Little more than one-quarter and one-third of these rural older adults received regular dental care or recent dental care, respectively. Few of the edentulous older adults received regular or recent dental care. The levels of regular and recent dental care among the rural older adults in this study are far lower than that reported for older adults in the US and elsewhere. Most research has focused on recent dental care. For example, in 1999, 71% of dentate and 18% of edentulous US adults aged 65 and older reported a dental visit in the previous year.16
Using two panels of the National Health and Nutrition Examination Survey (1999–2002; 2003–2004), Wu et al.14
reported that 66.8% of adults aged 60 and older had received dental care within the past year, with 68.9% of white and 48.5% of African American older adults receiving dental care. Based on 1991–92 data, Browthwell et al.15
reported that 36.5% of dentate Canadian adults aged 65 and older and about 13.5% of edentulous Canadian adults aged 65 and older reported a dental visit in the previous six months. In a sample of English adults aged 65 and older, Lang and colleagues24
found that 69.9% received regular dental check-ups.
The majority of older adults (72%) remain “problem-oriented attenders” for dental care.11
Among dentate rural older adults, regular dental care is more common than among their edentulous counterparts, but about six in ten only seek dental care to address a problem. The lack of regular dental care (or any dental care) among edentulous rural older adults is a major concern. The lack of regular dental care among rural older adults in North Carolina mirrors results for Florida older adults a decade earlier.11
The consistency of these results suggests little improvement regarding access and utilization for dental care among rural older adults.
Predisposing and enabling factors were associated with receiving regular and recent dental care among dentate participants. Having greater resources, including higher educational attainment, having insurance, and having greater income, were associated with obtaining dental care. These results are similar to findings from the review by Kiyak and Reichmuth10
of barriers and enablers of dental service use among older adults. Similarly, the asset of having a regular place for dental care was also associated with obtaining regular and recent dental care. Older adults having a regular place for dental care in the communities in which this study was conducted is an asset; these counties have few dentists (1.7 and 1.8 dentists per 10,000 residents in 2008).20
In bivariate analysis, fewer minority than white older adults received regular dental care, and this is consistent with other studies.14,25,26
However, ethnicity was no longer a predictor of receiving dental care in multivariable analysis. Rather, education and a regular place for dental care were associated with receiving care, indicating that structural rather than ethnic factors are the primary factors driving dental care. This is similar to the situation reported by Wu et al.14
for national data.
Contrary to expectations of the Behavioral Model of Health Services, those with the least need (e.g., better self-rated oral health), received regular dental care. These results reflect earlier research documenting the Paradox of Dental Need: those with the greatest need are those least likely to receive care.12
It is clear that most dentate rural older adults in this study with poor oral health are not receiving regular or recent dental care. It is also clear that those not receiving dental care are those who most need care. Rural older adults without any teeth are receiving almost no dental care, yet they would benefit from regular care to ensure early detection of oral cancer and numerous other oral pathological soft tissue and hard tissue conditions, as well as optimizing the function and esthetics of existing prostheses. Human and financial resources are keys to increasing regular dental care among these rural older adults. Policy needs to address providing resources to older adults that will allow them to have access to dental care. For example, Medicare could be expanded to include regular dental care. County health departments could expand programs that educate older adults about the need for regular dental care
The results of this research should be considered in light of their limitations. They are based on a cross-sectional survey design; it is not possible to document causal relationships. The results are subject to the recall bias of the participants. The research was conducted in two rural southern counties; this may limit generalization of results to adults in other regions. However, the research includes a large, random, ethnically diverse sample. The survey is complemented by an oral examination, which provides results consistent with self-reported oral health status.
Among older adults, receiving regular dental care is less common than receiving recent dental care, but the factors associated with both types of care are similar. Community access to dental care and the ability of older adults to pay for dental care must be addressed by public health policy if we are to improve the health and quality of life of older adults in rural communities.