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4 tips for serving older patients

Photo of Dr. Michael Tarighati smiling while wearing a blue dress shirt, navy tie and white lab coat.
Dr. Michael Tarighati

As your patients get older, factors beyond brushing and flossing play a significant role when it comes to maintaining a healthy smile. In 2019, there were about 54.1 million people (PDF) aged 65 and over in the United States. By 2040, that number is expected to reach almost 81 million.

We spoke with Dr. Michael Tarighati, our dental consultant with advanced training in geriatric dentistry, about how best to serve this population. Here are four tips he shared that will help your patients in their golden years. 

Know the unique circumstances of all of your patients

Each of your patients is unique, and so are their wants and needs.Take time to listen to your patients and understand what’s important to them before offering treatment recommendations. Provide options in best, better and good categories. Make sure all their questions have been answered and that they understand the proposed treatment recommendations by having them repeat the treatment back to you.

Once you have a better understanding, you can:

  • Appropriately schedule them for treatment. Most older patients take a variety of medications, such as Glucophage (metformin) for diabetes and to avoid hypoglycemia, so it’s often best to work on them in the morning hours. Make sure you give these patients breaks in between treatment and don’t book lengthy appointments.
  • Have patients disclose their medications to be aware of potential side effects. Antihypertensive medications, such as beta blockers, can cause dry mouth (xerostomia). Antiseizure medications, such as Dilantin (phenytoin), can cause gingival hyperplasia. Sugars in over-the-counter medications can cause tooth decay. Always cross check potential drug-drug interactions.
  • Watch for early warning signs of chronic conditions. Many conditions, such as diabetes, may present orally before patients begins to experience other symptoms. Through comprehensive intraoral exam, you’ll become aware of such issues before your patients do. As an example, most diabetic patients are susceptible to Class V lesions near the gingival margins. Regular oral evaluations can rule out oral cancer, as well as detect suspicious lesions, sore spots or root caries.

Think about care beyond the dental office

Americans over 65 are keeping more of their teeth, but this has given rise to new challenges. Because of this, it can be useful to think about how you can help patients manage their oral health at home.

  • Ask patients about their diets. Use a diet questionnaire to make sure that patients are eating a balanced diet that is supplemented by vitamins where necessary. Vitamin B-12 deficiency is prevalent in this age group and can cause angular cheilitis and soreness on the corners of the lips.
  • Provide written home care instructions. This is especially important for removable and complete denture appliances.Make sure each prosthesis is labelled on the intaglio side.
  • Recommend tools to better assist patients with their oral health. Recommend electric toothbrushes for patients with arthritis, prescribing toothpaste with 5,000 PPM fluoride and recommending dry mouth relief lubricants as appropriate.

Make caregivers and helpers part of the conversation (with  permission!)

Many adults 65 and older will need some form of long-term care services in their lives. About 80% of this care is likely to come from volunteer sources, such as friends or family. These caregivers may be a valuable resource when it comes to helping your patients, as they can provide insight into schedules, at-home routines, mental, emotional, and physical well-being and more.

In cases where a patient is transported to your office by an assisted living facility or nursing home, make sure to communicate the patient’s treatment plan (including alternative options), procedure details and post-operative instructions in a simple, written format. If a patient has a legal guardian, including one assigned by the state, communicate their care information and obtain the guardian’s consent before proceeding with the treatment. If such a patient doesn’t have a legal guardian, be sure that a signed informed consent is on file. To stay in compliance with the Health Insurance Portability and Accountability Act, don’t share such information with anyone else unless agreed to by the patient.

Emphasize accessibility

Making your practice accessible is especially important for aging patients. With the right technology and some consideration, you can make it easy for everyone to get the care they need.

  • Make the most of technology. Aim to make your website more accessible for patients with screen reading software, using larger fonts, alt-text descriptions for images and the thoughtful use of color and descriptive text for links. You can also offer teledentistry consultations with services like Delta Dental – Virtual Consult. Many older adults have smartphones and are used to using them, but you should still make sure to explain the installation of the application so that patients can get the most from its features. Be patient, as some individuals may need extra assistance with technology.
  • Consider the needs of your hard-of-hearing patients. Speak slowly, clearly, and directly to make it easier for them to read your lips. Allowing appointment scheduling by text, email, or social media can also make it easier for patients with hearing loss to communicate with you.
  • Make information accessible to blind and low-vision patients. When caring for patients with vision loss, verbally state any information they should know, such as your name and what procedures you will be performing.

