In 2018, an estimated 9.4% (53,100) adults 65 years of age and older had all their permanent teeth extracted, a decrease from 2012 of 12.8%, according to the Connecticut (CT) Behavioral Risk Factor Surveillance System (BRFSS) report. [i] The percentage has steadily decreased from a high of 15.4% in 2002 to a low of 8.7% of 2010. Comparison between data collected in 2011 and later and that from 2010 and earlier should be made with caution, due to BRFSS weighting methodology changes and the addition of cell phone only respondents beginning in 2011.

Connecticut has participated in state-added oral health questions in the BRFSS in 1990’s. BRFSS is an ongoing state-based system of health-related telephone surveys that collects state data about CT residents regarding their health related risk-behaviors, chronic health conditions as well as use of preventive services. The survey asked oral health questions: whether respondents had visited the dentist or dental clinic for any reason in the past year; whether respondents ever had any of their permanent teeth extracted.

Many Connecticut's adults ages 65 and over are retaining all their permanent teeth than ever before, CT ranked third in the nation.[ii] Having teeth does not always mean having healthy teeth, as people age they become susceptible to oral conditions/diseases such as tooth decay and periodontal disease. Tooth decay, known as dental caries, and periodontal (gum) disease share common risk factors with other chronic diseases. 

The Office of Oral Health's (OOH) report: The Oral Health of Vulnerable Older Adults in Connecticut revealed cost was by far the most frequently cited reason why adults have had not visited a dentist in the past year. Addressing barriers such as limited access to routine dental care is an important focus for public health professionals to reduce the prevalence of having all their permanent teeth extracted among low-income older adults.

[i]. Connecticut Department of Public Health. (2018). Behavioral Risk Factor Surveillance System. Hartford. [ii]. Centers for Disease Control and Prevention. (2015). National Center for Chronic Disease and Health Promotion, Division of Population Health. BRFSS Prevalence and Trends Data. Retrieved November 03, 2017. 

These data are current as of April 2022. Anticipated date for next data update: December 2023.

Connecticut Department of Public Health; Connecticut Department of Social Services; Connecticut Department of Developmental Services; Local Health Departments; Office of Healthcare Reform and Innovation; State Department on Aging Long Term Care Ombudsman Program; Connecticut Coalition for Oral Health and its Workgroups; Connecticut Oral Health Initiatives; Connecticut Dental Health Partnerships; Connecticut Oral Health for Older Adults Consortium; American Dental Association; Connecticut State Dental Association; Connecticut State Dental Hygiene Association; Community Health Centers Association of Connecticut; Connecticut Hospital Association; University of Connecticut School of Dental Medicine; Community Service Providers Serving Children, Older adults, and Underserved Populations; Faith-based Organizations; Philanthropic and Research Organizations that Address Oral Health; Southwestern Area Health Education Center; Dental Insurance Providers.

Most oral diseases are preventable and treatments are cost-effective if diagnosed and treated early. The 2000 Oral Health in America: A Report of the Surgeon General identified significant disparities exist in the oral health status of older Americans and the resulting consequences to their overall health.

Previous literature documented that having all permanent tooth extracted and poorly fitting dentures may cause individuals to forgo nutritious food choices such as fruit and vegetables due to an inability to chew properly.[i] Meeting dietary recommendations may also be more difficult when a person’s ability to chew and consume healthy and nutritious foods is impacted by tooth loss.[ii]      

Maintaining a healthy mouth is a critical factor in maintaining overall health. Tooth loss effects quality of life, self-esteem and the ability to speak. Current research also indicates that there may be a correlation between poor oral health and many chronic diseases and other health conditions such as diabetes, cardiovascular disease, respiratory disease, and stroke.[iii]

Oral Health America (OHA) recommends that states adopt a strategic, and ideally legal, mandate for providing oral health care for older adults to ensure that services, as well as broader and more equitable payment systems, are created and applied. With a special emphasis older adults living in their homes or in a growing variety of assisted living, skilled nursing and long-term care communities. 

i. Nowjack-Raymer R, Sheiham A. Association of edentulism and diet and nutrition in US adults. J. Dent. Res. 2003; 82(2):123-126. [ii]. Walls AWG, Steele JG, Sheiham A, Marcenes W, Moynihan PJ. Oral health and nutrition in older people. J. Public Health Dent. 2000, Vol. 60(No. 4), pp. 304-307. [iii]. Susan O. Griffin, Judith A. Jones, Diane Brunson, Paul M. Griffin, and William D. Bailey. Burden of Oral Disease Among Older Adults and Implications for Public Health Priorities. American Journal of Public Health: March 2012, Vol. 102(No. 3), pp. 411-418.

