10-17-2020 Retirement Living - Flipbook - Page 11
October 17, 2020
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 forms
under existing dental work such as
crowns and bridges, said dental hygienist
Michelle Vacha, founder of Community
Dental Health, which runs clinics in
Colorado Springs and Pueblo, Colorado.
Previously, a dentist would have had to
remove the crown, drill out the cavity and
make a new crown — a traumatic, timeconsuming procedure with a typical cost
of $1,000 or more, Vacha said. Unable to
afford the cost, many patients would
instead have the tooth pulled.
The paint-on liquid is significantly
cheaper than traditional treatment. Estimates vary, but a private dentist may
charge $10 to $75 for one application,
compared with $150 to $200 for a filling.
Hygienists often have lower fees. At
Vacha’s community clinics, the cost is $10
About half of state Medicaid programs
now reimburse for the treatment, said
Steve Pardue, scientific officer of Elevate
Oral Care that distributes Advantage
Arrest, the main brand of the topical
medication 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, Pardue said.
A small but growing number of mainstream dentists have begun to offer the
treatment to all patients, not just the
youngest and oldest.
It’s a good option for those who have
anxiety about dental work or concerns
about cost, said Dr. Janet Yellowitz, director of geriatric and special care dentistry
at the University of Maryland School of
A 2017 survey by the American Dental
Association found that almost 8 in 10
dentists had never used the treatment.
The ADA doesn’t have more recent statistics, but ADA spokesperson Matthew
Messina said anecdotal reports indicate
usage is increasing dramatically.
Yellowitz noted that dentists still have
a financial incentive to drill and fill. She
has made presentations highlighting the
benefits of the silver solution at national
“We’re trying to get everyone to use it,”
she said. “It’s a slow process because
we’re asking dentists who have been
trained for their whole careers to do
things one way to completely change
their mentality. It’s like asking them to go
to another country and drive on the other
side of the road.”
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promoting decay. They also may have
cognitive issues that make it difficult to
practice good oral care. And many are
either too frail for traditional dental treatment or too weak to be transported.
Take 87-year-old Ron Hanscom, for
example. A patient of Geiselhofer’s, he
has been in a Denver nursing home since
he had a stroke six years ago, and needs a
mechanical lift to get into and out of his
On a visit to Hanscom’s nursing home
earlier this year, before the pandemic,
Geiselhofer spotted a cavity under one of
his crowns. After checking in with his
dentist, she used a small brush to paint on
the silver treatment.
“It’s a good thing she had the silver,
because I couldn’t get to a dentist’s office
— no way,” Hanscom said. “She did it
right in my room.”
Across the country, dental hygienists
provide much of the care to patients like
Hanscom who otherwise might never see
a dentist. They also see patients in homeless shelters, schools, jails and low-cost
medical clinics. Since the pandemic hit,
Geiselhofer said she has received a flood
of requests for in-home care from seniors
who are too nervous to go into a dentist’s
office, but she has turned them down
because she is too busy caring for underserved populations.
Many states allow hygienists to work
directly with patients in public health
settings without a dentist’s supervision,
and Colorado is one of a few that allows
them to set up a completely independent
Because the silver treatment is relatively new in this country and can leave a
stain, the Colorado state legislature
passed a law in 2018 that says hygienists
must have an agreement with a supervising dentist to apply it. The law also requires them to get special training on
how to use the liquid, which at least 700
hygienists from across the state have
Other states, including Maryland and
Virginia, have no special requirements for
applying the cavity treatment but require
some supervision by a dentist, said Matt
Crespin, president of the American Dental Hygienists’ Association. In those
places, hygienists apply it under the same
rules that govern the application of other
Studies show silver diamine fluoride
stops decay in 60% to 70% of cases with
one application. A second application six
months later boosts the treatment’s longterm effectiveness to more than 90%.
In addition to killing cavity-causing
bacteria, the treatment hardens tooth
structure, desensitizes the tooth and even
stops new cavities from forming. Applying the liquid on the exposed root surfaces of older adults once a year is “a
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