Finally, for every patient, don’t forget to tell them about online resources such as the Grin! newsletter and the wellness library! These resources are full of informative articles that cover tips for maintaining oral health, overall wellness and more.

Explore the benefits of teledentistry

You probably already know that interest in teledentistry has risen greatly over the past few years, especially in the wake of the COVID-19 pandemic. But now that people are returning to their normal lives, there’s no reason to discontinue virtual exams. Televisits are here to stay and can be convenient for both patients and dentists.

Advantages of virtual dentistry for dentists

When you implement teledentistry in your practice, you can see your patient base and revenues increase. You’ll also enjoy:

  • Efficiency. You can reserve televisits for more minor issues and checkups while seeing patients with more serious concerns in the office. And since virtual dentistry appointments average about 10 minutes, you can see more patients than you can in-office visits.
  • More revenue. Fitting in more appointments means more revenue coming in. Also, patients who set up a televisit with you are more likely to see you for in-person procedures as well, which can mean more business. It’s also easier to schedule patients for second opinions, which can be a new revenue stream.
  • Safety. Dentists and hygienists are exposed to many infectious diseases every day. With televisits, there’s no infection risk.
  • Reduced costs. The more patients you see remotely, the less personal protective equipment (PPE) you’ll need to use, which means a reduction in supply costs.

Advantages of virtual dentistry for patients

Patients benefit from the convenience of seeing you straight from their location, which means minimal time away from work. They’ll also be less anxious, and it increases access to many disadvantaged groups who may not have previously sought dental care, including homebound patients and people with disabilities.

Delta Dental’s internal data shows there are still patients who aren’t fully utilizing their teledentistry benefits, so this is an untapped market. The service is available to 37 million Delta Dental enrollees as a covered benefit.  A 2021 McKinsey & Company study showed that around 40% of surveyed consumers said they would continue using telehealth going forward. This is up from 11% before the pandemic.

How to get started with teledentistry

Delta Dental’s Virtual Consult allows patients to schedule live (synchronous) virtual video visits with a dentist. You’ll be able to assess their issue, offer treatment (including medication) and schedule follow-up visits.

Delta Dental will provide you with a free software platform to conduct these teledentistry sessions.

If you’re interested in learning more about the Virtual Consult program, just fill out the online form and we’ll contact you about getting started.

5 surprising facts about teledentistry

It’s no surprise that the pandemic has brought a resurgence of interest in teledentistry. Even during lockdown, video conferencing platforms allowed dentists to have safe real-time interactions with patients.

But here are a few interesting facts about virtual dentistry you may not know.

The idea has been around for a long time

We tend to think of telehealth and teledentistry as recent innovations, but the notion of providing care remotely has actually been around for quite some time. An 1879 article in the medical journal The Lancet was among the first to describe the use of the telephone to reduce unnecessary office visits. And in 1925, the magazine Science and Invention speculated about how physicians might one day use radio and video technologies to diagnose patients.

The first major use of teledentistry as we know it was in 1994 by the Department of Defense, which started a teledentistry program called Total Dental Access. The program enabled referring dentists from the U.S. Armed Forces to consult with specialists on the status of patients. It demonstrated that teledentistry could reduce total patient care costs and extend dental care to distant and remote areas.

Nearly a quarter of dentists in private practice have used it

Polling data from the American Dental Association Health Policy Institute indicated that 24% of dentists in private practice were using and billing for teledentistry during the period when elective care was postponed due to the pandemic. Although that number has since gone down, the National Institute of Health suggests that the advent of COVID-19 nonetheless accelerated the adoption and use of teledentistry overall. Delta Dental likewise found that while the teledentistry peak in 2020 has dropped off, the usage of teledentistry in 2021 remained higher than before the pandemic. An American Dental Association survey showed that pediatric dentists and orthodontists are the specialists who use teledentistry the most.

Patients like it

It goes without saying that video technology can never replicate the experience of sitting in an actual dentist’s chair for a consultation. And of course, there are many procedures and evaluations that will probably never be done through teledentistry.

Nonetheless, patients tend to be satisfied with the sorts of care that they’re currently able to access through teledentistry platforms. A recent study found that patients’ satisfaction level with teledentistry services during the COVID-19 pandemic was 100% in the satisfied and very satisfied categories, with contributing factors being convenience and communication.

