[Congressional Record (Bound Edition), Volume 150 (2004), Part 15]
[Senate]
[Pages 20731-20732]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    ORAL HEALTH AND OLDER AMERICANS

  Mr. BREAUX. Mr. President, the oral health of older Americans is in a 
state of decay. Millions of vulnerable seniors are unable to access the 
oral health care they need, suffer needlessly, and ultimately require 
costly and invasive treatments that unnecessarily burden our troubled 
health care system.
  Good oral health care should begin at birth as part of overall health 
care. This important component of health care should not--and cannot--
end at retirement. Proper dental care must be a lifetime commitment. 
Unfortunately, for far too many older Americans, oral health care is a 
luxury. Too many of our ``greatest generation'' suffer from chronic 
oral pain and disease, severely limiting regular activities of daily 
living and impeding their independence. Neglect of oral health may 
result in the deterioration of overall physical health. Lack of access 
to care for even routine dental cleanings and exams can exacerbate 
serious and complicated overall health problems that increase with age.
  Limited access to oral health care poses one of the greatest crises 
for the health and well being of America's elderly. Not one older 
American receives routine dental care under Medicare. Medigap, used by 
some older Americans as a supplemental insurance to Medicare, is an 
expensive cavity when it comes to dental coverage. Less than 20 percent 
of Americans 75 and older have any form of private dental insurance. 
Under Medicaid, adult dental care is optional and close to 30 States 
are failing to meet even the most minimal standards of care. Millions 
suffer, often in silence.
  Older adults suffer from the cumulative toll of oral diseases over 
their lifetime. This results in extensive oral and periodontal disease. 
Surveys have shown that nursing home residents with teeth suffer 
particularly from untreated tooth decay, while those without teeth also 
have a variety of oral health problems. Medications often adversely 
affect oral health as well. Evidence suggests that periodontal disease 
can complicate or is linked to diabetes, heart disease, stroke and 
pneumonia.
  Some older Americans--especially those with special needs, the frail, 
and those classified by the Social Security Administration to be aged, 
blind and disabled--are often plagued with challenging oral health 
needs. Being disabled, medically compromised, homebound, or 
institutionalized increases

[[Page 20732]]

the likelihood of serious dental problems and limited access to dental 
care. Dental care for the 1.65 million people in long-term care 
facilities is problematic at best.
  I would like to tell you about Marcia Ball, who lives in a nursing 
home in Lafayette, LA. She is 64. One morning last July, she awoke to 
find her cheek swollen up like a balloon. An untreated abscess had run 
rampant, sending her to the hospital with a raging fever and labored 
breathing. After a surgical team drained the infection, her heart and 
lungs suddenly stopped working. She pulled through, but four days later 
developed pneumonia. A member of the medical team says that the 
bacteria from untreated tooth decay entered her lungs every time she 
inhaled. She returned to her nursing home after two weeks at the 
hospital. Medicaid paid for three rounds of antibiotics, two trips to 
the emergency room, two days in intensive care, and the remainder of 
her hospital stay. But Medicaid in Louisiana, like many other States, 
won't pay for extractions. So she still has badly decayed teeth, but 
she doesn't have the $60 needed to cover an extraction or insurance for 
routine dental care.
  Marcia Ball's story is not unusual, according to Dr. Greg Folse, a 
geriatric dentist in Lafayette. Most of Dr. Folse's patients are 
keeping their teeth as they age, but he says that over 85 percent have 
moderate to severe gum disease and 60 percent have tooth decay. 
Medicaid dental services in Louisiana, where Dr. Folse takes his 
practice to patients in his van, are limited to dentures, which are not 
much use for people who still have their teeth.
  A national report card released in September by the advocacy group 
Oral Health America before a forum of the U.S. Senate Special Committee 
on Aging examined seniors' access to key dental services and gave 
failing or near failing grades to each State and gave the Nation an 
overall ``D'' grade. When it comes to caring for vulnerable 
populations, the report said, the country is flat out failing.
  This lack of access to oral health care is compounded by a shortage 
of skilled geriatric dental care professionals, part of a larger 
national shortage of geriatricians described to the U.S. Senate Special 
Committee on Aging by the Alliance for Aging Research in their report, 
Medical Never Never Land. Just finding a dentist can pose a 
considerable challenge for older Americans and those with a disability. 
The good work of community health centers is limited to providing 
preventative and basic dental care to only about one-in-twelve patients 
who are fortunate enough to have access to such a facility. In many 
States that provide a dental benefit, reimbursement rates are too low 
to attract a sufficient number of dentists willing to treat Medicaid 
patients.
  With scientific advances and the graying of millions of baby boomers, 
this year the number of elderly on the planet passed the number of 
children for the first time. Although we have made great strides in 
promoting independence, productivity and quality of life, old age still 
brings inadequate health care, isolation, impoverishment, abuse and 
neglect for far too many Americans.
  Oral diseases can impact an otherwise independent, productive life, 
triggering a downward spiral that can result in malnutrition, serious 
illness and even death.
  In 2000, the Surgeon General's office called oral disease in this 
country a ``silent epidemic,'' but oral health continues to be an 
afterthought to other health care issues, and off the radar screen for 
most national leaders. Congress has never addressed the lack of oral 
health coverage for older Americans, failing to place these this issue 
into the national consciousness and addressed the issues at a national 
level.
  We need new infrastructure and funding--focusing resources, creating 
accountability and changing how we think about oral health in our 
country, particularly as it affects vulnerable populations. We must lay 
the foundation to address, in a meaningful and lasting way, a 
devastating and growing problem that has been invisible for far too 
long. We can no longer neglect these difficult issues afflicting frail 
and elderly victims.
  This effort needs to take numerous steps to improve access to oral 
health care:
  We need to ensure the provision of oral health screening, diagnostic, 
and treatment services, particularly for vulnerable individuals, and 
nursing home and long-term care residents.
  We must eliminate the barriers requiring determination of medical 
necessity. We must ensure that States comply with applied income laws.
  We need to ensure greater communication among States and nursing home 
and long-term care facilities about the need for and availability of 
oral health services.
  More and more of us will enjoy longer, healthier lives with our teeth 
intact, but with this gift comes the responsibility to prevent the 
needless suffering too often borne by our frailest citizens.
  I appreciate the work of my fellow members and a wide array of 
excellent groups such as Oral Health America, Special Care Dentistry, 
and the Alliance for Aging Research, and individuals like Dr. Greg 
Folse on behalf of oral health and older Americans and look forward to 
continued support from both sides of the aisle and in both Houses to 
make oral health a reality for all Americans.

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