Hidden Epidemic: Older Adults Suffering from Untreated Tooth Decay

Hidden Epidemic: Older Adults Suffering from Untreated Tooth Decay

A report released today by the Center for Oral Health (COH) found that a significant number of older adults in California are plagued by oral health problems despite the fact that dental disease is largely preventable. The study, “A Healthy Smile Never Gets Old: A California Report on the Oral Health of Older Adults,” found that, overall, one in three older adults need treatment for a decayed tooth immediately or within two to four weeks and untreated tooth decay is leading to a high prevalence of tooth loss in older Californians.

“Our study found that half of the older adults residing in skilled nursing homes that we screened have untreated tooth decay,” said Conrado Bárzaga, MD, Executive Director, Center for Oral Health. “Tooth decay not only impacts the ability to chew which affects nutrition, but also causes social and emotional setbacks such as the inability to speak, and altered appearance which can result in social isolation and shame. These repercussions further deteriorate both the physical and emotional health and well-being of older adults.”

Key findings from the report include:

  • Large Numbers of Older Adults Suffer from Untreated Tooth Decay. Half the older adults residing in skilled nursing homes have untreated tooth decay. More than one in three community-dwelling older adults suffer from untreated tooth decay.
  • Untreated Tooth Decay Leads to High Prevalence of Tooth Loss in Older Adults in California. One in three older adults in California’s skilled nursing homes have lost all their teeth. Eighteen percent of the community-dwelling older adults screened have lost all their natural teeth, most of them due to tooth decay.  
  • Many Older Californians Suffer from the Inability to Chew Due to Poor Contact Between Teeth. Nearly 40 percent of skilled nursing home residents cannot chew because they do not have functional contact between their upper and lower back teeth on either side of their mouth. Nearly 18 percent of community-dwelling older adults cannot chew because they do not have a functional contact between their upper and lower back teeth.
  • Many Older Adults Need Treatment for Tooth Decay and/or Gum Diseases. Sixty-five percent of older adults residing in nursing homes and 46 percent of older adults residing in community-dwelling homes need treatment for tooth decay and/or periodontal (gum) disease.
  • Older Adults Living in Rural Areas Are Worse off Than Those Living in Urban Areas. Older adults residing in nursing homes located in rural counties are nearly 10 percent more likely to have untreated tooth decay than their urban counterparts.

“There is a strong body of research demonstrating that properly addressing dental problems helps prevent various medical complications and reduces overall healthcare spending,” noted Dr. Sahiti Bhaskara, BDS, MPH, Director of Public Policy Research, Center for Oral Health. “However, in contrast to the growing awareness about children’s oral health needs, the oral health of older adults in the U.S. has received relatively little attention and few public health or public policy interventions until recently.  This report is designed to shed light on older adults’ oral health and what can be done to improve health outcomes.”

In addition to documenting the alarming findings regarding the oral health status of older Californians, the report by the Center for Oral Health outlined a series of recommendations to eliminate barriers to care and improve oral health. These include steps to increase treatment, access and awareness such as:

  1. Breaking down health care silos by increasing cross-professional communication and training, and adopting an integrated approach to improve health of older adults.
  2. Expanding the use of innovative practices in oral health including using Silver Diamine Fluoride for dental disease prevention among frail older adults at high-risk of dental caries and using mobile systems of dental care delivery to eliminate barriers of transportation.
  3. Prioritizing older adults’ access to care and ability to pay for services through inclusion of benefits in Medicare, and increasing reimbursement rates and prioritizing preventive services in Medi-Cal.
  4. Including older adults in pilot dental programs and oral health initiatives aimed at healthy aging, and convening a statewide partnership or advisory committee of stakeholders to focus on oral health needs of older adults.
  5. Promoting specialized education programs in the oral health care of older adults, for all oral health professionals during their training as well as advanced and specialty residency programs in geriatric dentistry.

The Study Approach
Between January 2016 and September 2017, COH conducted oral health screenings on 2,372 older adults in California. Screenings were conducted at 36 skilled nursing homes and 51 community sites that included congregate meal sites, adult day care centers and senior centers. COH used the Basic Screening Survey developed and standardized by the Association of State and Territorial Dental Directors for this study, which includes protocols for basic examination of key oral health indicators. Assessments in both settings were intended as observational to provide an overview of oral health needs of older adults. Screeners collected data on various indicators including tooth loss, condition of natural teeth (mobility, root fragments), presence of dentures, ability to chew, tooth decay, gum (gingival and periodontal) health, dry mouth and suspicious oral lesions. Demographic information collected included age, gender, race/ ethnicity, and whether the participant was in a rural or urban location.

The project was funded in part by Archstone Foundation, the California Wellness Foundation, Delta Dental Health Education and Research Fund, and Liberty Dental Plan Foundation.


Center for Oral Health
The Center for Oral Health is a California non-profit founded in 1985 and remains dedicated to improving oral health, especially of vulnerable populations, through innovation, research, education and advocacy.