Another study found that most patients (89%) were satisfied with a virtual appointment. Satisfaction rates were high among all age groups, and the majority of patients were willing to recommend the use of digital, remote counseling instead of in-person appointments to their family and friends.

Teledentistry is a big growth market

You probably already know that teledentistry is growing, but the numbers may still surprise you.  In 2019, the global teledentistry market stood at a little more than $667 million. Before the decade is out, the market is expected to reach $2.6 billion.

Delta Dental offers a free teledentistry platform

Delta Dental offers a free-to-access and easy-to-use teledentistry platform for virtual appointments, Virtual Consult. Available to you as a Delta Dental network dentist, Virtual Consult is a secure and HIPAA-compliant video platform that allows real-time face-to-face interactions with your patients.

You can connect to Virtual Consult online through any computer or iOS mobile device. Screen, assess and provide aftercare instructions (including e-prescriptions to manage pain and reduce risk of infection) to patients covered by Delta Dental PPO™ and Delta Dental Premier®.

Limited oral evaluations conducted through Virtual Consult are submitted to Delta Dental the same as in-office claims, so you don’t have to worry about learning a complicated new billing system.

Enrollment is easy. To get started, fill out the Virtual Consult interest form, and we’ll reach out to you.

How teledentistry can bring value to your practice

Since the start of the COVID pandemic, the use of teledentistry has increased significantly. This has created intriguing — and potentially lucrative — opportunities for dental practices. Are you taking full advantage of this new technology? Dr. Daniel Croley, Delta Dental’s chief dental officer, explains how.

In his new Dental Economics magazine article, “The value teledentistry visits bring to dentists and their patients,” Dr. Croley talks about the intrinsic value of teledentistry, the various types of teledentistry and how teledentistry can bring value to your dental practice and patients.

It’s no surprise that the pandemic accelerated the adoption of telehealth across the medical and dental spheres. As dental offices learned to navigate lockdown measures, extended safety protocols, and assuaged patients’ fears of becoming exposed to the virus via the dental office, virtual care has only scratched the surface of its potential in teledentistry. The market is expected to reach $2.6 billion by the end of the decade.

Dr. Daniel Croley 

Read the full article in Dental Economics.

What’s ahead for dentistry in 2022 and beyond?

The arrival of COVID-19 followed by the rapid development of vaccines created a bumpy, unpredictable couple of years for the field of dentistry. That turbulence has left everyone in the industry wondering and worried about what’s ahead in 2022. Here are our thoughts about what lies ahead for the field of dentistry next year and beyond.

1. Staffing will remain a major issue in the wake of the pandemic

The arrival of COVID-19 brought huge changes to nearly every aspect of American life, and dentistry was no exception. From the total suspension of non-emergency dental care at the peak of the outbreak to the adoption of updated infection control practices, the pandemic has had a major impact on the dental profession. It’s safe to say we’ll continue to see and feel the reverberations throughout 2022.

While more and more patients are returning to the dentist for routine care and other procedures, almost half of dentists report that hiring new staff post-outbreak is the No. 1 factor limiting volume. A poll from the American Dental Association found that 35.8% of owner dentists are currently recruiting dental assistants, 28.8% are seeking dental hygienists, 26.5% are looking to hire administrative staff and 13.1% are in search of associate dentists.  More than 85% of these dentists said that hiring for a position like dental hygienist was much more challenging than before the pandemic.

This disparity between staffing and volume won’t be soon or easily resolved, and we predict it will be one of the major issues for dentistry in 2022. 

2. Teledentistry will continue to grow

Teledentistry understandably picked up steam during the pandemic. Services like Delta Dental’s Virtual Consult  provide easy and safe access to dental care.

An analysis of Google trends published by the Journal of Clinical Medicine found a five-time increase in query rates for “teledentistry” during the COVID-19 pandemic. Any new growth is somewhat restricted by teledentistry’s limitation to triage and advice. Nonetheless, according to DocASAP’s annual State of Patient Access and Engagement survey, 40% of people would switch health care providers based on availability for both telehealth and in-person visits. Teledentistry is having a moment, and it’s likely to last into 2022 and beyond.