Advocacy and Policy

1) Advocate for legislative change to ensure that vulnerable older adults receive the oral healthcare they need and more dental providers accept public insurance through maintained dental Medicaid reimbursement rates. Advocate that Medicaid for adults provide coverage for fluoride treatment without prior authorization and coverage for periodontal services, case management and coordination services.

2) Work with public and private dental insurers to ensure reimbursement for periodontal services, and case management care and coordination services, and a standard oral health package for older adults to include the following services: (a) yearly oral cancer screenings, (b) yearly dental examinations, cleaning and x-rays, (c) coverage for periodontal care and routine restorative care and extractions, and (d) dental appliances (i.e., dentures) with a clear and simple appliance replacement policy of no more than three years.

Communications, Education and Training

1﴿ Design and implement a culturally and linguistically appropriate oral health education campaign targeting specific audiences such as the public, older adults, families of older adults, and health and social services providers.

2﴿ Promote increased communication between medical and dental providers including physicians who care for geriatric patients, to improve the health management of older adults.

3﴿ Work with Certified Nursing Assistant ﴾CNA﴿ training programs to enhance oral health competencies for CNAs as part of their curriculum and certification.

4) Train providers and promote the multi-disciplinary team approach to recognize and assess oral disease and oral health concerns of older adults in order to develop appropriate care plans for oral health.

5) Promote the use of portable dental equipment and tele-dentistry in long‐term care facilities and other settings serving seniors to increase access to preventive and restorative care.

This indicators is part of the Healthy Connecticut 2020 (HCT 2020) State Health Improvement Plan (SHIP) that documents the health status of Connecticut residents and an indicator within priority area for Coordinated Chronic Disease Prevention and Health Promotion Plan.

The Healthy People (HP) 2020, a compendium of indicators selected by the federal government to track the nation’s progress towards year 2020 public health objectives identified oral health as a priority area. Tooth decay and tooth loss are key oral health indicators used to monitor oral health status in the U.S. and internationally. The Connecticut Oral Health Surveillance System (COHSS) is a state-based oral health surveillance designed for monitoring the oral health of CT population.[i] 

According to the U.S. Census Bureau, in CT the population of adults 65 and over has increased from 14.8% in 2012 to 16% (577,403) in 2017.[ii] This "Boomer Generation" effect will continue for decades.[iii] The state's older adult population-people ages 65 and older will grow to 782,848 in 2025, and is estimated to increase to 21% in 2025, from 16% in 2017.[iv] With increasing life expectancies, adults with disabling conditions are likely to spend a longer periods of time in long-term care facilities. Advancing age, limited access to routine care, inability to maintain good oral hygiene put older adults at risk for a number of oral health problems including pain, infection, loose tooth, severe tooth decay, and gum disease. 

These data calls for oral public health professionals to focus on educational opportunities for older adults and their caregivers, as well as, to support and advocate for policy changes that would benefit improving oral health in the older adult population.

[i]. Connecticut Department of Public Health. Office of Oral Health. (2017). CT Oral Health Surveillance System Report. Unpublished. [ii]. National Center for Health Statistics. (2017). Vintage 2016 postcensal estimates of the resident population of the United States (April 1, 2010, July 1, 2010-July 1, 2016, by year, county, and single-year of age, bridged race, Hispanic origin, and sex. Prepared uder a collaborative arrangement with the U.S. Census Bureau; released June 26, 2017. [iii]. U.S. Dept. of Commerce, U.S. Census Bureau. (2011) The older population: 2010 (Publication C2010BR-09). Washington, D.C. [iv]. Connecticut State Data Center at the University of Connecticut Libraries Map and Geographic Information Center - MAGIC. (2012). Connecticut State Data Center - Population Projections 2015 - 2025.