Dental Health | Aging Matters | NPT Reports

– [Narrator] Coming
up on NPT Reports, Aging Matters: Dental Health. (light music) – [Dr. Switzer] When people
say that having poor teeth is a cultural inevitability, that it’s people’s own
personal responsibility, I say enough. We’re not blaming the
victims here of this disease. It’s a bacterial infection
and it’s preventable, but not everyone
has the same access to those prevention
tools and that care. – [Narrator] Tennessee
ranks 49th in oral health for older adults, a position that reflects
high rates of tooth loss and a lack of access
to affordable care. – I can deal with everything
that comes along with aging, except the loss of my teeth. To me, that has been
the biggest blow to my happiness on this Earth. – I think the prevalence
of extractions in Tennessee states that we don’t care
enough about our community, and I think if we just
spent a little bit more time letting people know the
benefits of saving a tooth, we could save teeth. – [Narrator] In Tennessee,
nearly 46% of adults over age 65 live with
severe tooth loss. – For those people that don’t
even have dental insurance, they’re paying out of
pocket to start with and dentistry is
really expensive. – [Narrator] 70% of
older adults in the U.S. don’t have dental insurance. – People die here
in the United States because they can’t get the
dental care that they need. – [Dr. Switzer] It’s
time to recognize that the health that we have in our mouth is a reflection of the health of the
rest of our body, and that it’s all tied together. (light music) – [Narrator] Funding
for NPT Reports: Aging Matters: Dental Health was provided through
a grant awarded by the Davidson County
Chancery Court, Part III from the SeniorTrust/ElderTrust
settlement, case number 11-1548-III, and through a contract
administered by the Tennessee Commission
on Aging and Disability. – A smile says a lot
about what we’re feeling, whether we’re happy or well, in good humor or among friends. But for many older adults, a healthy smile can feel
like a thing of the past. Hi, I’m Kathy Mattea and on this edition
of Aging Matters we’ll explore the
relationship between people’s oral health and
their overall health. Let’s begin with the good news. Dentistry’s come a long
way in the last century and today’s seniors are
maintaining their natural teeth longer than in the past. The bad news, older adults
are often susceptible to gum disease and tooth decay which can effect their general
health and quality of life. That’s especially
relevant in Tennessee where the state ranks
49th in oral health and many seniors lack access
to affordable dental care. How can we improve oral
health in Tennessee? What treatment options are there for seniors with
dental problems? How will older adults access
and pay for dental care, particularly when
they lack insurance? And what more can be done
to ensure older adults live a full life
with a healthy smile? Join us as we tackle
these questions on Aging Matters: Dental Health. (jazz music) – [Spokesman] Small cavities
will occur in your teeth from time to time, so you should visit your dentist
regularly for a check-up. – [Dudley] The first time I
remember going to the dentist, I was in the third grade. I don’t remember
regular appointments. I think you went to the dentist
when you had a toothache. (jazz music) – Dentistry was, I wanna say primitive. (laughs) If you had a cavity in your
tooth and it had to be drilled, we really shoulda
had a seat belt on. It was not much fun. – [Spokesman] You
can have good teeth if you take care of them. – [Narrator] Born in
1925, Eleanor Dudley’s
early experience with dentistry left a
withering first impression and throughout much
of her adult life, dental health was
an afterthought. – I didn’t pay any
attention to prevention. I know that I never heard
the word dental floss I guess until I was married. I didn’t have I think good
instructions on brushing. I just put the toothbrush
in there and went… (brushing sounds) I don’t know if that contributed
to gum disease or not, it probably surely didn’t help. – [Narrator] By the time
Dudley reached her 50’s, her oral health was in
decline and she realized she needed to do
something about it. – As I got older I
more and more valued having teeth that worked. I would hear some
people around me, friends about my age saying, “Well I remember
when I’d bite into “a good, hard, juicy apple,
but I can’t do it anymore.” That kind of impressed me, the fact that I like
a nice, juicy apple and I’d like to
keep on eating them. (bites into apple) – [Narrator] For older adults,
maintaining good oral health means more than just
brushing and flossing. It means taking into account
one’s overall health. (gentle music) – Aging has been associated
