Dental visits among older U.S. adults, 1999: The roles of dentition status and cost

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Dental visits among older U.S. adults, 1999: The roles of dentition status and cost
2004
MARK D. MACEK, D.D.S., Dr.P.H., LEONARD A. COHEN, D.D.S., M.P.H., M.S., BRITT C. REID, D.D.S., Ph.D. and RICHARD J. MANSKI, D.D.S., M.B.A., Ph.D.
Journal of the American Dental Association

ABSTRACT

Background. The proportion of older adults in the United States will continue to grow during the next few decades. Aging populations will bring unique challenges to dentistry. Understanding dental visit patterns will help the profession become prepared.

Methods. The authors used data from the 1999 National Health Interview Survey to describe dental visit patterns among adults aged 55 years or older. Outcome variables included presence of a dental visit in the previous year, reasons for the last dental visit and reasons for not having had a dental visit. Descriptor variables included age, sex, race/ethnicity, poverty status, region, private dental insurance status and dentition status.

Results. Approximately 71 percent of dentate and 20 percent of edentulous adults had had a dental visit in the previous year. Among dentate adults, age, sex, race/ethnicity, poverty status, region and dental insurance were associated with visits. Among edentulous adults, age, poverty status and dental insurance were associated with visits. Among all older adults, the main reason for a visit was preventive/diagnostic. Edentulous adults also were likely to visit for problems. The majority of adults who had not had a dental visit did not recognize a need for one; however, dentate adults were more likely to recognize a need than were edentulous adults. For those who recognized a need but did not visit a dentist, cost was a prevalent barrier.

Conclusions. Among those who visited a dentist, most went for a diagnostic/preventive procedure. Among those who did not visit a dentist, most did not recognize a need to do so. Cost remains a serious barrier.

Clinical Implications. Some older adults recognize a need to visit a dentist, whereas others (particularly the edentulous) do not. As more adults recognize their oral health care needs, cost may prevent some from seeking care.


If demography is destiny, the aging of the U.S. population is sure to have profound implications for the dental profession. Projections of a 35 percent increase in the number of adults aged 55 years or older by the year 2025 lend a sense of urgency to considerations about how the dental profession might best address demographic changes that already are well under way.1 Not only are adults aged 55 years or older becoming a larger segment of the U.S. population, they also are retaining more teeth2 and have more concomitant disease3,4 than in the past. As a consequence, the oral health needs of older adults can be expected to continue increasing in prevalence, severity and complexity during the foreseeable future.

Among older adults who visited a dentist, most went for a diagnostic/preventive procedure.

A critical step in meeting the oral health care needs of older adults, whether preventive or restorative, is a dental visit. With this in mind, a useful way to assess some of the anticipated oral health needs of older adults is to examine their patterns of utilization.

Such an assessment requires two inquiries:


Ò Who is and is not visiting the dentist regularly?

Ò What factors determine whether an older adult visits a dentist?

In answering these questions, we need to consider further the older adult population. Two important characteristics that affect older adults are edentulism and retirement, and these characteristics are especially relevant for any exploration of utilization. A low utilization rate among edentulous adults has been well-established5,6 and may affect the maintenance of pros-theses and the early detection of oral cancer.

In addition, the traditional transition into retirement at the age of 65 years, with its loss of private dental insurance benefits and the institution of fixed incomes, might herald a reduced financial capacity for obtaining dental care.7,8 Despite the reduced capacity to afford dental care, the oral health care needs of retirees and edentulous adults persist,2 which creates the potential for an increase in unmet needs and diminished oral health status among members of these groups.

During the next few decades, adults aged 55 years or older can be expected to have substantial oral health care needs owing to the combination of a projected increase in their proportion of the total U.S. population, an increase in the number of retained teeth (decrease in edentulism) and the complexity of their medical histories. Meeting these oral health care needs could be challenging, especially for those with diminished financial capacity after retirement. Consequently, a better understanding of the dental visit patterns of older adults is at the crossroads of oral health care needs and the ability to meet them.

The traditional transition into retirement at the age of 65 years, with its loss of private dental insurance benefits and the institution of fixed incomes, might herald a reduced financial capacity for obtaining dental care.

We conducted an investigation to examine this intersection of oral health care needs and constraints by using the most current nationally representative data to describe the utilization patterns of adults aged 55 years or older, including the reasons reported for visiting or not visiting a dentist. The investigation also accounted for edentulism in all analyses, and explored cost as a potentially relevant factor in visit patterns for this age group. Findings will be useful for anticipating visit patterns, as well as for developing and targeting interventions to improve visit patterns as one means of addressing the oral health care needs of older Americans.

© 2004 American Dental Association

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