UMB's Interprofessional Education and Care in Geriatrics team is assisting these neighbors in securing appointments with dental providers and educating them on alleviating temporary dental pain.
Before the coronavirus pandemic, the dental needs of the neighbors in the community resurfaced in many of our weekly on-site community engagement encounters. For instance, Mr. J was an older immigrant from a country in Africa who sought help from the students in the Interprofessional Education and Care in Geriatrics (IPE) team for tooth pain. He did not have the resources to afford dental care. After a basic clinical and financial evaluation, one student from the University of Maryland School of Social Work (UMSSW) embarked on finding a grant to finance the dental needs of this older neighbor while another student from the University of Maryland School of Pharmacy (UMSOP) discussed the clinical picture with the staff at the University of Maryland School of Dentistry (UMSOD).
Two weeks later, the two students knocked on Mr. J’s door. The pharmacy student happened to speak Mr. J’s language, and as soon as Mr. J and his wife opened the door, the student broke the good news: “You now have an appointment with the University of Maryland School of Dentistry and your initial screening and treatment plan is all paid for.” Hearing this, Mr. J was almost in tears. “Thank you,” he said in English. Mr. J later explained that he would have never thought that voicing his pain and financial concern to the interprofessional student team would have yielded such an astonishing outcome. Looking many months forward, the faculty and staff of all schools involved worked very closely with Mr. J’s insurance plan to have his dental needs met.
Almost 1 1/2 years into our endeavor, the inadequacy of dental care among most neighbors cannot be overlooked. The vast majority of the neighbors who participate in our wellness visits have significant unmet dental needs. It is common to hear responses like “I cannot eat certain foods because I have no teeth”; “I only have two teeth left, and I need them extracted”; and “They removed all my teeth but gave me nothing.”
Although empathy is an essential quality of health care professionals, it is challenging to walk in the shoes of a person who has adequate senses of smell and taste, and good swallowing capabilities, but is unable to consume the required nutrients because of chewing difficulty.
Our interprofessional team members are at work to quickly assist these neighbors and others in securing appointments with dental providers while educating them on alleviating temporary dental pain and maintaining good oral health. In our work with the community residents whom we call our “neighbors,” it becomes obvious that there are inadequate finances for dental coverage to prevent the dental decline of these individuals.
Poor oral health, leading to poor nutrition, negatively affects their overall health. Since disease in the teeth, gums, and other oral structures affects systemic health, dental neglect can result in infections that can spread to other parts of the body. The entire body can have difficulty fighting disease due to the infections in the mouth — this is particularly worrisome in an aging population that often has multiple medical diseases. It goes without saying that dental care in this population is important in efforts to keep the entire body and mind healthy.
Despite the reduced fees in the dental school, as well as grants that provide an additional discount, many times the neighbors still struggle with being able to afford required dental care. Living on a limited income simply does not leave funds for additional dental and medical care. Often, neighbors struggle with even the most minimal of medication co-pays, their costs in subsidized transportation, and the cost of food. Proper dental care is out of reach for most of this population. While most of the neighbors have Medicare and/or Medical Assistance, the cost of dentures or plates is not covered. Ultimately, the IPE team encountered barriers to securing dental treatments for the neighbors due to their limited finances. A long-term solution to this predicament is necessary.
One solution would be a “healthy teeth” program for older adults that would focus first on prevention through early education, and, secondarily, on availability of dental care. Such a program might be possible if those of us in the health care industry lent support to policies to provide funding for dental care via Medicare or Medicaid coverage. In fact, this increased dental coverage for older adults is being pursued by dental professionals and other organizations such as the Maryland Dental Action Coalition. Furthermore, consolidated efforts are needed to enable greater resources and funding allocated to dental care in our communities.
The University of Maryland, Baltimore (UMB) is attempting to provide a path forward through the IPE Care in Geriatrics Aging Place Program (PHMY 5011/CIPP 621) at the Peter Lamy Center on Drug Therapy and Aging in Baltimore. This is a 1- to 3-credit, graduate-level course that provides a model of education through a shared classroom of community members and interprofessional students from UMB; the University of Maryland, College Park; and the University of Helsinki, Finland. Students in audiology, bachelor’s and master of nursing programs, dental hygiene, dentistry, the doctor of nursing practice program, medicine, physical therapy, pharmacy, physician associate, social work, as well as gerontology trainees from the University of Maryland Graduate School participate in the program, working together to bridge the health disparities that older adults face. One of the goals is to assist the neighbors to age in place through collaboration with the UMB health professional schools, educational efforts as well as community partnerships.
Faculty, students, and trainees are partnering with UMSOD via weekly education sessions and one-on-one appointments open to all older adults in West Baltimore and beyond. These one-hour health-education sessions are held each Thursday at 1 p.m., with individual appointments scheduled for 2 p.m. More information on the IPE Care in Geriatrics Aging Place Program can be found at www.pharmacy.umaryland.edu/centers/lamy/clinical-initiatives/interprofessional-care-in-geriatrics/
And find upcoming events at https://www.pharmacy.umaryland.edu/centers/lamy/events/ or call 410-706-2434.
Hopefully, the future will yield additional funding and advocacy efforts for comprehensive dental care for our neighbors in West Baltimore and beyond.
— Daniel Z. Mansour, PharmD, BCGP, FASCP, AGSF; Victor Olekanma, RN; Deborah Rodriguez, DDS, FACD; Scotti Hutton; Nicole J. Brandt, PharmD, MBA, BCGP, BCPP, FASCP
Disclaimer: Elm Voices & Opinions articles reflect the thoughts or opinions of their individual authors, and may not represent the thoughts or values of UMB as an institution.