Oral health disparities among the 65+ age group

Objective: Oral and dental health significantly impacts the quality of life and nutrition of the older population. While government action has been taken in Israel to reduce barriers to using dental care services by welfare recipients among older adults, there are still disparities associated with socioeconomic status in the older adult population. In 2019, a dental care reform for the older adults was implemented in Israel assuring dental Universal Health Coverage (UCH) for them. This has improved accessibility to dental services and reduced cost barriers. The aim of the present article was to explore the oral health disparities among the 65+ age group by their socioeconomic situation, and their additional barriers to using dental services at the start of the reform.
Method and materials: Telephone interviews were conducted with a representative sample of 512 older adults aged 65+ from February to April 2020.
Results: The self-perceived oral health status was rated as better in the higher socioeconomic group (73.4% perceived their oral health status as good or very good), compared with the lower socioeconomic group (52.5%). In the lower socioeconomic group, 38.5% were edentulous, compared with 18.1% of the higher socioeconomic group. The latter group had four more natural teeth, on average, than the former. Regarding the prevalence of dental problems, double and triple gaps were also found, as well as loose, sore, and sensitive teeth, and difficulty chewing. Oral health behavior, as reflected in tooth brushing patterns and routine preventive check-ups, was found to be better in the higher socioeconomic group than in the lower socioeconomic group. Dental care costs were found to be a barrier to dental care, primarily in the lower socioeconomic group (18.2%, compared with 4.8% of the higher socioeconomic group, were faced with a financial barrier). At the same time, 66.7% of the higher socioeconomic group were aware of the inclusion of dental care services for the older adult population in the basket of health services provided by the health plans, compared with 27.8% of the lower socioeconomic group.
Conclusions: Lack of awareness to proper oral health behavior and to their legal rights were the main barriers to dental care in the lower socioeconomic groups. Dental practitioners play a vital role and have an opportunity to lower these barriers. Existing disparities and barriers should be monitored as a vital part of including dental care in Universal Health Coverage.