“I can’t drill. I can’t pull a tooth, “said Gieselhofer, whose mobile clinic is called Dental at Your Door. “I think they would recommend seeing a dentist, but this was often out of the question due to mobility challenges. So after the trip, I will come back and there will be more caries.”
But now Giselhofer has a weapon to destroy a cavity with some brushstrokes.
Silver dimine fluoride is a liquid that can be painted on teeth to prevent caries. Fast, low cost and pain-free, treatment is rapidly gaining nationwide momentum as the cavity treatment of choice for patients who cannot easily fill one, such as the very young or the very old.
“It’s life-changing for my patients,” said Geisselhofer, who has been using the treatment for about 18 months.
Geiselhofer is not able to go to nursing homes during the COVID-19 epidemic, but she uses the liquid on older adults going to private homes. She also uses it to treat patients’ cavities in homeless shelters, prisons and Head Start programs – now wearing more protective gear, including gloves, a surgical mask, an N95 mask, and a face shield.
Dental experts say dental specialists are a particularly good option for seniors, as there remains a major decrease in dental health insurance coverage, as poor dental hygiene is associated with heart disease and other health problems such as diabetes and pneumonia is. Medicare does not cover most dental care, and often cannot provide treatment to patients on a fixed income. But due to the effectiveness and lower cost of silver dimine fluoride, more state Medicaid programs now cover it – and older adults who pay out can afford it outright.
Silver diamine fluoride has been used in other countries for decades, and studies have proven it to be safe. Its biggest downside is that it permanently blackens the decayed area – a turnoff, especially, for people with front-toothed caries.
Dental providers say that dark spots can be covered by tooth-colored materials for an additional cost. For older adults, Giselhofer said, there is a small price to pay for a treatment in a dark place that prevents cavities quickly, requiring no drilling, needle pricking, or a dentist.
Oral care is a problem for older adults
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 shock-free treatment for tooth erosion in children under 5 years of age.
Pediatric dentists have adopted it as a solution for children who cannot sit still for treatment and whose parents want to avoid general anesthesia. In 2018, the then president of the American Academy of Pediatric Dentistry, James Nickman, stated that, aside from fluoridated water, the topical cavity fighter “may be the biggest innovation in pediatric dental health in the last century.”
But today, with more than decades of older Americans keeping their natural teeth, the treatment is also serving as a boon for a different generation. Due to insurance gaps and prohibitive costs of most dental treatments, many seniors miss preventive care to prevent dental caries, putting them at risk of dental disease that can trigger serious health problems. According to the Centers for Disease Control and Prevention, approximately 27% of Americans 65 years of age and older have untreated cavities.
Studies show that residents in long-term care facilities are particularly at high risk. Drugs dry their mouths, which promotes caries. They may also have cognitive issues that make it difficult to practice good oral care. And many are either too weak for traditional dental treatment or too few for transport.
Dental hygienists lead the way
For example, take 87-year-old Ron Hancom. A patient of Geisselhofer, he has lived in a Denver nursing home since he had a stroke six years ago, and needed a mechanical lift to get out of a wheelchair.
On a visit to Hanscom’s nursing home earlier this year, before the epidemic, Gieselhofer saw a cavity under one of his crowns. Upon examination from her dentist, she used a small brush to paint over the silver treatment.
Approximately 27% of adults have tooth decay. Dental hygienist Jennifer Gisselhofer treats seniors with silver dimine fluoride, a cavity-fighting alternative to a filling. (Jennifer Geisselhofer)
“It’s a good thing he had silver, because I couldn’t go to a dentist’s office – no way,” Hanscom said. “He did it right in my room.”
Across the country, dental hygienists provide a great deal of care to patients such as Hanskom who might otherwise never see a dentist. They also see patients in homeless shelters, schools, prisons and low-cost medical clinics. Since the epidemic, Geisselhofer said she has had a flood of requests for in-home care from seniors who are too nervous to go to the dentist’s office, but she has turned them down because she is a very populous people Is busy taking care of.
Many states allow dentists to work directly with patients in public health settings without a dentist’s supervision, and Colorado 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 state legislature passed a law in 2018 stating that hygienists would have to enter into an agreement with a supervising dentist to implement it. The law requires them to receive specialized training on the use of liquid, which has been completed by at least 700 cleaners across the state.
Other states, including Maryland and Virginia, do not have any special requirements to implement cavity treatment, but some supervision by a dentist is required, said Matt Crispin, president of the American Dental Hygienists Association. In those places, hygienists apply it under the same rules that govern the application of other fluoride products.
Stopping new cavities, too
Studies show that silver dimine fluoride decay stops in 60% to 70% of cases with one application. A second application after six months increases the long-term effectiveness of the treatment by more than 90%.
In addition to killing cavity-causing bacteria, the treatment hardens the structure of the teeth, sensitizes the tooth and even prevents new cavities from forming. Applying the liquid once a year on exposed parent surfaces of older adults is “a simple, inexpensive and effective way to prevent cavities”, a 2018 study concluded.
One of the most important benefits of the application on older patients is that the liquid can reach decay that builds up under existing dental work, such as crowns and bridges, said dental hygienist Michelle Wacha, founder of Community Dental Health, which Runs clinics in Colorado Springs. Pueblo, Colorado.
Before that, a dentist would have to remove the crown, take out the cavity and create a new crown – a painful, time-consuming procedure with a specific cost of $ 1000 or more, Vacha said. Unable to bear the cost, many patients will have teeth pulled instead.
Paint-on liquid is significantly cheaper than conventional treatments. Estimates vary, but a private dentist may charge $ 10 to $ 75 for an application, while one to fill is $ 150 to $ 200. Hygienists often have lower fees. At Wacha’s community clinics, the cost is $ 10 a tooth.
Nearly half of the state Medicaid programs now reimburse for treatment, said Steve Pardew, Scientific Officer at Elevate Oral Care, which distributes Advantage Arrest, the main brand of topical medicine used nationally. Reimbursement rates range from $ 5 to $ 75 per application.
More private insurers – about 20% to 30% of them – have also started covering it, Perdue said.
Coming to a dentist near you soon?
A small but growing number of mainstream dentists have started offering treatment to all patients, not just the youngest and the oldest.
This is a good option for those who have concerns about dental work or worry about costs, Drs. Janet Yelitz is the director of geriatric and special care dentistry at the University of Maryland School of Dentistry.
A 2017 survey by the American Dental Association found that about 8 in 10 dentists had never used the treatment. The ADA does not have recent statistics, but ADA spokesman Matthew Messina said critical reports indicate that usage is increasing dramatically.
Yelitz said dentists still have a financial incentive to drill and fill. She has made presentations at national conferences highlighting the benefits of silver solutions.
“We’re trying to get everybody to use it,” she said. “It is a slow process because we are asking dentists who have been trained for their entire careers to change their mindset completely. It is like asking them to go to another country and drive on the other side of the road. ”