Geriatric Dentistry: Is It a Hope or a Challenge?

In 1967, as a response to the demographic changes indicating an aging population, Dr. A. Elfenbaum, along with such leaders and "gerodontists" as Saul Kamen and Sidney Epstein, founded the American Society of Geriatric Dentistry. At the time, there seemed to be some interest in the emerging field of geriatric dentistry; but some 32 years and several journals later, interest appears to be fading. In this short essay, how the demographic transformation of our population might impact the health, especially the oral health, of our people will be briefly discussed. On the way, a few myths about older people will need to be dispelled.

To consider all people over the age of 65 years as a homogenous group called "the elderly" is about useful as grouping birds and butterflies because they both have wings. Yet, we have gone even a step further. We now have subgroups labeled the new old, old, old old, and oldest old. Labeling groups this way has damaging consequences for individuals and society. It misleads many older people into premature withdrawal from prime-time life. People who are or were actively contributing to society during their later years -- such as Pablo Picasso, George Burns, Pablo Casals, Anton Rubinstein, Count Basie, Jascha Heifetz, Grandma Moses, Michelangelo, George Bernard Shaw, Eubie Blake, Alberta Hunter, and Lena Horne -- and millions of frail, fragile, terminally ill elderly people do not make a class. All "old" people are not alike.

Myth -- old means poor. All elderly American women are not bag ladies roaming the street. All elderly men are not retired, in wheelchairs, and playing checkers in rest homes. Twenty percent of American households are headed by people older than 65. They own 40 percent of the nation’s personal assets. One of three people older than 65 own his or her own home, most of them without a mortgage. This does not mean that all old people are rich. Many are sick and poor. The point is, those older than 65 do not form a special economic class.

So, how big a group is this?

In 1900, there were 10 to 17 million people older than 65 on our planet. That was less than 1 percent of the world’s population. By 1992, there were 362 million people in that age group, or 6.2 percent of the population; and by 2050, the number is estimated to expand to at least 2.5 billion, or 20 percent of the population. That’s the global view.

Nationally, in 1994, 33.2 million, or 12.7 percent, of the U.S. population was older than 65. It is estimated that the number of people older than 65 will almost triple by the year 2005; and those older than 80, the fastest growing segment of the U.S. population, will show a 200 percent increase.

It is also estimated that "elders" will make up about 80 percent of a dentist’s practice.^1,2 Their treatment will not be limited to full dentures. As leaders in the field of health care, what do we offer governmental and societal planners as options to the tripling of our elderly population? Do we advise them to triple the number of nursing homes? Educate three times as many nurses? Three times as many dentists? Three times as many physicians? There must be better options.

We have failed to recognize the environmental aspect to healthy aging. The health of our population, especially the elderly, is intimately related to their physical, psychosocial, and socioeconomic environments. Health, especially in the elderly, is a reaction to the environment, just as disease is a reaction to injury.

Periodontitis is a good example of the interaction of the internal environment with the external environment and how the disease might differ with age. Periodontitis is, in all probability, an immune reaction to bacterial injury. Many, but not all, investigators have shown that the immune system in elderly animals, including man, is depressed or markedly changed. The thymic arm of the immune system is especially reduced. Some 13 years ago, I asked the question, "Is periodontitis a disease of the aged?"³ Today I might view it differently and ask: "Is periodontitis in the aged the same as periodontitis in the young?"

In the mid 1980s, both Page⁴ and I³ pleaded for more data on periodontitis of the aged. There is still a pressing need for careful studies of the disease in various age groups and in individuals of varying ethnic background. To repeat³ "The challenge to dentistry and dental science is in the development of investigative teams anxious to work together on the oral biology of aging and the aged." The challenge is still there. Can we meet it?

Author/

Barnet M. Levy, AB, DDS, MS, is a special lecturer in geriatric dentistry at Columbia University School of Dental and Oral Surgery and the University of Medicine and Dentistry of New Jersey. He is also professor of pathology emeritus at the University of Texas at Houston Dental Branch.

References/

1. Aschenbrener CA, The future is in the present: The impact of generations. J Am Coll Dent 65(4):23-8, 1998.

2. Murdock SH and Hoque MN, Current patterns and future trends in the population of the United States: Implications for dentistry and the dental profession in the twenty-first century. J Am Coll Dent 65(4):29-35, 1998.

3. Levy BM, Is periodontitis a disease of the aged? Gerodontology 5(2):101-7, 1986.

4, Page RC, Periodontal diseases in the elderly: A critical evaluation of current information. Gerodontology 3:63, 1984.

To request a printed copy of this article, please contact: Barnet M. Levy, AB, DDS, MS, Department of Behavioral Sciences, Columbia University School of Dental and Oral Surgery, 630 W. 168th St., New York, NY 10032.