Oral Health in Aging Populations: Access and Systemic Complexity
Medicare, which covers roughly 69 million Americans including about 62 million aged 65 and over, has never included routine dental coverage. Proposals to add a Medicare dental benefit were dropped from the Build Back Better package and the Inflation Reduction Act of 2022 contained no dental benefit, so no routine coverage was ever enacted. Meanwhile, elderly Americans in nursing facilities are among the most underserved oral health populations in the country: many cannot access outpatient dental offices, facility staff are not trained to manage oral hygiene for cognitively impaired residents, and dental diseases in this population are linked to aspiration pneumonia, malnutrition, and cardiovascular risk. How should dental professionals and the healthcare system respond to the oral health crisis in aging Americans?
Likely follow-up · A 78-year-old patient with moderate dementia presents with a severely fractured molar. Her adult daughter, who holds her healthcare proxy, wants the tooth extracted, but the patient becomes distressed and resistant when you approach her. How do you navigate decisional capacity, proxy consent, and the patient's expressed distress?