NATIONAL ORAL HEALTH REPORT: A STATE OF DECAY
CHICAGO, APRIL 17, 2018 – Oral Health America (OHA) today published a national report examining factors impacting the oral health of older adults. With an expected 72.1 million seniors living in the United States by 2030, OHA’s A State of Decay, Vol. IV, illustrates progress in some areas and the need for continued action to ensure America’s rapidly growing population of seniors age healthily and independently. Top report findings include:
- One-third (33%) of older adults have lost six or more teeth
- 25 U.S. states received a poor overall score based six key performance measures
- Minnesota, Wisconsin, Iowa, Connecticut and Colorado all earned an “Excellent” Composite Score. Iowa and California made big improvements, jumping from 23 and 30, respectively, in 2016, to 3 and 9 in 2018
- The states with the lowest overall scores are Wyoming, Delaware, West Virginia, New Jersey, Arkansas, Texas, Oklahoma, Louisiana and Tennessee, with Mississippi’s score being the least favorable. Alabama improved from 50 in 2016 to 29 in 2018
- Community water fluoridation (CWF) increased from a state average of 71.9% in 2016 to 72.6% in 2018, a national increase of about 2.2 million people
- Medicaid coverage of oral health benefits increased. Two states (Delaware and South Dakota) provided no benefits in 2016 but added some of the 13 services measured in this 2018 survey.
- More state oral health officials are including older adults in State Oral Health Plans (SOHP) and administering Basic Screening Surveys (BSS) that include seniors. The 2018 data show 34 states have SOHPs; 31 include older adults
- Sociodemographic factors, such as income, race, gender and education play a critical role in oral health outcomes. The severe tooth loss and recent dental visit data, analyzed individually on a national basis, showed an association with household income. Low household income directly correlates with predicted measures of poor oral health. As income levels rose, so did the probability of good oral health
“Oral health for older adults is in fragile condition,” says Caswell Evans, DDS, MPH, associate dean for Prevention and Public Health Sciences, UIC College of Dentistry. “Oral health for seniors is important for their diet, nutrition, self-esteem, socialization, and freedom from pain, among many other benefits.”
A State of Decay, Vol. IV gives a rating of “Poor,” “Fair,” “Good,” or “Excellent” based on state level data analyzing six variables impacting older adult oral health: Severe Tooth Loss (loss of 6+ teeth), Dental Visits, Adult Medicaid Dental Benefits, Community Water Fluoridation, State Oral Health Plans and Basic Screening Surveys. For the first time, A State of Decay, Vol IV adds a national analysis of the Centers for Disease Control and Prevention’s (CDC) individual data on severe tooth loss and recent dental visits by considering associations with sociodemographic factors such as income, education, age and gender.
Since the last report in 2016, state advocates have implemented action based on A State of Decay findings. An increased number of states are taking steps to advance the oral health of older adults in their communities. More states have commissioned surveys to measure the state of older adults’ oral health (Basic Screening Surveys), added goals for older adults to State Oral Health Plans, increased the percentage of people in areas served by community water fluoridation and covered a greater number of adult dental services under Medicaid.
“Tooth loss and poor oral health are not inevitable during the aging process,” says Karen Tracy, Vice President, Strategic Alliances and Integrated Communications, The Gerontological Society of America. “The Gerontological Society of America is pleased to see the growth in the number of states taking positive steps to advance their oral health services for older adults. And, through coordinated strategies in the education, practice, policy and research arenas, millions of older adults can maintain their oral health for a lifetime and enjoy the far-reaching benefits of overall better health and quality of life.”
OHA ranked each of the 50 states based on the overall health status among the older adult population as measured by an overall state score. In order, the 10 states with the highest overall scores are Minnesota, Wisconsin, Iowa, Connecticut, Colorado, North Dakota, Rhode Island, Michigan, California and Vermont. The states with the lowest overall scores are Wyoming, Delaware, West Virginia, New Jersey, Arkansas, Texas, Oklahoma, Louisiana and Tennessee, with Mississippi’s score being the least favorable.
