Study highlights prevalence of dental problems among Medicare beneficiaries

Key takeaways:

• Having no natural teeth or having only tooth fragments were the most common dental problems among Medicare beneficiaries.
• There were significant disparities across several groups.

A recent study showed a “considerable prevalence” of dental problems among nursing home residents enrolled in Medicare — as well as disparities between certain groups of patients.

“Older adults in the U.S encounter significant barriers to maintaining good oral health, and disparities in disease prevalence and access to oral care are persistent challenges,” Steffany Chamut, DDS, MPH, a full-time instructor in the department of oral health policy and epidemiology and the office of global and community health at the Harvard School of Dental Medicine, and colleagues wrote in JAMA Network Open. “Notably, a substantial portion of Medicare beneficiaries (51%) lack dental coverage, further exacerbating the problem.”

The researchers conducted a cross-sectional study to determine how prevalent dental issues are among Medicare beneficiaries who live in nursing homes and identify the characteristics associated with experiencing dental problems.

The researchers included 2,355,366 Medicare beneficiaries — 91% of whom were aged 65 years or older, 61.4% of whom were women and 77.6% of whom were white — living in CMS-certified nursing homes in 2020.

Chamut and colleagues found that, per 1,000 beneficiaries, the most prevalent dental problems were:

• no natural teeth or tooth fragments (175.1 beneficiaries),
• cavities or broken natural teeth (72.89);
• pain, discomfort or difficulty chewing (10.79);
• broken or loosely fitting dentures (9.61);
• inflamed or bleeding gums or loose teeth (2.15); and
• abnormal mouth tissue (2.06).

The researchers observed significant disparities in the prevalence of dental problems across various demographic and clinical groups. For example, compared with beneficiaries in urban nursing homes, those in rural nursing homes were 70% more likely to experience three of the six dental problems and more than 30% more likely to experience the other three.

Those with at least three chronic conditions had 27% lower odds of having inflamed or bleeding gums or loose teeth (adjusted OR = 0.73; 95% CI, 0.66-0.81) and 16% lower odds of having cavities or broken natural teeth (aOR = 0.84;95% CI, 0.83-0.86) than those with no chronic conditions. However, they also saw increased odds for pain, discomfort or difficulty chewing (aOR = 1.22; 95% CI, 1.16, 1.28), abnormal mouth tissue (aOR = 1.5; 95% CI, 1.34-1.67), no natural teeth or tooth fragments (aOR = 1.57; 95% CI, 1.54-1.59) and having broken or loosely fitting dentures (aOR = 1.26; 95% CI, 1.2-1.33).

When broken down by race, the researchers found that Black beneficiaries had 5% higher odds of having cavities (aOR = 1.05; 95% CI, 1.03-1.07) or broken natural teeth and 16% higher odds of having no natural teeth or tooth fragments (aOR = 1.16; 95% CI, 1.15-1.18) compared with their white counterparts.

American Indian or Alaskan Native beneficiaries also faced significant disparities. Compared with white beneficiaries, they had:

• 45% higher odds of having inflamed or bleeding gums or loose teeth (aOR = 1.45; 95%, 1.05-2.01);
• 34% higher odds of having no natural teeth or tooth fragments (aOR = 1.34; 95% CI, 1.27-1.4); and
• 20% higher odds of having cavities or broken natural teeth (aOR = 1.2; 95% CI, 1.11-1.29).

Chamut and colleagues wrote that their findings “highlight the considerable prevalence of dental problems among Medicare beneficiaries in nursing homes, revealing disparities across various demographic and clinical factors.”

“Notably, beneficiaries with more chronic conditions were more likely to be edentulous, which makes eating properly and managing other health conditions challenging,” they wrote. “Targeted interventions addressing oral health disparities in this high-risk population are essential to improve overall health and well-being.”