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Dentists make urgent call to get seniors help with oral care

New Hampshire Union Leader

August 14. 2017 9:56AM
Experts say good oral health is a big part of healthy aging. Shown in his Atkinson office, Dr. Robert Perreault and his patient, Marj Knowles, 83, of Plaistow. (GRETCHEN GROSKY/Union Leader)
Tips for a healthy mouth as you age
• Dry mouth: This can happen as the body ages, but can also be caused by medications. It increases the risk for oral disease. Drink or sip lots of water. Use an alcohol-free mouthwash.

• Dentures: Diseases, including oral cancer and less serious illnesses such as thrush, a fungus in the mouth, are sometimes found under dentures.

• Enamel: Attrition or “wear and tear” can cause enamel to wear down, increasing the risk of cavities. Increase fluoridation; avoid tobacco.

• Gums: Receding gums lead to an increased rate of decay.

Source: Dr. Robert Perreault of Atkinson

Marj Knowles of Plaistow said it seems she’s “always” in the dentist’s chair at Dr. Robert Perreault’s office in Atkinson.

“There was not good dental care in my day,” the 83-year-old said. “We didn’t understand the importance of keeping good teeth.”

Today, dentists and doctors know poor oral health care is linked to cardiovascular disease, diabetes, some cancers and can increase the risk of hospitalization. A reluctance to smile or difficulty eating can also cause social isolation and loneliness.

But for many older adults, getting dental care is difficult. A 2014 state study of 610 Granite Staters over the age of 60 showed 15.9 percent had lost all their natural teeth. Almost 19 percent reported they were in need of early or urgent dental care that they couldn’t get because of the cost or the inability to get a ride to the dentist.

Of those surveyed, 82 percent said they had no dental insurance. Perreault said many dentists like himself in New Hampshire are helping those older patients get care without their having to worry about the cost. However, he said Medicare should be covering dental care like it would with any other medical cost.

“They will pay for them to have their hair done in a nursing home, but they won’t pay for them to have their teeth fixed unless it’s an emergency and that means an extraction,” Perreault said. “When getting your hair done gets priority over oral health, that’s really unfortunate.”

Dr. Stephen Shuman of the University of Minnesota School of Dentistry agreed.

“We will have poor outcomes and higher expenses if we don’t pay attention to good oral health,” Shuman said. “It only leads to better health and it costs less.”

The state of oral health

Last month, Shuman and 40 other national experts in oral health issued a call to action to help older Americans with their teeth and gums. At the World Congress of Gerontology and Geriatrics, the group showed how the national shortage of dentists, cost and transportation barriers are hurting seniors’ health.

They are urging more oral health care training and education for all medical professionals, Medicare coverage for dental care, and for doctors to check older people’s mouths as part of their initial evaluation of a patient’s heart, eyes, ears, nose and throat.

Northeast Delta Dental CEO Tom Raffio said promoting better oral health care among older people is an effort many in New Hampshire are already working on.

Hope Saltmarsh, the state’s oral health program director, agreed and pointed to the 2014 study as benchmark data for better outcomes in the future. She said there are early discussions of implementing oral care coordinators to work alongside public health nurses and others to help residents get help.

“New Hampshire is really growing with the number of oral health stakeholders that have been doing a lot together, a number of groups working closely together on seniors,” Raffio said. “That’s something that really speaks to New Hampshire.”

Access to care

Raffio said there is one dentist for every 1,386 people in New Hampshire, which is above the national average. Dr. Donald Cox, a periodontist and dental director for Northeast Delta Dental, said New Hampshire’s issue is that the bulk of dentist offices are concentrated between the state’s southern border and the capitol of Concord.

Cox said the federal government has identified shortage areas in the northern and western parts of the state affecting some 30,449 residents. A shortage means a person must travel more than 15 minutes in a car to get care, he said.

Mike Auerbach of the New Hampshire Dental Association said access to care is also difficult for those in nursing homes and for those stuck in bed, living alone and without anyone to get them to the dentist.

“On the senior front, this has always been a challenge, but we are working closely with our public health hygienists,” Auerbach said. “We’re working on improving the connection between senior centers, the nursing home and dentists.”

Auerbach said many local dentists donate their time to help seniors in nursing homes. Dr. Michele Saunders of the University of Texas Health Science Center said dentists have an obligation to do such work.

“When you have an older patient who goes from living at home to assisted living to a nursing home, you have an obligation to follow your patient,” Saunders said. “If you don’t, it’s essentially abandonment.”

Boomers expect more

Shuman said access to good oral care and coverage is an expectation among baby boomers. Auerbach agreed.

“They have grown up in a generation where oral health care is very much a part of good health, and that’s a good thing,” Auerbach said. “This round of seniors may be easily identified, so to speak. At the same point, we have a much larger section of seniors that will be out there in need of care.”

Perreault said baby boomers did not have access to fluoridation and sealants like today’s generations. He said dry mouth leading to decay, the damage done by medications, and diets full of processed food are among the greatest challenges to older people’s oral health.

However he said many of his patients are fighting to keep their teeth. He’s also hopeful the baby boomers will stand up for Medicare coverage for dentistry.

“We’ve been talking about this for years and it seems to fall on deaf ears,” Perreault said. He noted baby boomers “are a big voting bloc and they vote.”

Saunders said the federal government is starting to recognize the issues with older people’s oral health care.

Shuman agreed there is hope that this will become a bigger priority for government leaders, “but we know this is the beginning of the fight, not the end.”

Silver Linings is a continuing Union Leader/Sunday news report focusing on the issues of New Hampshire’s aging population and seeking out solutions. Union Leader reporter Gretchen Grosky would like to hear from readers about issues related to aging. She can be reached at or (603) 206-7739. See more at

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