States are employing creative strategies to address the oral health needs of older adults. A State of Decay’s State Spotlight demonstrates how many states have created coalitions of stakeholders in aging, oral health and public health to devise specific strategies to address the oral health needs of older adults in their states.
- Iowa: From 23 in 2016 to 3 in 2018: Iowa made significant strides by adding a State Oral Health Plan (SOHP) with SMART objectives for older adults as well as completing a statewide older adult Basic Screening Survey (BSS). The state also maintained support for all 13 common dental benefits for Medicaid beneficiaries aged 65+ and expanded its I-Smile Silver pilot, which helps older adults find providers, afford care, receive transportation to dental appointments and overcome barriers related to medical problems or mobility.
- California: From 30 in 2016 to 9 in 2018: California restored the full set of 13 Medicaid services and created an SOHP with SMART objectives for older adults in an effort to carry the state through 2028.
- Alabama: From 48 in 2016 to 29 in 2018: The University of Alabama at Birmingham School of Dentistry is setting the stage at the local level for further improvements by changing access, attitudes and assumptions among the people of the state and expanding their program throughout the state, including more of its most rural and vulnerable areas. Additionally, the Alabama Department of Public Health created a new State Oral Health Plan (SOHP) with SMART objectives for older adults.
- Mississippi: From 46 in 2016 to 50 in 2018. Mississippi developed a State Oral Health Plan (SOHP) to help establish a “culture of health that includes oral health.” Goals and objectives are guiding the efforts of state officials and stakeholders through 2021 and a community water fluoridation toolkit is being created by the Office of Oral Health to educate leaders and residents about its importance.
“With half of the United States receiving a ‘fair’ or ‘poor’ rating relative to meeting minimal standards for the oral health of older adults, we must identify and address the steps needed to ensure the health of our burgeoning senior population,” said Beth Truett, President and CEO of Oral Health America. “As depicted in this report, even with improvements by certain states, millions of older adults are still at a disadvantage when it comes to oral health care. Access to and utilization of care and to the coverage needed to pay for care is critical to increasing the overall health and wellness of America’s seniors.”
Federal and state policies are needed to address the underlying, systemic variables that prohibit older adults from achieving good oral health outcomes. A State of Decay, Vol. IV recommends the following actions to promote healthy aging and independence for this rapidly growing cohort of America’s population:
- Reinstate, establish or maintain a comprehensive adult Medicaid dental benefit. If Medicaid does not provide the dental benefit these low-income older adults need, they are at risk of tooth decay, other serious medical problems and unaffordable out-of-pocket expenses.
- Integrate comprehensive dental coverage in Medicare. Currently, Medicare does not cover routine or preventive dental services.
- Sustain or expand community water fluoridation. Community water fluoridation is the most simple, equitable, cost-effective way for millions of Americans to protect their teeth and receive preventive oral health care.
- Include specific objectives for older adults in all State Oral Health Plans (SOHP). An SOHP is key to establishing a vision for improving the oral health and well-being of the citizens of a state and its local communities, developing policies, and targeting actions.
- Conduct Basic Screening Surveys (BSS) of older adults in all states. Data from a public health surveillance system can be used to measure the burden of a disease, identify populations at high risk and identify new or emerging health concerns, allowing states to make informed decisions regarding the oral health of their older adults.
“A State of Decay allows us to remain committed to ensuring oral health equity among all older adults, leveling the field to improve the quality of life for all,” says Michael Monopoli, DMD, MPH, MS. Executive Director, DentaQuest Foundation. “Everyone deserves the right to oral health screenings, diagnoses and most importantly, access to care. This report provides a gauge of where we are and where we need to go to meet the unmet dental needs of older adults.”
Through publication of A State of Decay, OHA continues to lead the way toward healthier mouths for older adults. States, advocates and public health coalitions that share OHA’s commitment can use these actions to push forward policies needed to positively impact the oral health of older adults as a key factor for overall health.
Links to the latest volume of A State of Decay and advocacy tools can be viewed on astateofdecay.org.