D-E-N-T-A-L: A rapid self-administered screening instrument to promote referrals for further evaluation in older adults

Visits to the dentist by older adults are a more frequent now than in the past. Unfortunately, only 43% of Americans over the age of 65 visit the dentist at least once a year.(1) These visits are usually for routine preventive examinations and cleanings, but what about the others who do not make a habit of routine checkups? For those older adults who do not make routine dental visits, unmanageable pain in the oral cavity is usually the main motivator for a visit to the dentist. By the time pain is present, the disease has usually progressed to where it requires more invasive, costly, and complex dental treatment, which can be traumatic, both physically and emotionally, especially to those older adults who may be cognitively compromised or physically challenged. Delaying treatment may also exacerbate existing negative beliefs this population has regarding dental treatment. Several reasons for underutilization of dental services by older people are cited in the literature. The three mentioned most commonly are financial constraints, transportation difficulties, and lack of perceived need.(1-4) A survey of older Americans' reasons for not visiting the dentist in the last 12 months found the greatest responses were ''no mouth problem'' (31%) or ''no teeth'' (50%). Fear, cost, and access were cited by only 5% of those surveyed as barriers to visiting the dentist.(1) Verification that lack of perceived need is one of the greatest barriers to older adults seeking dental care was demonstrated by Holtzman et al.(5) Results indicated that key predictors of seeking dental services by older adults were dentate status and perceived need.(5) These findings, in concert with others regarding perceived need, highlight the lack of an appropriate vehicle for increasing the older adult population's awareness. Prevention of diseases, or halting their progression, are still the best remedy. The question then arises how do we encourage dental visits by this age group, Can we increase their self-perception of dental treatment needs which may be silently present? The solution must involve a screening instrument that is inexpensive, self-administered, easy to use, and the results of which are easily understood by the average lay-person. This could serve as a vehicle to increase care-seeking behavior. The aims of the D-E-N-T-A-L instrument are to examine the relationship between older adults self-perception of treatment needs compared with actual treatment needs and to educate this population about the signs of harmful dental conditions in the mouth.