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New dental treatment can help fill in tooth decay and insurance gaps in the elderly

Denver-Dental hygienist Jennifer Geiselhofer often cleans the teeth of elderly patients who cannot easily go to the dentist’s office. But until recently, if she found the hole, she was almost helpless.

“I can’t practice. I can’t extract my teeth,” said Geiselhofer, whose mobile clinic is called “the teeth at the door.” “I recommend that they go to the dentist, but due to travel difficulties, this is usually impossible. Therefore, after visiting again and again, I will come back, and there will be more decay.”

But now Geiselhofer has a weapon that can wipe out the cavity with a single blow.

Silver diamine fluoride is a liquid that can be applied to teeth to prevent tooth decay. Fast, low-cost and pain-free, this treatment method has been rapidly developed nationwide, because for those patients who are not easy to obtain fillers (such as very young or very old patients), cavity therapy is the first choice.

“For my patients, this has changed their lives,”

; said Geiselhofer, who has been using the therapy for 18 months.

During the COVID-19 pandemic, Geiselhofer was unable to enter the nursing home, but she used the fluid in elderly people visiting in private residences. She also uses it to treat tooth decay in homeless shelters, prisons and patients in the Head Start program-now wearing larger protective gear including gloves, surgical masks, N95 masks and face shields.

Experts in the dental industry say topical medication is a particularly good choice for the elderly, because although poor dental hygiene is related to other health problems such as heart disease and diabetes and pneumonia, dental care is still a major gap in health insurance coverage. Medicare does not cover most dental care services, and patients with a fixed income usually cannot afford treatment. But because of the effectiveness and low cost of silver fluoride diamine fluoride, more state Medicaid programs now cover the program-and it is directly affordable for seniors who pay out of their pockets.

Silver diamine fluoride has been used in other countries for decades, and studies have proven that it is safe. The biggest disadvantage is that it will permanently blacken the decayed area-especially for people with decayed front teeth, this is a kind of closure.

The dentist said that dark spots can be covered with colored materials on the teeth, but at an additional cost. Geiselhof said that for the elderly, the dark spot is a small amount of money that needs to be paid for treatment, which can quickly stop tooth decay without the need to drill holes, needles or go to the dentist.

Oral care is a problem for the elderly

Silver diamine fluoride was approved by the U.S. Food and Drug Administration in 2014 to reduce tooth sensitivity. However, its off-label use to treat tooth decay was quickly adopted. It made the headlines for the non-invasive treatment of tooth decay in children under 5 years of age.

Pediatric dentists have seen it as a solution for children who cannot sit still and whose parents want to avoid general anesthesia. In 2018, James Nickman, then Dean of the American Academy of Pediatric Dentistry, stated that in addition to fluoridated water, this topical bucket “may be one of the greatest innovations in the field of pediatric dental care in the last century. One.”

But today, compared with the past few decades, more and more Americans retain their natural teeth, and this treatment method also brings good news to another generation. Due to insurance gaps and the high cost of most dental treatments, many elderly people miss preventive care to prevent the occurrence of dental caries, putting them at risk of developing dental diseases that can cause serious health problems. According to data from the Centers for Disease Control and Prevention, approximately 27% of Americans aged 65 and over have untreated tooth decay.

Research shows that residents of long-term care facilities are at particularly high risk. Drugs can dry their mouths and promote tooth decay. They may also have cognitive problems and have difficulty carrying out good oral care. And many are either too fragile for traditional dental treatment, or too fragile to transport.

Dental hygienist leads the way

Take the 87-year-old Ron Hanscom as an example. He is a patient with Geiselhofer disease and has been in a nursing home in Denver since he suffered a stroke six years ago. He needs a mechanical lift to get on and off the wheelchair.

Before the pandemic, at the beginning of this year, Geiselhofer found a hole under one of his crowns during a visit to Hanscom’s nursing home. After checking with the dentist, she used a small brush to paint on the silver therapeutic pen.

