Oral Health Challenges Facing Healthy Boomers

With the Baby Boomer population being healthier, wealthier and happier than previous aging populations, they tend to be more active, are better educated, eat better and are keeping their natural teeth longer.1 In fact, the edentulism rates have decreased significantly over the past 20 years and according to data from the National Health and Nutrition Examination Survey, 2011-2012, only 19% of those aged 65+ have no natural teeth.7 Not only do almost 80% of this population cohort have their own natural teeth, they are also living on average, 34 years longer than their grandparents. Society seems to have coined the 60’s as the new 40’s. With changes in the way we view the world, i.e., through television and the social media, role models such as Jane Fonda (1937) and Goldie Hawn (1945) seem to inspire the baby boomers to seek that eternal “Fountain of Youth.”

Baby Boomers have, for the most part, received dental care throughout most of their lives if they have been gainfully employed. Many employers offer dental insurance as one of the benefits of employment; however upon retirement, these benefits are typically lost.8 Since the majority of boomers have their own natural teeth, it is likely they have also had numerous dental procedures such as crowns, bridges and possibly implants and are accustomed to having regular periodontal maintenance appointments. At a time when it is crucial to continue to maintain these restorations as well as their periodontal health, dental and dental hygiene visits often decline due to reduction in income as well as loss of dental insurance.

The middle-class more educated and more affluent boomers will most likely continue to visit their private dental practitioners, however those who are less educated and who no longer have dental insurance will more than likely no longer seek dental care.8 In the US, dental insurance coverage for seniors has been reported to range from 14.5% (those 65+) to 28% (65-74) and 16.5% (those 75+).8 Since retirement also results in a significant loss of income, priorities often change thus accounting for seniors having the lowest dental utilization rates. According to the US News and World Report, the 2014 median Social Security benefit was $18,113 for men and only $14,234 for women in the US. In Canada, the 2015 median income for senior women was about one-third less than men ($21,900, compared to $32,300 for men). The largest discrepancy in the US was that only 30% of all retirees had additional income from other sources such as employment pension plans and 401K’s.

In addition to reduced dental visits, the effects of aging have an impact on overall health such as: reduced ability to fight infections, loss of manual dexterity, possible loss of appetite, and even possible malnutrition. It has been well-documented that as one ages, medication requirements increase which could have significant side-effects such as xerostomia and drug-induced gingival enlargements.4,9 These changes can significantly impact the oral health of the individual. Lack of dental maintenance may result in both breakdown of restorations as well as periodontal disease. The American Academy of Periodontology reports older adults have a higher prevalence of periodontal disease, and the most recent National Health and Nutrition Examination Survey (NHANES) study found 70.1% of adults older than 65 had periodontal disease.9,10

Additionally, the effects of xerostomia place the individual at higher risk for root caries, pain, loss of teeth and ultimately an inability to chew food properly. These consequences may negatively impact the overall quality of life of the individual as well as placing them at higher risk for systemic disease such as cardiovascular disease, diabetes, respiratory disease and numerous other chronic conditions that are inflammatory in nature. The evidence for links between oral and systemic health has been mounting rapidly and will be discussed in further detail in the next section.