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Dental Tribune U.S. Edition

HYGIENE TRIBUNE The World’s Dental Hygiene Newspaper ·U.S. Edition february 2013 — Vol. 6, No. 1 HYGIENE TRIBUNE The World’s Dental Hygiene Newspaper ·U.S. Edition Are you ready for the silver tsunami? JAniCE H. SiEgEl, RDH, is a long-standing dental hygienist who is continuing her education through postgraduate certification in gerontology and a master’s degree in dental hygiene from the University of Tennessee. She is an instructor in dental hygiene at Wake Technical Community College in Raleigh, North Carolina. She can be reached at ‘Crest Kids’ demand for healthy, white teeth won't diminish as they age By Janice H. Siegel, RDH T en thousand baby boomers re- tire every day in the U.S. And this silver tsunami is only get- ting bigger. As these individuals age, they are doing so with the greatest number of healthy mouths and teeth ever seen in the elder-care industry. Today's older client/patient/resident is different than those of previous genera- tions. The number delineating chrono- logical age no longer represents features seen in retirees of times past. Rare is the removable denture, night-stand denture cup or pureed food. Today is the age of the retiree with implants, porcelain res- torations and a history of whitening. This group of people born between 1946 and 1964 have led and won many revolutions that have changed our soci- ety; and the chance of seeing them slow because of the aging process is highly unlikely. The demand for oral health care is expected to surge from this group of “Crest Kids.” Where do we find the caregivers? Now that many of us are aware of this growing population of need, where will we find our population of caregivers? My answer: The dental hygienist, a pre- vention specialist prepared to treat and prevent oral disease, is the person most prepared and capable to guide an oral health-care maintenance program with- in elder care facilities. One example already in place: A suc- cessful group of hygienists in Wisconsin have opened an avenue of care among elder-care facilities with its “Adopt a Nursing Home Project.” This is a “front- door” access program, with dental hy- gienists volunteering time to assist care- givers, families and certified nursing assistants with critical oral health-care needs among residents. The hygien- ist regularly visits a facility and guides biofilm (plaque) removal techniques and offers additional methods of reduc- ing bacteria — with the goal of creat- ing healthier residents. With improved health, residents display an increase in communication skills and become more interactive, said Shirley Gutkowski, lead of the Adopt a Nursing Home Project. But these efforts are not yet the norm. The stumbling blocks or barriers to care are two-fold. Not surprisingly the man- agement or decision-makers of elder- care facilities, keeping an ever-vigilant eye on the bottom line, often fail to see the value of oral-health maintenance. Understandably, financial issues are cru- cial for management; but they should not trump the cost of the potentially compromised health and well-being of those being managed. Costs drop as oral health improves A documented correlation exists be- tween oral disease and pneumonia. Medical and dental fields have agreed that the oral health of an aging resi- dent in a facility steadily declines due to multi-factorial reasons, including the aging process and the influence with co-morbidity of chronic diseases. At the top of the list are diabetes, cardiovascu- lar disease and pneumonia. Studies have found a relationship between periodon- tal disease, diabetes and pneumonia and have concluded that the health costs of an elder are decreased when oral health is maintained daily (Ide, Hoshuyama and Takahashi, 2007, Shay, K., 2002, Terpen- ning, M., 2005). A limited thought process seen within some decision-makers reflects an often- seen denial that oral health care matters. The ageist adage that oral health care does not matter — and pureed food is the primary form of nutrition — no longer applies. That's because in today's world, people are aging with a majority of their teeth still functional. State regulations in the way? A second barrier to more enlightened oral health care in older populations is that many states have regulations that constrain opportunity for dental hy- gienists to deliver services. The bulk of responsibility for changing such regu- lations will rest on the silver tsunami's ability to motivate decision makers to understand that the status quo no longer applies to issues of oral health. The Wisdom Tooth Project, as part of Oral Health America, is creating multiple methods of disseminating information and offering opportunities to advocate for the increasing numbers of aging Americans. The “Crest Kids” have for the most part taken care of themselves and expect their hard work of brushing, floss- ing and visits to the dental office to not be in vain in their later years. Many from this generation are partnering with Oral Health America and the American Asso- ciation of Retired persons — with both of those organizations providing informa- tion about oral health and the challenges looming on the horizon. Another relatively recent effort was sponsored by the American Dental As- sociation and its "National Coalition Consensus Conference: Oral Health of Vulnerable Older Adult and Persons with Disabilities" (NCCC), held in November 2010 in Washington, D.C. Members of the ADA met with geriatric specialists to attempt to piece together an action plan related to the special needs of the older population. One of the agreements reached by the 1,500 attendees was that there is a need for a dental director posi- tion at organized facilities where elders reside or spend a majority of their day. This is a powerful idea; but the reality is that there is a shortage of dentists avail- able to serve in this role for such special- needs communities. Conclusions reached at the NCCC event were released with much fanfare within the dental community, but since then, the initial enthusiasm appears to have faded, with the various proposals never reaching a hoped-for level of implemen- tation. If a second coalition meets, a more-purposeful inclusion of the dental hygienist’s perspective could help pro- vide higher-value outcomes — because the dental hygienist is fully prepared to step up as an oral health director within care facilities. A large number of hygien- ists are seeking employment in areas where their expertise is needed to care for individuals with special needs — but many applicants are finding doors closed or only pro-bono invitations to work. Hygienists take up rallying call A rallying call has already begun among the dental hygienist population to seek out areas of need and provide care for the underserved. The challenge is that many people remain unaware that the need even exists. Oral health-care needs are not at the top of the list when bedsores and soiled clothing need attention from caregivers. Cost of care is not considered when the bottom line is already consid- ered uncontrollable. But, as stated pre- viously, costs can be reduced when the quality of life improves. This includes ” See TSUNAMI, page C2 Clinical Opinion This chart shows the increases in the older population from 3.1 million people in 1900 to 35 million in 2000 and projected to 72.1 million in 2030. Projections for 2020 through 2050 are by the U.S. Census Bureau as of August 2008. The source of the data for 1900 to 2000 is Hobbs, Frank and Nicole Stoops, U.S. Census Bureau, Census 2000 Special Reports, Series CENSR-4, Demographic Trends in the 20th Century. The 2010 data is from the 2010 Decennial Census. Note: Increments in years are uneven. Chart Data/Provided by U.S. Census Bureau 3.1 4.9 9 16.6 25.5 31.2 35 40.3 54.8 72.1 0 10 20 30 40 50 60 70 80 1900 1920 1940 1960 1980 1990 2000 2010 2020 2030 People Age 65-Plus 1900–2030 (in millions) Year (as of July 1)