Oral Health in Older Adults: 10 Pandemic-Driven Transformations in Care

The disruptions in long-term care facilities caused by the COVID-19 pandemic have created opportunities for positive long-term changes in this setting, according to a new publication from The Gerontological Society of America (GSA) titled “Pandemic-Driven Disruptions in Oral Health: 10 Transformative Trends in Care for Older Adults.”

It calls attention to transformative trends with the potential to improve oral health care for residents — based on webinars developed by GSA’s Oral Health Workgroup and presented by nationally recognized speakers under the theme of “Geriatric Oral Health and COVID-19: Old Problems, New Challenges.”

“During many years of dealing with oral health barriers, it always seemed to me that oral health had wound up somewhere near the top of Maslow’s hierarchy of needs in long-term care,” moderator Stephen K. Shuman, DDS, MS, FGSA professor of dentistry at the University of Minnesota and chair of the GSA Oral Health Workgroup, said in opening the first webinar. “When COVID-19 was added to the bottom of the pyramid, it bounced oral health completely off the top. And that’s what moved the GSA Oral Health workgroup to plan these webinars.”

The following trends are presented in the publication:

1. Pandemic disruption can produce permanent transformation: “COVID-19 gives us the chance to accelerate the change we want to see,” said Terry Fulmer, PhD, RN, FAAN, FGSA, president of The John A. Hartford Foundation. “We have a mandate — ethical, moral, and clinical — to get things right going forward.”

2. COVID-19 will change nursing homes: The COVID-19 disaster presents an opportunity to reimagine the role of nursing homes and health care for older adults, Fulmer added, in the areas of staffing, infection prevention, personal protective equipment, social and physical isolation of residents, and racial/ethnic inequities.

3. Workforce and dental coverage challenges: Practitioners are aging, and better coverage options are needed for older adults.

4. Chronic oral health problems need to be better managed: Conservative approaches should be used earlier to treat caries in frail and functionally dependent older adults, said Leonardo Marchini, DDS, MSD, PhD, of the University of Iowa College of Dentistry and Dental Clinics.

5. Implementing teledentistry and teletriage: Michael J. Helgeson, DDS, of Apple Tree Dental described how oral health services were “on the back burner” during the early months of the pandemic and his company was able to use teledentistry and teletriage to provide care while convincing administrators and clinicians of the need to restart in-person care.

6. Mobile dentistry in patients with dementia: For patients with dementia, onsite services are highly preferred, as they avoid the need for transport and care by unfamiliar individuals. Jeffrey E. Dodge, DMD, a general dentist in Woonsocket, Rhode Island, who also provides mobile dentistry services to long-term care facilities as lead dentist with CareLink, described innovations in mobile dentistry used during the pandemic to address acute problems and unfinished care.

7. Vaccines by dentists: Recognition of dentists as vaccinators — and health professionals on the frontlines of care — will lead to important new roles for oral health care providers and collaborative care.

8. Interprofessional oral care: Closer cooperation and collaboration among dentists, other oral health practitioners, and medical and allied health professionals has the potential to improve care in nursing homes and in other underserved areas such as rural and inner-city locations.

9. State laws and long-term care regulations: During the pandemic, Samuel Zwetchkenbaum, DDS, MPH, of the Rhode Island Department of Health, had the opportunity to collaborate with providers and deploy to facilities, thereby learning new ways of stopping the spread of influenza and future pathogens.

10. COVID-19–related research opportunities: The biological, social/behavioral, health service use, and policy areas are fertile with COVID-19–related queries, said Bei Wu, PhD, FGSA, Dean’s Professor in Global Health in the Rory Meyer’s College of Nursing at New York University. Solutions identified will go far in helping to leverage the COVID-19 experiences to address the oral health challenges faced by older adults.

Support for this publication was provided by GlaxoSmithKline Consumer Healthcare.

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The Gerontological Society of America (GSA) is the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society.