UI College of Dentistry clinic specializes in dental health of geriatric, special needs patients

This story first appeared in Healthy You - November 2024, The Gazette’s quarterly health publication.

As one ages, it can be easy to overlook a major health concern right under one’s nose.

“As people age, their teeth have had a lot of years in their mouth,” said Dr. Jennifer Hartshorn. “They experience a lot of wear and tear on a daily basis, and there’s some upkeep. It sometimes gets a little harder to do your daily maintenance, you get a bit more (gum) recession. You have to be a little better at your cleaning than you were during your younger years.”

But thanks to a long-running University of Iowa program, dentists practicing in the state are more likely to recognize and address older patients’ dental health needs. The first of its kind in the nation, the Geriatric and Special Needs Clinic at the university’s College of Dentistry trains future dentists in the conditions specific to aging adults and those with developmental disabilities.

“It’s a background that every dentist should have,” said Hartshorn, clinical associate professor in the school’s Department of Preventive and Community Dentistry and director of the Geriatric and Special Needs Clinic. “If every dentist can do a little, it adds up to a lot. There are always going to be those patients that need that little bit of extra effort.”

Hartshorn’s students staff a mobile dental clinic that serves 10 Iowa nursing homes. Since 2019, all UI dental graduates have clinical experience treating patients who have mild cognitive impairment, mobility issues, and learning and physical disabilities.

“There was always that need for the care then, and it’s dramatically increased since,” said Dr. Howard Cowen, Delta Dental of Iowa Foundation’s professor in geriatric and special needs. He helped start the mobile clinic in 1982.

While about 40 percent of older Americans aged 65 and over were fitted with dentures in the 1980s, only about 16 percent wear them now, Cowen said.

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“People are keeping their teeth for a longer period of time, which is great,” he said. “But you get a bigger problem, which is now you have teeth you can’t take care of.”

“The people getting dentures these days are generally the less healthy patients, or the low-income patients,” Hartshorn said.

The diagnosis of rapid oral health deterioration (ROHD), a combination of symptoms and conditions affecting seniors’ dentistry, was developed by Cowen and his colleagues. It’s now a widely recognized condition.

“Anything that happens as you get older gets more difficult to recover from,” Cowen said. “One of the things in daily life that’s easy to forget about is your mouth.”

Seniors are more likely to take prescription medications, and Hartshorn said they should keep their dentist current on the ones they’re taking. Medications can change the chemistry of a patient’s saliva, which helps combat cavities.

“Someone who has normal saliva, they drink some sugar and the Ph (measure of acidity) in their mouth is back to normal in 20 minutes,” she said. “Someone on medication may not be back to normal in 90 minutes or longer. It’s a huge effect on cavities.”

“It also has a drying effect on gums,” Cowen said.

The dentist or hygienist may remind the patient to be more diligent at brushing and flossing. They might also apply a dye that colors the plaque on a patient’s teeth, an effective way to show special needs patients where their brushing misses.

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“They’re really good at getting it off, once they see it,” Hartshorn said. “Patients with special health needs may just need some assistance.”

Periodontal disease and gingivitis also affect the patient’s bloodstream, potentially enhancing the progression of dementia and other conditions, Cowen noted.

In addition to dental students, the clinic trains nursing home staff and workers who provide care to older Iowans. Keeping up with the need is a challenge, for both dentists and the senior care industry — where the mobile clinic once visited 26 nursing homes ranging from Grinnell to Burlington, it now serves just 10, visiting about every 18 months.

“All the nursing home shortages out there, it affects the administrators, the directors of nursing,” Cowen said. “(Staff are) not trained, and it’s such a big problem.”

The clinic worked with the Iowa Caregivers Association to develop a curriculum for staff, but many facilities are hard-pressed to schedule training, Cowen said.

“It worked fantastic, but you have to train the people,” he said.