The Seniors Are Coming!

Michael C. Alfano, DMD, PhD, Guest Editor

With the number of senior citizens in America quickly escalating, what are the oral health needs of this burgeoning population group? In this special issue, Compendium explores the biological changes and unique clinical requirements of the aging “baby boomers,” the potential inadequacy of the current oral healthcare delivery model, and various approaches to pay for expanded care.

It started about 6 years ago. After decades of being the primary engine driving our economy, the baby boomer generation, those born between 1946 and 1964, began retiring. Now, with the oldest members of this population group having surpassed age 70, hordes of baby boomers are hanging up their work uniforms, suits and ties, and office attire, abandoning their daily commute, and retiring at a dizzying rate of 10,000 per day.

From medical breakthroughs, civil rights advances, and safety innovations, to cell phones and the internet, this post-war cohort has given us dramatic achievements that have impacted most aspects of life in America. However, perhaps the greatest societal impact of this generation is yet to come—its effect on the healthcare system.

The debate on the various public and private healthcare options to meet the needs of our aging society is raging as I write this editorial. Some of the issues involve payment and insurance systems for long-term care, what to do about older people staying healthy longer thanks to advances in medicine and behavioral changes, and the changing societal view of aging to better integrate elder citizens into community life.

While the debate carries on, some things are certain: both the number and percentage of seniors will continue to rise for many years, and—from a dental professional point of view—these seniors will retain greater numbers of teeth than ever before. How will our profession meet these burgeoning needs? What diseases and conditions will these seniors present to dental offices? How will the necessary care be paid for? Most importantly, will the current movement to recognize that the relationship between periodontal disease and systemic disease is not merely one of an interesting “association,” but rather one of a “contributory cause,” create a flood of new patients seeking care in the dental office?

Answers to these questions can be found in the excellent contributions to this special issue of Compendium of Continuing Education in Dentistry, authored by highly experienced clinicians. In our first CE article, Drs. Elisa Chávez and Amruta Hendre present an authoritative review of each of the significant clinical issues that a practitioner is likely to confront in an aging patient. Next, with equal measures of keen insight and admirable courage, experts in workforce design and evaluation Dr. Frank Catalanotto, Jane Koppelman, and Dr. Judith Haber undertake a discussion of the often controversial area of workforce.

Speaking of courage, Drs. Judith Jones and Michael Monopoli are among the first out of the gate with their article on new payment models for oral care. When proposing a payment model for healthcare these days, one is likely to be in the line of fire from all sides. Nevertheless, they have triangulated this minefield of a topic quite adeptly, with an approach designed to make reimbursement rates attractive to clinicians while also affordable to patients and funders.

Additionally, given the increasing penetration of dental service organizations (DSOs) in the management of dental practices nationally, we offer a roundtable discussion featuring several of the leading minds in dental insurance and DSO management who provide their opinions and insights on the role of DSOs in meeting the needs of an expanding senior population.

To anyone who thinks that this topic will go away if we simply ignore it, I would caution that there is a growing coalition of influential consumer and health policy groups that have put the expansion of oral healthcare access for seniors squarely in their sights. Among them are the Center for Medicare Advocacy, the Medicare Rights Center, the Gerontological Society of America, Oral Health America, the Santa Fe Group, Pacific Dental Services Foundation, the Dental Lifeline Network, and Families USA. These groups are organizing to influence the Centers for Medicare and Medicaid Services, Congress, and seniors everywhere in the interest of expanding dental services in Medicare. In addition, the American Dental Association is awaiting a report from PricewaterhouseCoopers on an appropriate design for a dental benefit within Medicare. Please stay tuned!

Santa Fe Group Position Statement on Oral-Systemic Interactions

After decades of research and thousands of scientific papers, the relationships between oral health, especially periodontal health, and systemic health are well known. Moreover, during the past 10 years, data analysis by health economists and public statements and actions by several large, private dental insurers have identified additional benefits of oral health by revealing that insured individuals who receive treatment for periodontal disease show fewer hospitalizations and reduced cost of care for a number of systemic diseases, including diabetes, cardiovascular disease, and stroke.

Therefore, the Santa Fe Group has concluded that sufficient evidence now exists that periodontal disease is a contributory cause to certain systemic diseases, and the public should benefit from this knowledge. Specifically, Medicare, Medicaid, and other public and private health insurance programs should incorporate oral health benefits as a component of comprehensive health insurance. These health benefits will not only improve oral health for its own sake, including speech, mastication, and social acceptance, but will also produce substantial economic benefits and total health improvement for the public.

About the Author

Michael C. Alfano, DMD, PhD
President
Santa Fe Group
New York, New York
Professor
Dean, and Executive Vice President Emeritus
New York University
New York, New York