with tooth loss and gum disease mainly because the general
health changes in a person as they get older. Their progressive, chronic
diseases may not have effected em so much
when they were younger, but now that they’re older, they’re really
starting to effect em. – Our mouth is connected
to the rest of our body. The inflammation, the
infection that’s in our mouth can affect the rest of our body. So, poor oral health
can increase our risk of heart disease, stroke,
and certain cancers, and it can make
our diabetes worse. (gentle music) – We’ve always thought
of dentistry as being separate from medicine. In medicine, inflammation
is a big part of the disease process
of chronic diseases. Because of the new research, we’re finding
associations between
inflammation in the mouth and systemic diseases. So, now it’s not just you need
teeth to chew and swallow, you need good oral care so that
you don’t increase the risk for cardiovascular disease,
stroke, increased progression of Alzheimer’s disease,
aspiration pneumonia, not to consider nutritional
deficits as well. – [Narrator] Dr. Howard
Cowen is director of the Geriatric and Special
Needs Dental program at the University of Iowa
College of Dentistry, one of few geriatric
certificate programs throughout the United States. Cowen and his colleagues
are leaders in the field of geriatric dental care. – Hi, how are you today? – Our main mission is
to train these dentists so they can go out
into their communities to understand the
needs of the elderly and then feel comfortable
providing that care for them. And I think all dental schools
could do that same thing. – [Narrator] But geriatric
dentistry is not a specialty recognized by the American
Dental Association and a few dental schools
offer intensive training to deal with older adults’
evolving health needs. Educators like Dr. Jennifer
Hartshorn argue that older adults deserve
specialized care. – We’re looking at people
individually saying, what is your risk of having
deterioration in your mouth? And we always notice that when we see that change
in oral health, it’s tied to an event
in their general health. That event could
be a new diagnosis, maybe their chronic diseases
have progressed to a stage that they needed more
medications to manage it. And we’re always teaching
the dental students to look for those changes. – You’re taking a lot of
significant medications. – I know. – Some of them specifically
that would have an effect in your mouth. I think there’s a range
of almost 200 medications that could cause
your mouth to be dry. Without the saliva
in your mouth, as you eat foods the acidic
byproducts aren’t cleaned out, you’re much more
susceptible to decay, to your tissues not
being hydrated properly, and that then compounds
the issue even greater. – [Narrator] Conditions that
affect mobility and dexterity can also impact a
person’s oral health. – [Dudley] I have arthritis,
primarily in my hands. It makes it more
difficult to do things. My grip isn’t quite
as good when I try to pull the floss back and
forth between my teeth. It’s a little harder to do. – [Narrator] Sometimes
a simple change can make a big difference. Dudley’s son-in-law recognized
that the effects of arthritis might make it difficult
to hold and manipulate a regular toothbrush, so he bought her an
electric toothbrush with a large,
easy-to-grip handle. – I had never used an
electric toothbrush before my son-in-law
gave me one. (electric toothbrush) I probably don’t use it
quite as often as I should, but when I do I’m very
conscious of the fact that my teeth feel
slippery and clean and I like it. (laughing) (cheerful music) – Our teeth are connected
to the rest of our body and as things happen, whether it be side effects from
medications and a dry mouth or limited mobility, we’ve gotta find
a way to continue to do the oral care
maintenance that we’ve always done throughout our life and make those adjustments. – [Dr. Hartshorn]
Prevention is really key. It’s one of the things
that I stress most often. Keep going to your hygienist, keep going to your dentist
and have things checked out. That fluoride application
once a year, twice a year, can really make a
difference for these people. – Okay, well now I can report that was a pretty good check-up. – [Narrator] Telling older
adults they need to go to the dentist is one thing, but getting them into
the chair is another. Dr. Rhonda
Switzer-Nadasdi is CEO of Interfaith Dental Clinic. Established in
Nashville back in 1994, its mission is to provide
complete and affordable care to the working poor
and older adults. – [Woman] Alright, thank you – No problem. – There are lots of challenges caring for older
adults in Tennessee. We have high poverty rates, we have high rates of
