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Texas Dentist Demonstrates Successful Model for Treating the Elderly in Nursing Homes

April 4, 2014

Dentists throughout the country have long known there’s a plight facing the elderly – maintaining oral health when they can no longer care for themselves.

The reasons are many.

Medicaid doesn’t fund most dental care. Most people aren’t aware of the problem. Ironically, dramatic improvements in oral health in the US mean that more elderly people have kept their teeth—and therefore are at risk for dental disease.

Dr. Sarah Dirks started Geriatric Dental Group of South Texas, PA in 2006 after spending 18 years teaching at The University of Texas Health Science Center at San Antonio. About 75 percent of Dr. Dirks’ patients live in long-term care facilities, while the remaining 25 percent live in their homes with the help of family or professional caregivers.

Many dentists are hesitant to treat patients who have complex medical issues, and are unaware that there is a little-known provision in Medicaid law that allows some nursing home residents to use their social security payments to cover medically necessary dental expenses not covered by their state’s Medicaid.

“If you extract teeth from an 85-year-old nursing home resident, that patient is going back to a controlled environment where they will be watched and provided the proper medication,” she said. “There are many elements in a nursing home that are more controlled than in a private home.”

Dr. Dirks has four “mobile teams” – three teams are composed of one dentist and two assistants, and the fourth team consists of a hygienist and an assistant – that visit elderly patients who live in long-term care facilities.

For elders who are “aging in place,” dentists in the office use a wheelchair lift that allows the patient to back up into the apparatus and strap in without having to get out of the wheelchair.

Dr. Dirks favors the system because transferring patients can be challenging.

Yet there are other barriers that Dr. Dirks and her team are still trying to overcome.

Federal regulations that govern the use of controlled substances – including some pain medications – may delay nursing home residents getting their medication.

“I’m planning to meet with a group of pharmacists to discuss the issue,” said Dr. Dirks. “It’s something we take for granted when we write a prescription for more mobile, independent patients.”

Patients who suffer from dementia and those who regularly take pain medication also may not communicate any dental issues they’re experiencing. In fact, many don’t even know there’s anything wrong.

“You could have a patient not complaining about pain, and yet they have 20 broken off teeth, and there are abscesses and infections in the bone,” Dr. Dirks said. “You can have chronic conditions simmering, but not boiling. What’s going to trigger that to potentially become a life-threatening condition?”

A dentist’s success in treating patients in long-term care facilities ultimately is reliant on her outlook.

“When I started practicing, I thought that long-term care had to enter the world of dentistry,” Dr. Dirks said. “Since I’ve been in this field so long, I’ve changed my approach. I now realize that dentistry has to enter the long-term care world.”