The state of dental care for older Americans is mixed, according to a new report from Oral Health America (OHA) released on April 17, 2018. While 25 U.S. states received a poor overall score on key oral health performance measures, the number of people covered by community water fluoridation increased from 2016 to 2018.
Coverage needed to pay for care was critical to increasing older Americans' overall health and wellness, noted OHA President and CEO Beth Truett.
"With half of the United States receiving a 'fair' or 'poor' rating relative to meeting minimal standards for the oral health of older adults, we must identify and address the steps needed to ensure the health of our burgeoning senior population," she stated in an OHA press release.
Mixed messages
The report, "A State of Decay, Vol. IV," combines information gathered from surveys of state dental directors with data from publicly available sources. The report is issued every two years by OHA.
Key findings of the report include the following:
- A third of older adults age 65 and older have lost six or more teeth.
- Community water fluoridation increased from a state average of 71.9% in 2016 to 72.6% in 2018, a national increase of about 2.2 million people.
- Fifteen U.S. states have 90% or more of their population receiving fluoridated water.
While the number of people receiving fluoridated water increased, many states do not cover basic dental treatments for older adults on Medicaid, according to the report. Extractions are covered by 42 states to some extent, but only 31 states reimburse for a periodic oral evaluation, and periodontal maintenance is only covered by 23 states (see table below).
| Common dental procedures and number of U.S. states that reimburse for procedure | ||
| Code | Procedure | No. of states that cover procedure |
| D7140 - 7250 | Tooth extractions | 42 |
| D0140 | Limited oral evaluation, problem focused | 40 |
| D1110 | Adult prophylaxis | 35 |
| D0150 | Comprehensive exam | 34 |
| D2140 - 2161 | Amalgam restorations | 32 |
| D2330 - 2394 | Composite restorations | 32 |
| D0120 | Periodic oral evaluation | 31 |
| D5510 - 5212 | Dentures | 31 |
| D3220 - 3999 | Endodontic treatment | 24 |
| D4910 | Periodontal maintenance | 23 |
| D4341 - 4342 | Scaling and root planing | 23 |
| D2930 - 2954 | Crowns | 21 |
| D1206 | Fluoride varnish | 14 |
State rankings
Oral Health America also ranked each of the 50 states based on state-level data that affects the oral health of older adults. The metrics included community water fluoridation, dental visits, adult dental Medicaid coverage, severe tooth loss, and basic screening surveys.
Minnesota ranked No. 1 on OHA's list for the third time and was one of just five states rated as excellent for oral health for older adults. Wisconsin, Connecticut, Colorado, North Dakota, Rhode Island, and Michigan also made the top 10 list for the third survey in a row.
At the other end of the spectrum, Mississippi ranked last for oral health for older adults, receiving a score of 0%. Alabama, which ranked last in 2016, jumped to 21 places to No. 29 in 2018.
View the infographic below to learn how other states performed in OHA's latest oral health analysis.