heart disease, et cetera. You could say it’s our culture, but it’s really about access. Dental care is not available if you don’t have
the funds to get it. It’s simply not there. – [Dr. Hartshorn] Once
you retire from a job you lose your dental
insurance a lotta times, and then Medicare
does not provide you with dental insurance, and so they’re paying
for it out of pocket, which hopefully they have
saved money for over the years. (suctioning) – It neither makes biological
sense nor policy sense, that oral health isn’t
included in Medicaid for adults or for Medicare. Now, some states have gone ahead and made it be part of
Medicaid for adults for dental, but Tennessee has not. So, if you’re over age
21, there’s absolutely no government assistance through
your Medicaid or Medicare to get dental services. (light music) – [Narrator] At Neighborhood
Health, a community clinic, Dr. Michele Blackledge
often sees patients who’ve avoided the dentist
because they didn’t think they could afford it. Her clinic is part of a
patchwork of community providers who are trying to
meet a growing need. – I think most people come
in here for dental pain. That’s usually where we see
people is at their lowest. So you’re trying to
eat on gum tissue, gum tissue’s not
meant to be eaten on. I think people wait. Especially our older generation, they wait til they
get into a situation that they can’t handle. – [Freeman] So, when I
got into my late 50s, I was feeling, when I
would brush my teeth, a lot of tenderness in my mouth. And then when I eat food,
it got stuck into my teeth. I started feeling the
pains through my gums and it got into my head and my ears, so I started having infection. – [Narrator] The
experience took a toll. Not just on Zelda
Freeman’s oral health, but on her general well-being. – [Freeman] I just was
irritable talking to people, but nobody understood
why I was so cranky. It effected my
relationship with anybody that was close to me. – [Narrator] Her oral health
may have been associated with other chronic
conditions as well. – My blood pressure
was high a lot, and my thyroid was
out of balance, and the diabetes was
just on the borderline. – [Narrator] For Freeman,
things were getting worse. Despite a recommendation
from her doctor, she continued
avoiding the dentist. – [Freeman] I was scared. The thought was, oh I’m
gonna have a lot of pain. It just made me feel, I don’t wanna go through this. – [Narrator] When she finally
did work up the courage to go, she was afraid of
being turned away. – [Freeman] At the
Neighborhood Health center I went to them and asked them, how can y’all help me, a person that doesn’t
have insurance? – [Dr. Blackledge] What I
often get is people saying, “ell I can’t afford it.” And that’s why community
health centers are so important because we are on
a sliding scale. We will make arrangements,
we’re gonna take care of you, but we don’t wanna see
you at your lowest point because that means
that you probably have other things going on. – [Narrator] Unfortunately,
Freeman had waited so long to go to the dentist
that many of her teeth were beyond repair. – I had to have quite
a few teeth pulled. – So, we got all the teeth out. – [Freeman] And it
left me with 15 teeth. A few at the top and
some at the bottom. – So, now we’re looking for you to be able to eat and
do all the good things that you used to be
able to do again. – Okay – So no more bad teeth. Deal? – Deal! – Alright. – [Narrator] In Tennessee,
more than 20% of people over 65 have all their natural
teeth extracted. That’s compared to less
than 15% of all Americans. – Alright, let me take a look. Every day I see
someone who comes in that has to have a tooth pulled, and I wish that wasn’t the case, but every day I extract a tooth. That’s an issue because
I think it becomes part of a monetary thing. Is it cheaper to
get a tooth pulled or cheaper to get
a tooth filled? And people will say, “You know what? I’ll pay
$25 to get that tooth pulled “versus $1000 for a
root canal and a crown.” (laughing) – [Narrator] Older adults
face a culture of extraction across the state, but a handful of charity clinics
have expanded their reach and make restorative
care more accessible to the working poor. Dr. Laurie Hodge is the dental
director at Church Health. – How are you? Good to see ya. – [Narrator] A comprehensive
healthcare facility in downtown Memphis. – In the U.S., if you don’t have the financial
means to access dental care, then you may not
ever see a dentist. Being a nonprofit that’s able
to offer not only emergency, but restorative and
comprehensive care for people can show that there’s
another way to do this. That we are able to provide
that dignity and hope to those people that
otherwise would never have access to this care. (light music) – Just a few weeks ago I was