3. New tech will continue to reshape the industry

Dentistry is a field that’s defined by innovation. Some of the technologies we’ll have our eyes on for growth in 2022 and beyond include:

  • Augmented reality. AR has found a home in dentistry for both educational and clinical purposes. But look for it to become more and more prevalent in reconstructive and aesthetic procedures in the near future. AR apps use a digital camera to overlay virtual depictions of an improved set of teeth prior to a procedure. This allows patients and dentists to configure features such as height and spacing to their liking before they even enter the surgery room.
  • Virtual reality. VR completely closes off the outside world with a dedicated headset and immerses the user in a virtual environment. By slipping such a headset on their head, students and aspiring dental surgeons can be transported to the operating room, or patients can visualize a calming landscape while seated in the dentist’s chair to improve their experience.
  • 3D printing. As this technology is set to become an integral part of many healthcare practices, it’s also becoming more and more incorporated into dental labs. With a 3D printer doing the hard work, dental labs can eliminate the bottleneck of manual modelling and quicker creation of crowns and bridges.
  • Chatbots. Up to 80% of customers’ frequently asked questions could be answered by a chatbot, according to estimates by IBM. It’s no wonder that the healthcare chatbot market is expected to reach $967.7 million by 2027. Chatbots can streamline inquiries and save office staff time by answering routine questions and even scheduling appointments. The technology has the potential to save businesses up to $8 billion in 2022, according to IBM.
  • Appointment confirmation software. Like chatbots, appointment confirmation software automates a previously time-intensive process prone to error and neglect. Many appointment confirmation software systems even offer patients the option to make their own appointments. In 2022, look for confirmation software to continue to integrate with online payment, virtual dentistry and other office and data collection software.

4. Dentistry will get greener

Dentistry is an energy- and resource-intensive field with a significant environmental impact. Dental practices discard approximately 680 million chair barriers, light handle covers and patient bibs, as well as 1.7 million sterilization pouches each year, according to the Eco-Dentistry Association. Many dentists are responding to concerns over the practice’s carbon footprint, and patients are becoming more likely to choose environmentally conscious practices. The industry continues to respond to providers’ and patients’ concerns about the environment, with new high-tech innovations often allowing for waste reduction. In 2022 and beyond, we predict that more dental practices will seek ways to reduce pollution and to serve the wellness lifestyle that more patients are choosing.

COVID-19 by the numbers

The early days of the pandemic brought a tidal wave of changes to the dental industry. Doubtless you felt the impact on your practice’s day-to-day operations. Here’s a high-level view of the way COVID-19 impacted patients, dentists and the dental insurance industry based on claims data, patient surveys and expert opinion.

The rise of teledentistry

During the early stages of the pandemic in the United States, dental offices were closed for weeks. This led to a massive surge in the popularity of teledentistry services.

Synchronous appointments (those with live phone or video interaction between dentists and their patients) saw a 3,000% increase between 2019 and 2020, according to Delta Dental claims during that period. Asynchronous appointments (where patients took photos or videos that were sent to a dentist for later review) saw a 1,000% increase in the same time period.

The use of teledentistry has declined as the pandemic has worn on and dentist offices have reopened, but 2021’s synchronous and asynchronous appointment numbers still remain six times and two times higher than 2019 levels, respectively.

More states also updated their teledentistry laws during the pandemic. Based on Delta Dental’s internal tracking, fourteen states added teledentistry regulations to their laws or expanded existing regulations, including states like Texas, which had previously not allowed the practice of teledentistry at all.

Most importantly, in a phone survey of teledentistry patients during the pandemic, patients expressed widespread satisfaction with their options. This aligns with pre-pandemic expectations that patients had about teledentistry. Of those surveyed before the pandemic, 78% expected to use teledentistry within the next five years, and that working people, children and people with disabilities would benefit the most from teledentistry.

Dentists also had praise for teledentistry, with over 80% of dentists nationwide identifying it as useful for improving access to oral care, increasing specialists’ access to rural and underserved communities and as a time-saving technique. Virtual visits may not replace in-person checkups, but they remain a valuable tool in your arsenal.

Mitigating the costs of COVID

The beginning of the pandemic was marked by profound economic uncertainty as dental practices closed and patients sheltered in place. General practitioner income dropped nearly 18% in 2020 compared to 2019.

Fortunately, Delta Dental was able to assist with loans, reimbursements for personal protective equipment (PPE) costs and free teledentistry tools that allowed dentists to see patients remotely.

