The Tsunami is Coming! Are You Prepared to Ride the Wave? By Michelle Vacha RDH, BS Hu-Friedy Master Clinician 2010

Happy New Year!  January 1^st marks the beginning of a new year with reflections of the year that has passed, and for hopes and dreams of a good year to come.  I think the buzz word for 2010 was "economy," surrounded by negative connotations.  I hope 2011 brings a new buzz word filled with positive meanings.  January 1^st, 2011 also marks the beginning of an historical event.  It is the day the first "baby boomer" turns 65 years old, and is officially a "senior citizen" by most standards.

So what does that mean to us in dentistry?  According to a well conducted survey from California, which has been utilized to represent national growth, the population of disabled is growing at a rate faster than the growth of the population itself (Department of Developmental Services, 2003).  From the 2005 White House Conference on Aging, the mean age of 82 will reach the long-term care population by 2028. This means that the population of those 80 years of age and older will grow the most, so the health care needs of the home bound and institutionalized population will increase substantially.

This population growth also means that the number of teeth per person in the elderly will increase substantially.  The number of teeth in the U.S. population will increase from 4.5 Billion in 2010 to 5.5 Billion in 2050.  With greater retention of posterior teeth, periodontal disease will increase.

Oral ramifications 

Consequences of untreated dental infections include brain abscess, facial cellulitis and airway compromise, to name a few.  The chewing dysfunction cascade of caries and periodontal disease moves to tooth loss and chewing problems resulting in malnourishment.  The extent of malnutrition in the older adult population results in decreased protein intake and deficiencies in Vitamin D, B12, Zn and SE.  The impact of malnutrition results in three times longer length of hospitalization, three times higher risk of infection and more dependency in activities of daily living.

We also are well versed in the oral/systemic relationship and how the inflammatory process plays an increasingly recognized role in the oral/systemic interactions.

Costs of medically compromised oral manifestations (i.e., hospitalizations)

We as hygienists play a vital role in preventive medicine. Yes, that's right, medicine.  One of the paradigm shifts that our profession needs to address, and educate the public on, is the importance of preventive oral health and our role as a part of the preventive medical team. According to information collected during ADA's coalition conference in 2010, 8,000 hospitalizations were due to a periapical abscess resulting in a three day hospital stay costing close to $14,000 (Allareddy et al., 2010). The cost savings from prevention or early treatment of dental disease is higher than those from HIV screenings or influenza immunizations. Oral cancer treatment costs are 60% lower if found earlier. Improving oral health saved >$4 billion in treatment costs (Doietowski, 2010).

With the buzz word of last year being "economy", we can play a role in decreasing the burden of high medical costs of this tsunami population and be collaborative partners in their care.  Educating the policy makers and administrators of long-term care facilities in the importance of oral health care, and creating a program to easily provide and report needed care, is an essential first step in addressing this problem.  Educating these people will also bring attention to the importance and professionalism of dental hygienists and the roles we play in accessing care to populations who have received little to no care thus far.  Understanding the importance and ramifications of oral health will be a first step in creating this collaborative care partnership.

References

Allareddy V., Yu Lon, C., Shah, A., Nalliah, R. & Allareddy, V. (2010). Outcomes in patients hospitalized for periapical abscess in the United States. The Journal of the American Dental Association, 41, 1107-1116.

Department of Developmental Services Information Services Division. (2003). Department of developmental services fact book, 6th Ed. Retrieved December 1, 2010, from http://www.dds.ca.gov/factsstats/docs/factbook_6th.pdf.

Dolatowski T. Confronting the burden of dental disease: employers hold key to lessening the effects. Delta Dental Plans Association. Retrieved October 1, 2010, from www.deltadental.com.