Barriers to Seeking Oral Health Care

The older adult population is more likely to have chronic conditions that may affect their oral health, but they are less likely to visit an oral health care provider than younger adults.44,61 Chronic health conditions can inhibit older adults from seeking oral health care because such health conditions take precedence. The health care team should work together to help patients understand that oral health can affect overall health and that many chronic health conditions display secondary oral manifestations. In addition, chronic health conditions and physical impairments may keep the older adult from being able to get to the dental office. They may not be ambulatory or they must rely on others to transport them or utilize public transportation. Older adults may feel burdensome to others if they ask for help and may find public transportation confusing or intimidating. Those with impaired vision or literacy problems may have difficulty reading transportation schedules or the phone book. Older adults confined to wheelchairs may have difficulty obtaining transportation to and from the dental office. Likewise, patients unable to be transferred from their wheelchair to the dental chair may require special accommodations not available in many dental offices.61

Cost of dental services is another consideration. Most people with dental insurance utilize dental services. However, when persons retire they tend to lose their dental insurance coverage.44 Medicaid provides limited coverage for routine oral health care for low income and disabled older adults, and Medicare does not cover routine oral health care at all. Therefore, most dental care expenses are out-of-pocket for the older adult. This can be very challenging for those on a fixed income; consequently dental care is not used.61 People of all ages fear dental visits. However, older adults may compound their fear with worry about what they may encounter. Patients who are visually and/or hearing impaired may find communication with office personnel and practitioners too challenging. In addition, they may feel that their chronic health conditions will interfere with dental treatment.61

Attitudes and beliefs also can influence obtaining oral health care.61 Many of the old and old-old age groups (see key terms) still believe that losing one’s teeth is a part of the aging process and, therefore, they do not seek oral health treatment. People from other cultures may view the close proximity of the oral health care professional to patient as an invasion of privacy. This feeling of uneasiness could deter them from seeking treatment. Oral health care professionals also may exhibit ageism. They may feel that assessing the older adult patient takes too much time or in a person of advanced age, extensive treatment planning would be a disservice rather than a service. They also may be uncomfortable around older adult patients due to personal issues about getting older. These attitudes must change. Oral health care professionals need to become more familiar with older adult patients and their oral health needs. Communication skills must be improved to insure positive relationships between provider and patient.61