental coverage through Medicaid. But last year, the state dropped Medicaid coverage for certain dental procedures.

The stock-market decline also has cut into people's retirement income and, consequently, their ability to pay out of pocket, Moore said.

Nationally, about 30 percent of older adults have untreated cavities and about 23 percent have severe gum disease. In Washington, severe gum disease, among those age 67 to 74, afflicts 17 percent of high-income elders, 19 percent of the middle-class and 38 percent of the poor.

People who don't qualify for free or low-cost care are left to find a private dentist and work out a payment plan. It's not uncommon to see notices on church bulletin boards seeking treatment from a dentist in the congregation, Moore said.

Even though the Seattle area has a relatively robust dental-care safety net compared to other cities, it is becoming frayed, said Mark Secord, executive director of the nonprofit Puget Sound Neighborhood Health Centers, where about 6 percent of patients are over age 65.

Hardest hit are the near poor and lower middle class, rural residents and ethnic minority elders, especially immigrants.

In rural counties such as Skagit, some patients' dental problems are comparable to what's found in Third World countries, said Dr. Ron Guderian, who manages a mobile dental van for Northwest Medical Teams.

Some seniors can't eat solid food anymore.

"They don't come out in public," Guderian said. "They're ashamed. If they do, they never open their mouth."

An equally vulnerable group — unless their families intervene — are seniors who can't leave the house by themselves or who live in long-term care settings.

Federal law requires nursing homes to provide emergency care, but not routine dental care such as cleanings by a hygienist, said Asuman Kiyak, director of the University of Washington's Institute on Aging.

A nurse must examine a resident's teeth when he or she first comes in and then once a year, said Kiyak, also a professor in the UW's School of Dentistry.

"You see people who've had gold crowns and beautiful dental work when they were younger. Now their teeth are falling apart because no one is willing to pay for it," said Kiyak, who urges people to buy dental insurance in retirement.

Gap in care standards

There is no minimum standard for dental services in alternative long-term care settings, such as in the person's own home or in adult family homes or boarding homes.

That's a crucial gap given the state's aggressive shifting of Medicaid recipients out of nursing homes and into less expensive in-home and community settings, some experts say.

The Washington Dental Service Foundation is piloting a curriculum to teach workers who help seniors and disabled clients in their homes how to prevent oral disease. The curriculum will be made available to home-care agencies and other groups that train caregivers.

The UW's School of Dentistry for years has required students to treat older adults in certain community settings. Now, the school also is running a demonstration project with a dentist and students to screen and treat seniors from the community in adult day health centers. The state Department of Social and Health Services funds the project.

The idea is to help homebound seniors such as Bobbie Gean Hopkins, a receptionist at Harborview Medical Center for 31 years before she had a stroke and passed out walking down the street.

"The fall pushed all my teeth up in my gum," said Hopkins, who lives in the Central Area with her daughter. She now uses a wheelchair and a cane.

Two days a week, Hopkins attends an adult day health program at Jefferson Terrace to give her daughter a break. That's where she saw Dr. Lawrence McCormick, a dentist.

McCormick referred Hopkins to Harborview for oral surgery. Afterward, she'll get dentures.

"I'm quite excited. I can't hardly wait," Hopkins said. "I want to look pretty again. The first thing I'm going to do is eat me some apples and some nuts."

As for Peebles, she's changed her careless ways, finally signing up for a cleaning at the mobile dental van, which visits Northshore Senior Center in Bothell once a month.

She waited awhile to be seen, but the $10 cost made it worth it. On the first visit, the dentist spotted the ugly, infected tooth. A cavity underneath a crown had gone undetected too long and the tooth had to be pulled.

The mobile dental van with its volunteer staff is "a blessing" for more reasons than one, Peebles said.

"It gives us dignity to go in over there and lay down our own $10," she said, "and not have to call on a daughter or a son."

Marsha King: 206-464-2232 or mking@seattletimes.com

Copyright © 2004 The Seattle Times Company

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