A 2015 article in Pediatric Dentistry noted that just 6 percent of American children had unmet dental care needs, but 15 percent of American children on the autism spectrum did not have their dental care needs met. The aging population worldwide faces similar challenges in receiving appropriate oral care. A scoping review published in 2021 in Nursing Ethics, focused mainly on the United States and Europe, found oral and dental care to be significant unmet needs of elderly people living at home and in long-term care settings.

With the Baby Boom generation now retiring, dental care for older Americans is likely to receive more attention. At present, scattered studies paint a dispiriting picture. A 2008 Canadian study found that only 31 percent of nursing home residents with teeth (rather than full dentures) had received dental care in the past year, and only 47 percent of community-dwelling adults 85 and older had. An alarming 47 percent of nursing home residents with teeth had root decay.

Lowering barriers

to care

Dr. Christina R. Carter, DMD, has a dental practice in Madison, N.J., 45 minutes from the Lehigh Valley. As a pediatric dentist, Carter has more training than a general dentist in caring for patients with special needs. She has built a practice particularly well equipped to break down barriers to care that exist for children with special health care needs.

“Many people, including many neuro-atypical people, have heightened senses,” Carter explains, so her waiting room is not over-bright, over-loud, or overstimulating to olfactory senses. There is low music – “almost like white noise” – but no video games, no scent diffusers, and no live flowers. Sunglasses are available for patients who find the lighting overwhelming.

Prior to their appointments, Carter sends her patients stories, illustrated with photos of her office and her staff, so that they can see, step by step, what will happen when they come to her practice. She has multi-patient rooms and single-patient treatment rooms, depending on the patient’s preference, and music can be silenced or adjusted. Children are booked for the same chair on each visit, so that they know what to expect.

“Dentists violate every sense,” Carter remarks, noting that a dentist enters a patient’s physical space, touches the patient’s mouth, uses tools that make noise, and uses products with distinctive smells and flavors. “We have to find a way to gently get into the patient’s world.”

One way she accomplishes this is to offer her patients sticks of lip balm, which both soothe dry lips and allow Carter to enter their space in a non-alarming way. Patients have a choice of flavors, including unflavored.

“First I’m putting my hand near them to smell, which causes [them to take a] deep breath,” she explains. “Then, I put it on their lips, and again, I’m in their space.”

Carter makes home care recommendations based on this same philosophy of accustoming patients to necessary invasions of personal space and doing the work necessary to maintain good oral health. She recommends products from Kutztown-based Radius (MadeByRadius.com), like specially angled brushes and organic toothpaste. The brushes have removable heads and large handles; their angled “shields” can function as retractors to ease a patient’s cheek away from the teeth for easier cleaning. “All my patients’ parents tell me, ‘This makes life so much easier,’” Dr. Carter says. “Whatever it takes to make life easier, that’s where we go.”

Improved technology

No one likes the pinprick of local anesthesia, but Carter has found that the delivery of a local anesthetic (commonly called “Novocaine,” but usually another, similar drug like bupivacaine) is less stressful with the new “wand” injectors that are more like a pen and less like a syringe. “We have ways of being as gentle and efficient – and distracting, if need be – as possible,” she says. Distractions include stress-reducing toys – “fidget spinners,” “pop-its,” or squeeze balls – and engaging patients in tasks like counting something.

Taking X-rays has also become easier. Carter uses a handheld device called a NOMAD that delivers a low dose of radiation and often doesn’t require the patient to bite down on anything. The patient’s caregiver can stand in the doorway, rather than having to leave the room and close the door, and the process is complete in a matter of seconds.

Special tools for special needs, and for special populations

There is a pediatric dental specialty, but no geriatric dental specialty, so it’s impossible to use the Pa. Dental Association’s search tool (padental.org/PDA22/PDA22/Directory/Find_a_Dentist.aspx) to find a dentist with credentials for treating elderly patients, patients with dementia, or patients with age-related oral issues. These credentials do not exist.

Families looking for dentists with a particular affinity for the geriatric population typically resort to word-of-mouth and the recommendations of friends. Whether an elderly patient sees a dentist who focuses on geriatrics or a general dentist, though, three main issues are particularly important: comfort, visibility and ease of care provision.

Cherie Le Penske, CEO of Armor Dental, spoke with the Press about her company’s game-changing soft retraction products, and how they help solve these key problems in oral care provision for all patients, especially elderly patients and those with special health needs.

Missing teeth, age-related or medication-associated xerostomia (dry mouth), and other oral issues make comfort a major concern for many elderly patients. Visibility is also an issue, particularly when a caregiver is brushing an elderly person’s teeth.

“You can’t brush well what you can’t see well,” Le Penske says.

Finally, creating a daily oral care routine and sticking to it is possible only when oral care is relatively easy to perform. Le Penske said she was stunned when she was told that many certified nurse assistants working in nursing homes and patients’ homes use a spongy tool that they simply run through a patient’s mouth. Armor Dental products are designed to be easy for caregivers to use and comfortable for patients, so they quickly become part of daily care routines and are not left out of CNA workflows.

Armor Dental has 10 patents and a line of soft retraction products to assist health care professionals, patients and caregivers in oral care visits and home care. Comfort Soft, for example, is a soft tissue retractor that dentists can use to pull patients’ cheeks away from their gums to see the teeth better and clean them more accurately, without the discomfort of a hard tool like a metal or plastic dental mirror. Dentists can use this product chairside, then autoclave (heat clean) it and send it home with the patient. Mouth Mate is a similar product designed for home use.

Le Penske knows that when oral hygiene is difficult – uncomfortable for a patient, or hard for a caregiver to do well – it can be neglected, and her company’s products are designed to minimize the difficulty of good oral care, in dentists’ offices and at home. Like Carter, she emphasizes the connection between good, regular home care and successful office visits.

“Connected health is so important,” she says. “How can we connect the clinician, what you’re doing with the patient in the office, with what they’re doing at home?”

Caregivers brushing a patient’s mouth may struggle to see the back teeth or the top teeth, and are essentially “brushing blind.” Le Penske recognizes that “caregivers don’t have it easy when they’re brushing for someone else.” She adds that even patients who can brush their own teeth, but need better visibility, can benefit from using soft retraction tools.

Health care professionals can find Armor Dental products in bulk at the company’s website (www.Armor-Dental.com); individuals interested in single items can contact the company’s support team at info@armor-dental.com.