at a very low point in my life when I came to see
the doctor here at the Church Health center. – [Dr. Hodge] Okay, just a
little bit of movement here. – I’m an Uber/ Lyft driver, I drive full-time. How are you? – [Man] I’m good how are you? – Wonderful, wonderful. I’m gluing my teeth in every
day so I can go to work. It’s embarrassing, but
there was just nothing I could do about it. I can no longer afford to go to the dentist in America. It’s out for me. I draw my Social Security, but that only makes
my house payment. I don’t have any other
money to pay my bills with. I’m struggling, I’m struggling. – [Narrator] For the majority
of Donna White’s working life, it wasn’t this way. – I had a very, very good
dentist for 25 years, but since I was a
server for 46 years and had no access
to dental insurance, I got behind. – [Dr. Hodge] But that
is for one of your, actually one of
your older crowns. – [Narrator] The dental work
White had done 20 years ago was starting to decline. Not only were White’s dental
issues effecting her outlook, they were directly effecting
her diet and overall health. – [White] I couldn’t
bite because my
veneers would pop off. I’m down to eating Ramen
noodles and soft things. I’m 64. In the last few years, my blood
pressure has gotten higher, my cholesterol went
up, I am prediabetic, but I think that
my missing teeth and my low self-esteem made me not care about what I was eating. (light music) – [Dr. Hodge] Elderly people
often live under the stigma that they don’t deserve to
have their teeth look great. They feel that social
isolation a lotta times because of how their teeth are. Nutrition wise, for a lot
of our elderly patients if they’ve lost a lotta teeth, they can’t eat or chew, which we know that will
affect their quality of life long-term because they’re
not able to get the nutrition that they need, and so then
their health is effected negatively as well. – [Narrator] Today,
restorative treatment options are better than
they’ve ever been, offering people an
alternative to dentures. But they do come at a cost, and for those with
limited income, restorative treatment
is simply out of reach. – [White] I don’t mind
paying for my dental work. I just could not afford a private dentist anymore. The dentists at the Church
Health center are going to completely restore my smile. – [Dr. Hodge] That canine,
I’m gonna raise him up just a little bit for you. – [White] And it will be a
fraction of what I would’ve paid at the private dentist. – Just the water back. – [White] Everything is going
to be repaired in my mouth. I got two crowns
prepped last week and I’m gonna have those
crowns put on today. (laughs) And I can eat salad now,
which is really good. – Smiling with confidence now. – Okay. (laughs) – Being able to
have a place where we stress restorative care, we can actually provide
restorative care at a cost that’s affordable for patients, is a big deal in cutting off
that cycle, and that psyche, of that, I just gotta get my
teeth pulled, it’s that time. This is what everyone in
my family has always done since the beginning. – You wanna see em? – Yeah, yeah I do. (laughing) I know that having
my smile restored is going to make me a
much happier person. I want to work, I want to
smile, I want to be healthy. And I think in
order to be healthy, you have to have healthy teeth. That looks great. – [Dr. Hodge] That looks great. – [Narrator] But
outside large cities, like Memphis and Nashville, there are few
safety net providers and the sheer volume of
need often goes unmet. Nowhere is this more apparent
than in rural communities where geographic
barriers further
challenge access to care. – So, all of this is going
to Emporia, Virginia. – [Narrator] Stan Brock is
founder of Knoxville-based Remote Area Medical,
also known as RAM. For years, RAM has been
providing free dental, vision, and medical care to far-flung
communities around the world. – [Brock] We’re supposed
to parachute into jungles and the Amazon and Africa and places like
that, and indeed we do. But, pretty soon people
started asking me, “Well, we need help
in our county here.” The first time we
were asked to perform a RAM event here in
the United States, in fact was in Tennessee. In a little place
called Sneedville where the local dentist
had just left town because it wasn’t enough
business in his opinion, and the local hospital
had just closed. About 150 people showed up and they were all
adults that needed their teeth taken care of, and most of em
needed extractions. (drilling) – [Narrator] Here at a RAM
event in Jefferson County, patients line up the night
before the clinic opens to receive care that is
otherwise out of reach. – What individual,
average individual, average working
individual can afford $400 to get her tooth pulled? – [Narrator] Without