Loans offered in partnership with Provide (formerly Lendeavor) allowed dentists to make practice acquisitions, expand to new locations, purchase commercial real estate and equipment, build out their practices and refinance existing practice and commercial real estate debt. These loans featured favorable terms and conditions, like covered interest for up to 24 months, deferred payments for six months, repayment terms of 10+ years and working capital of up to $200,000.

Delta Dental also offered a supplemental reimbursement for qualifying evaluations and consultations during the second half of 2020. This Return to Care reimbursement led to an additional $80 million for dentists last year to help offset the costs of PPE and enhanced office sterilization.

As another way of helping dentists deal practice safety, two teledentistry options were rolled out: Delta Dental – Virtual Consult and Toothpic.

  • Virtual Consult is a synchronous service where members can use a smart device to have a live video chat with a Delta Dental dentist.
  • Toothpic is an asynchronous service that allows members to take photos of problem areas and get an assessment from a Delta Dental dentist within 24 hours.

As a network dentist, you can join for free to grow your patient base and to assist patients who may have difficulty making it to in-person visits.

How patients used their benefits

The early stages of the pandemic saw a sharp decline in the number of patients going to the dentist’s office. One of the main reasons for the decline was that the sharp economic shutdown led to over 20 million Americans losing their jobs and their dental coverage as well.

This decline in visits to the dentist office had a profound effect on patients’ oral health. In 2019, the most common procedures according to Delta Dental claims data were either diagnostic and preventive care or evaluations for specific issues. This shifted in 2020, when the most common procedures included fillings and root planing, which help address the effects of dental neglect.

In addition to economic hardships, COVID also increased mental and emotional strain. Since the pandemic began, the number of adults reporting symptoms of anxiety or depressive disorders has risen from about 10% in 2019 to over 40% in 2021.

These symptoms can manifest in jaw clenching and teeth grinding. Based on Delta Dental claims data, the number of patients requiring occlusal guards to prevent damage from bruxism rose nearly 10% in the second half of 2020 compared to the same period in 2019.

Anxiety and depression can also worsen an unhealthy diet or substance abuse, which can lead to oral health issues such as cavities. This may also help to explain the surge in fillings and scaling and root planing procedures in 2020.

Health and safety in the dental office

Even though COVID-19 is spread by exhaled aerosolized droplets, visits to the dentist’s office proved safer than visiting any other medical professional during the pandemic. 

Nearly 100% of dentist offices rapidly adopted enhanced infection control measures like pre-appointment screenings, in-office air purification and antiviral mouthwashes. 

Once available, vaccines saw widespread adoption among dentists, even before state and federal mandates. By fall 2021, over 94% of dentists had received at least one vaccination shot for COVID-19.

Patients also view dentists as valuable sources of information about their overall health in addition to their oral health. Two-thirds of dentists reported receiving questions from patients about the COVID-19 vaccine, according to the American Dental Association. 

Dentists rose to the occasion, with over 80% reported feeling prepared for these discussions and 95% who said it was important to have such discussions with patients.

What did we learn from COVID-19?

Here are three key takeaways for you and your practice as you look to the future.

  • Develop contingency and resiliency plans for your practice. Even if we don’t see another global pandemic within our lifetimes, disruptions from natural disasters like hurricanes, earthquakes and wildfires remain a possibility. Discussing emergency plans with staff ahead of time can help everyone to feel more secure and prepared when crises arise. Be sure to follow the news, Delta Dental and professional organizations to learn what resources are available to help your practice mitigate the costs of disasters.
  • The right tools and technology can mean the difference between staying open and having to close. Patients will come to your office if they feel safe doing so, but the right resources can empower your more hesitant patients. Invest in effective and visible infection control measures to let patients understand that your practice is taking steps to ensure their well-being. For patients who simply don’t feel safe coming into the office, teledentistry can provide you with another way to stay in touch with your patient base — and even grow it.
  • Make the most of your status as a trusted health professional to your patients.  It can be easy for patients to compartmentalize their oral health from their overall well-being. As a health professional, your opinions and advice are especially important for patients who may be getting information from misinformed or unreliable sources like social media. Advising on wellness and current topics, such as the safety and efficacy of vaccines, can go a long way towards building lasting relationships with your patients and your community. Explore ways to foster trust with patients who may have concerns for their safety, come from a different cultural background than you and your staff or may simply benefit from feeling seen and heard.
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