The Grey Avalanche Coming to Dentistry
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- Published: Wednesday, 25 October 2023 09:12
- Written by Peter Ingle
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Across the UK, NHS dentistry is vanishing, there is a cost of living crunch, and there are service stopping gaps in the dental workforce. If that sounds bleak, it may still miss one of the biggest challenges for those planning dental care in the coming years. A recent report from the University of Colorado provides a timely reminder for those in charge of UK dental public health, that demographic changes are not on their side.
In an interview headlined, “Ageing Americans Foreshadow Oral Healthcare Crisis,” Dr Bruce Dye, speaks from his perspective as the Department Chair for Community Dentistry and Population Health and the Delta Dental Endowed Chair of Early Childhood Caries Prevention at the University of Colorado School of Dental Medicine.
This follows a study among Medicare beneficiaries in American nursing homes which underlined the consequences of inadequate oral health. It also showed major inequalities between ethnic groups.
In a Q&A, based on an interview with the Journal of the American Medical Association network, Dr Dye, commented on the study and the need for expansion of Medicare coverage to routinely include dental care.
He referred to a “grey tsunami” – of retirement-age people, “Every American has access to medical care at age 65 and older, but they don’t for dental health,” Dye said. “And oral health and general health, we know are strongly interconnected.”
Back in the UK with more of the public opting for private dentistry, little thought has been given to how they will manage if their income drops when they retire.
Dr Dye’s observation about the USA situation is likely to mirror the situation for a significant number of UK private patients on retirement: “I think it would be fair to say that as more people age, they’re not going to have access to the dental care they have been used to – unless they have the economic means to be able to buy it. That is the crux of the problem. Because if you can’t access care regularly, you’re more likely to have poor oral health over your remaining lifespan.”
In the USA Medicare does not always provide a dental benefit, leaving more than half of people over the age of 65 without any dental insurance. This is the largest demographic in the United States with no dental insurance. In the USA one solution would be to extend Medicare.
Just as in the UK, an apparent saving made by ignoring dental care, be it by the NHS or Medicare, is going to add to costs in the long run. Dr Dye explained, “And it’s going to cost our society through the other side of Medicare – spending more and more money taking care of chronic conditions that may be exacerbated by poor oral health.”
Speaking about the particular dental health risks in older patients he highlighted root caries and the cumulative effects of periodontal diseases. He added that some oral cancers were more prevalent in older patients, which in combination with the other known risk changes may make the push to biennial recalls in the UK look like a false economy.
Dr Dye went on to point out that nutrition was not just of biological importance, but impacts quality of life since many customs, celebrations and other events revolve around food.
To quote Dr Dye: “Oral health in a person’s golden years is a numbers game. The more natural teeth people retain – ideally at least 20 – the greater their quality of life and the lower their risk of chronic disease. For the 51% of Americans on Medicare who lack dental care, the odds are stacked against them.”
Despite the differences between Medicare and the NHS, the odds for older people in the UK may be no better. A government and NHSE stuck in crisis management mode will be too preoccupied with tomorrow’s headlines, to look ahead to this challenge.
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