insurance or access to a charitable clinic, some surgical extractions
can cost up to $600, forcing people to
live with the pain. – [Brock] To the people
that come to our clinics are coming to see the dentist. Of course, the older they are, the more serious their problems. I mean, we’re seeing people
in the age group 50 and 60, they’ve never been
to the dentist. And their teeth are
just a terrible mess, and we have to remove every
tooth that they’ve got. (drilling) – [Narrator] Like other
charity providers, RAM relies on donations
and volunteer services to do this work. Based on event turnout,
Brock continues to believe this brand of benevolent
care is critical. But, is it a long-term solution? Even he questions that logic. – Why are we doing this in
the world’s richest country? We’re glad to do
it. It’s necessary. We’ll keep doing it as
long as it’s necessary here in the United States. And hopefully at some
point we can work ourselves out of a job here, and go back to concentrating
in places like the Amazon and Africa and places like that. – [Narrator] With current
numbers, it may be awhile before RAM uproots. 70% of older Americans
don’t have dental insurance. With little access
to dental care, many older Tennesseans
are forced to live with tooth decay and gum disease. (gentle music) – [Dr. Switzer] I have
never met anyone that said, gee, I like my
teeth being rotten and I don’t wanna do
anything about it. It’s helping people
have the ability to do something about it, and to keep their
teeth for a lifetime. And it takes a system. – [Narrator] In Tennessee,
there is no system of dental care for
low-income older adults, but that is about to change
albeit on a limited scale and for a limited time. Interfaith Dental
in Middle Tennessee is building a network
of charitable clinics across the state to
expand the scope of care for older adults. – It’s a way of
building a network of the safety net clinics
that already exist, and this involves dental
schools, mobile units, federally qualified
health centers, faith-based clinics
like Interfaith Dental, being able to take on an
increased number of older adults into a system so that
there’s ways of attacking the problem that’s unique to
each individual older adult. – [Narrator] More than
just dental visits, the goal is to pool resources
and overcome barriers to care, from affordability to
transportation and education about preventive care at home. – So, you actually want to
start with these bristles at the gum line. – [Dr. Hodge] We hope that it
serves as a model to our state and to those that are
in the legislature on how we can provide
care at a reduced cost to those that are aging, because they often don’t have
any other resources for that. – And you have clean floss. – [Narrator] The network,
called Smile On 60+, will reach 20,000 unique
adults over three years, but that only covers 10%
of the estimated need. And that need is
only going to grow. (light music) Since 2011, every day 10,000
baby boomers turn 65, and for nearly half
of older Americans, Social Security is their
main source of income. Charitable organizations
may be able to test an oral healthcare solution, but experts suggest
bringing a network to scale will require changes
in public policy. – [Dr. Cowen] The easiest
way to provide this care would be to have some
dental benefit within the Medicare program. Emergency care, preventive
services, restorations, and maybe even limited
denture types of care. And that would be the beginning, at least they would
have the ability to say I have some insurance. (light music) – [Narrator]
According to Switzer, it’s a matter of priorities. – [Dr. Switzer] If older
adults are covered, if you eliminate the
financial barrier and they have access to clinics, they will get healthier. It’s time to recognize that
the health that we have in our mouth is a
reflection of the health of the rest of our body. Having good oral health
shouldn’t be a privilege. It should be something
that all of us can access. (light music) – We’ve learned a lot
about what it will take to maintain a healthy mouth, and as a consequence,
a healthy body. What we can do as
individuals is important, but if we’re gonna
change the state of oral health in Tennessee, it’s gonna take
a broader effort. For more information
and to see all of Nashville Public Television’s
Aging Matters series, visit our website at Thanks for watching. – [Narrator] Funding
for NPT Reports: Aging Matters: Dental Health was provided through
a grant awarded by the Davidson County
Chancery Court, Part III from the SeniorTrust/ElderTrust
settlement, case number 11-1548-III and through a contract
administered by the Tennessee Commission
on Aging and Disability.

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