Approximately 27% of elderly people suffer from untreated tooth decay. Dental hygienist Jennifer Geiselhofer treats the elderly with silver diamine fluoride, which is an alternative to filling. (Jennifer Gasserhof)

Hanscom said: “It’s a good thing that she got the silver because I can’t go to the dentist’s office. “She did it in my room. “

Across the country, dental hygienists provide most of the care for patients like Hanscom, otherwise they might never go to the dentist again. They also saw patients in homeless shelters, schools, prisons and low-cost medical facilities. Since the pandemic, Gashoff said that she has received applications for home care from elderly people who were too nervous to enter the dentist’s clinic, but because she refused to take care of underserved people, she refused their request.

Many states allow hygienists to work directly with patients in public health facilities without dentist supervision, and Colorado is one of the few states that allows them to establish completely independent clinics.

Because silver care is relatively new in the country and may leave a stain, the Colorado legislature passed a law in 2018 that requires hygienists to reach an agreement with a supervising dentist to use silver. The law also requires them to receive special training on how to use liquids, and at least 700 health workers across the state have completed this training.

Matt Crespin, president of the American Association of Dental Hygienists, said that other states, including Maryland and Virginia, have no special requirements for the implementation of cavity treatment, but some supervision by a dentist is required. In those places, hygienists should use it according to the same rules governing other fluoride products.

Prevent new cavities

Studies have shown that after a single application, fluorinated diamine silver can stop attenuation in 60% to 70%. The second application six months later increased the long-term effectiveness of the treatment to more than 90%.

In addition to killing the bacteria that cause tooth decay, this treatment can also harden the tooth structure, desensitize the tooth, and even prevent the formation of new cavities. A 2018 study concluded that applying liquid to the surface of the bare roots of the elderly once a year is “a simple, inexpensive and effective way to prevent tooth decay”.

Dental hygienist Michelle Vacha, founder of a community dental care company that opened a clinic in Colorado Springs, Colorado, said that one of the most important benefits of the drug for elderly patients is that the liquid can reach existing teeth (such as Crowns and bridges). Pueblo, Colorado.

Vacha said that in the past, dentists had to remove the crown, drill the cavity and make a new crown. This is a time-consuming and laborious operation that usually costs $1,000 or more. Many patients have to have their teeth removed because they cannot afford the cost.

The coating liquid is much cheaper than traditional treatment. Estimated fees vary, but private dentists may charge US$10 to US$75 per application, compared to US$150 to US$200 per application. The cost of health workers is usually lower. At the community clinic in Vacha, the cost is $10 per tooth.

Elevate Oral Care’s scientific officer Steve Pardue said that about half of the state’s Medicaid programs now reimburse the treatment, and the official distributes Advantage Arrest, the main brand of topical medications used nationwide. The reimbursement rate for each application ranges from $5 to $75.

Padu said that more private insurance companies (about 20% to 30%) have also begun to provide insurance.

Is a dentist near you coming soon?

A small but growing number of mainstream dentists have begun to provide treatment for all patients, not just the youngest and oldest patients.

Dr. Janet Yellowitz, Director of Geriatric and Special Care Dentistry at the University of Maryland School of Dentistry, said this is a good choice for those who are anxious about dental work or worry about costs.

A survey conducted by the American Dental Association in 2017 found that eight in ten dentists had never used this therapy. ADA does not have the latest statistics, but ADA spokesperson Matthew Messina said that anecdotal reports indicate that usage is increasing dramatically.

Yellowitz pointed out that dentists still have financial incentives to drill and fill. She gave a speech at a national conference, focusing on the benefits of silver solutions.

She said: “We are trying to get everyone to use it.” “This is a slow process, because we have to ask dentists who have received the entire vocational training to do things in a way that completely changes their mindset. It’s like asking them to go to another. A country and drive on the other side of the road.”

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