New dental treatment helps fill cavities and insurance gaps for seniors – InsuranceNewsNet – About Your Online Magazine


DENVER – Dental hygienist Jennifer Geiselhofer it generally cleans the teeth of elderly patients who cannot easily reach the dental office. But until recently, if she found a cavity, there was little she could do.

“I can’t drill. I can’t pull my teeth,” said Geiselhofer, whose mobile clinic is called Dental at Your Door. “I would recommend that you see a dentist, but that was usually out of the question because of the mobility challenges. So, visit after visit, I would come back and there would be more cavities.”

But now Geiselhofer has a weapon to obliterate a cavity with a few strokes.

Silver diamine fluoride is a liquid that can be applied to teeth to prevent tooth decay. Fast, low-cost and pain-free, treatment is rapidly gaining traction across the country as the cavity treatment of choice for patients who are unable to obtain a filling easily, such as the very young or very old.

“It was life changing for my patients,” said Geiselhofer, who has been using the treatment for about 18 months.

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Geiselhofer was unable to go to nursing homes during the COVID-19 pandemic, but she uses the liquid on the elderly she visits in private homes. She also uses it to treat cavities of patients in shelters for the homeless, prisons and Start at the front programs – now using larger protective equipment, including gloves, surgical mask, N95 mask and face shield.

Topical medication is an especially good option for the elderly, dental experts say, because dental care remains a huge gap in health insurance coverage, despite poor dental hygiene being linked to heart disease and other health problems like diabetes and pneumonia. Medicare does not cover most dental care, and fixed-income patients are generally unable to pay for treatment. But due to the effectiveness and low cost of silver diamine fluoride, more state Medicaid programs now cover it – and older adults who pay out of pocket can pay for it immediately.

Silver diamine fluoride has been used in other countries for decades and studies have proven it to be safe. Its biggest disadvantage is that it makes the deteriorated area black permanently – a deviation, in particular, for people with caries on a front tooth.

Dental service providers say black stains can be covered with tooth-colored material at an extra cost. For older adults, Geiselhofer said, a dark spot is a small price to pay for a treatment that stops cavities quickly, without the need for drilling, a needle stick or going to the dentist.

Silver diamine fluoride was approved by the Food and Drug Administration in 2014 to reduce tooth sensitivity. But its off-label use to treat cavities was quickly adopted. It made headlines as a trauma-free treatment for cavities in children under 5 years old.

Pediatric dentists have adopted it as a solution for children who cannot sit for treatment and whose parents wish to avoid general anesthesia. In 2018, the then president of American Academy of Pediatric Dentistry, James Nickman, said that in addition to fluoridated water, the topical cavity fighter “may be the biggest innovation in pediatric oral health in the past century.”

But today, with more older Americans maintaining their natural teeth than in previous decades, the treatment is also serving as a blessing for a different generation. Because of insurance gaps and the prohibitive cost of most dental treatments, many elderly people miss preventive care to prevent cavities, putting them at risk for dental illnesses that can trigger serious health problems. About 27% of Americans aged 65 and over have untreated cavities, according to the Centers for Disease Control and Prevention.

Residents of long-term care facilities are at particularly high risk, studies show. The drugs dry out the mouth, promoting decomposition. They may also have cognitive problems that make good oral care difficult. And many are too fragile for traditional dental treatment or too weak to be transported.

Take an 87 year old Ron Hanscom, for example. A Geiselhofer patient, he was in a Denver nursing home since he had a stroke six years ago and needs a mechanical elevator to get in and out of his wheelchair.

On a visit to Hanscom’s nursing home earlier this year, before the pandemic, Geiselhofer saw a cavity under one of his crowns. After consulting her dentist, she used a small brush to paint the silver treatment.

“It is a good thing that she has the silver, because I was unable to go to the dentist’s office – no way,” said Hanscom. “She did it right in my room.”

Across the country, dental hygienists provide much of the care to patients like Hanscom who might otherwise never go to the dentist. They also serve patients in shelters for the homeless, schools, prisons and low-cost medical clinics. Since the pandemic struck, Geiselhofer said she has received a flurry of home care requests from elderly people who are too nervous to go to the dentist’s office, but she declined because she is too busy caring for poor people.

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

Since silver treatment is relatively new in this country and can leave a stain, the Colorado the state legislature passed a law in 2018 that says hygienists must have an agreement with a supervising dentist to enforce it. The law also requires them to receive special training in how to use the liquid, which at least 700 hygienists from across the state have completed.

Other states, including Maryland and Virginia, have no special requirements for the application of caries treatment, but require some supervision from a dentist, said Matt Crespin, president of American Dental Hygienists’ Association. In these places, hygienists apply it under the same rules that govern the application of other fluoride products.

Studies show that silver diamine fluoride stops caries in 60% to 70% of cases with one application. A second application six months later increases the effectiveness of long-term treatment to over 90%.

In addition to killing cavity-causing bacteria, the treatment hardens the tooth structure, desensitizes the tooth and even prevents the formation of new cavities. Applying the liquid to the exposed root surfaces of older adults once a year is “a simple, inexpensive and effective way” to prevent cavities, a 2018 study concluded.

One of the most important benefits of application in older patients is that the liquid can reach the caries that form under existing dental treatments, such as crowns and bridges, said the dental hygienist Michelle Vacha, founder of Community Oral Health, who runs clinics in Colorado Springs and Pueblo, Colorado.

Previously, a dentist would have to remove the crown, drill the cavity and make a new crown – a traumatic and time-consuming procedure with a typical cost of $ 1,000 or more, said Vacha. Unable to bear the cost, many patients would have their teeth pulled out.

The paint liquid is significantly cheaper than traditional treatment. Estimates vary, but a private dentist may charge $ 10 for $ 75 for an application compared to $ 150 for $ 200 for a filling. Hygienists generally pay lower fees. At Vacha community clinics, the cost is $ 10 a tooth.

About half of state Medicaid programs now reimburse treatment, he said Steve Pardue, Elevate scientific officer Oral hygiene which distributes Advantage Arrest, the main topical drug brand for national use. Refund rates vary from $ 5 for $ 75 per application.

More private insurers – about 20% to 30% of them – have also started to cover it, said Pardue.

A small but growing number of conventional dentists have started offering treatment to all patients, not just the youngest and the oldest.

It is a good option for those who are anxious about dental treatment or concerned about costs, said Dr. Janet Yellowitz, director of geriatrics and special care dentistry at University of Maryland School of Dentistry.

A 2017 survey by American Dental Association found that almost 8 out of 10 dentists had never used the treatment. The ADA doesn’t have the latest stats, but ADA spokesperson Matthew Messina anecdotal reports indicate that usage is increasing dramatically.

Yellowitz noted that dentists still have a financial incentive to drill and fill. She made presentations highlighting the benefits of the silver solution at national conferences.

“We are trying to get everyone to use it,” she said. “It is a slow process because we are asking dentists who have been trained throughout their careers to do things in a way that completely changes their mindset. It is like asking them to go to another country and drive across the road.”

Distributed by Tribune Content Agency, LLC.

Legend: Silver diamine fluoride (SDF) is a topical medication that is applied to teeth to contain cavities.

Courtesy of Jennifer Geiselhofer/ TNS



Paula Fonseca