1. Oral Health Status among Older Adults in Florida, 2015-2016
Abigail Holicky, MPH, Jennifer Wahby, MPH, and Christina Vracar, DA, MPH
Contact Information:
Public Health Dental Program
Oral Health Status of Older Adults
Results
Results
Oral health is vitally important for overall health and should be maintained across the life course.1 Dental decay and infection can cause significant health problems, amplify existing chronic diseases, and cause nutritional deficiencies among older adults.2
Periodontal (gum) disease, tooth decay, and tooth loss are all common oral health problems among older adults. In 2014, 73.1% of Florida adults aged 65 years and older reported having at least one permanent tooth extracted, and 13.2% had lost all of their natural teeth.3
Oral health indicators were highest among those with the highest level of education, in part due to their low rate of complete edentulism.
As education level increases, the percent of complete edentulism decreases.
The percent of older adults that are edentulous was two times higher among older adults with less than a high school education when compared to those with a high school education.
Consent forms were provided to 3,288 adults attending 35 congregate meal sites.
Status
N (%)
Consent Form Returned
709 out of 3,288 (21.6%)
Positive Consent Form Returned
678 out of 709 (95.6%)
Total Screened
674 out of 3,288 (20.5%)
More than half of older adults (58.5%) reported no insurance coverage for dental care and only 10% had private dental insurance.
One in five adults (19.2%) age 60 years and older had lost of all of their natural teeth (edentulous).
Almost half of older adults (46.7%) reported the use of an upper denture (or partial) and over one in three older adults (39.5%) reported the use of a lower denture (or partial).
One in five adults (22.9%) had untreated decay and one in three (28.6%) were in need of early dental care.
Males had higher rates of all indicators, with the exception of urgent dental care.
Project Description
The Florida Department of Health’s Public Health Dental Program conducted the first Older Adult Oral Health Surveillance Project in thirty-five (35) congregate meal sites statewide from 2015 – 2016.
Project Objectives
Indicators
Denture Use
Need for Dental Care
Suspicious Soft Lesions
Need for Periodontal Care
Root Fragments
Untreated Decay
Number of Teeth
Assess the current oral health status of older adults attending Florida congregate meal sites.
Identify gaps in access to care and unmet dental needs.
Provide additional information for future prevention programs.
Survey Challenges and Best Practices
Challenge #1: Gaining consent from sites
Strong support from partnering agencies including Florida Council on Aging and Department of Elder Affairs
Flexibility from Florida Dental Hygienists Association (FDHA) when scheduling screening dates; tailored to each site
Challenge #2: Low participation rate
Advertise the screening date with flyers
Use of participant-specific “goodie bags” which included toothbrush, toothpaste, floss, denture cleaner and adhesive, denture brush based on specific dental needs (including preferred brand of dental supplies)
Non-Hispanic Black adults had almost two times higher prevalence of root fragments (44.4%) when compared to their non-Hispanic White counterparts (25.5%).
Untreated decay was the highest among non-Hispanic Blacks (32.2%).
Methodology
The Basic Screening Survey (BSS) tool for Older Adults, developed by the Association of State and Territorial Dental Directors, was used.4
After receiving consent from each congregate meal site, screenings were conducted by licensed, trained, and calibrated dental hygienists through the Florida Dental Hygiene Association.
Participants aged 60 years and older completed individual consent forms, which captured information on demographic and other health indicators.
Participants received an open mouth screening, oral health education, referral to a dental home for follow-up care and treatment, and an oral hygiene kit.
Data were collected electronically utilizing a touch-screen tablet and Epi Info software, and then validated, analyzed, and weighted according to the sample selection.
Prevalence (95% CI) of the Oral Health Indicators
Race/
Ethnicity
Untreated Decay
Root Fragments
Need for Periodontal Care
Soft Tissue Lesions*
Early Dental Care*
Urgent Dental Care*
White
24.6
(16.5, 32.6)
25.5
(18.3, 32.7)
18.1
(8.8, 27.4)
5.7
(1.0, 10.5)
30.0
(21.8, 38.2)
6.1
(1.6, 10.6)
Black
32.2
(19.1, 45.3)
44.4
(27.3, 61.6)
12.9
(0.7, 25.0)
1.6
(0.0, 3.9)
32.0
(7.9, 56.1)
7.4
(0.3, 14.5)
Hispanic
18.6
(10.6, 26.5)
14.2
(6.3, 22.1)
16.8
(7.7, 25.8)
6.6
(4.3, 9.0)
26.2
(17.6, 34.8)
4.5
(1.6, 7.5)
Multi-Racial
23.1
(8.8, 37.5)
3.4
(0.0, 7.6)
25.0
(5.9, 44.1)
5.2
(0.0, 10.3)
37.3
(27.3, 47.2)
0.8
(0.0, 2.6)
Conclusions
This project revealed poor oral health status and a high need for dental care in the older adult population.
Older adults benefited from this screening project through the identification of untreated dental needs in a location that was convenient to their lifestyle.
Florida is one of only nine states that have used the BSS methodology to assess the oral health status of the older adult population.
References
U.S. Department of Health and Human Services. (2000). Oral Health in America: A Report of the Surgeon General – Executive Summary. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health.
Centers for Disease Control and Prevention. (2013). Oral Health for Older Americans. Retrieved from CDC Division of Oral Health:
Centers for Disease Control and Prevention. BRFSS Data query from the BRFSS Prevalence and Trend data website. Retrieved October 14, 2015 from:
Association of State and Territorial Dental Directors (ASTDD). (2010). Basic Screening Surveys: An Approach to Monitoring Community Oral Health: Older Adults.
*Per the 2010 Older Adult BSS manual, soft tissue lesions, early dental care, and urgent dental care indicators are inclusive of all participants, including the edentate population. All other indicators in figure are reported for dentate population only.
6/5/2017