Cost, transportation, multiple medical problems, being frail, and senility make traditional office-based dental care out of reach for many seniors. Our mission is to reduce the barriers to good oral health among low-income older adults. Since 2012, we have collaborated with our stakeholder partners through prior work, discussions, and surveys to propose the treatments and design of the project. We found that community-based dental care is feasible at the housing facilities where older adults live. The patient stakeholders confirmed that dental care is a priority, and said having simple and quality dental care at their place of residence rather than office-based care would address multiple barriers. Local, state, and national stakeholder partners have enthusiastically indicated that they would use the results of our work to make changes to improve access and clinical care, Medicaid policies for reimbursement, and make results widely available.
The overall goal of our proposed project is to reduce oral health disparities by determining the most effective, efficient, and patient-centered treatments that can be delivered in community-based or clinical settings. To address this goal, researchers will compare two community-based tooth decay treatments: a simple medical treatment of topical silver fluoride, and a less complicated dental filling that does not use a drill and fluoride. We expect that both treatments will be similarly effective in arresting untreated decay, preventing new decay, reducing tooth pain, and improving quality of life. A total of 22 subsidized housing facilities will be randomized to receive either of the two treatments. Eligible older adults who consent in a given facility will receive the treatment two times a year and be followed for 12 months. By providing dental care to older adults where they live, we will not only reduce the barriers to dental care, but also more than double the dental care access of low-income seniors, and subsequently reduce their pain and improve their quality of life.
Nearly 96 percent of all US older adults have experienced tooth decay (dental cavities), and nearly 28 percent have teeth with decay that has gone untreated because of barriers to treatment. Low-income and minority (non-Hispanic black and Hispanic) older adults have much higher rates of untreated tooth decay that has led to painful toothaches, infection, and tooth loss. Tooth decay and tooth loss make heart and lung disease and diabetes worse, thus impacting the overall quality of their lives. Most often fillings fail, and decay starts in the roots of the teeth, making treatment difficult for many older adults to tolerate and for dentists to perform. This is a disparity issue because there is a lack of quality research information that can inform the best treatments for patients and providers to prevent and treat tooth decay.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.