Ageism in Dentistry

Rev. Beth Long-Higgins 00:07
Hello and welcome to the Art of Aging part of the Abundant Aging podcast series from United Church Homes. I am Beth Long-Higgins, the director of the Ruth Frost-Parker Center for Abundant Aging and I am your host for this conversation. On this show we look at what it means to age in America and around other places around the world with empowering conversations that challenge, encourage and inspire us all to age with abundance. Our guest today is Dr. Leonardo Porcini Yo is Professor and Chair of preventive and community dentistry at the Iowa College of Dentistry and Dental Clinics. He is also president of the special care dentistry Association. Leo teaches pre doctoral students in the geriatrics and special needs program and treats patients in the general faculty practice. He also acts as a general practitioner with an emphasis in geriatric dentistry. Leo’s current research focus includes geriatric dental and general health epidemiology in satisfaction of crossing the daunting again, always tripped up on that word, patients. Dr. Marchini is also interested in researching the very best way to teach general dentistry with particular interest in geriatric teaching. Welcome, Leo.

Dr. Leo Marchini 01:24
Thank you, Beth, for the wonderful words of introduction. I really appreciate it.

Rev. Beth Long-Higgins 01:30
So our topic for this podcast isn’t prompted in part because we are having this conversation. We’re recording this podcast exactly two weeks before our annual symposium with the Parker center. And the topic this year is dismantling ageism. How prejudice stereotypes and discrimination based on age affect us all. If you’d like to find out more information about the podcast, you can go to our website, abundant aging.org and click on the events and conference tab. And then the 2023 symposium page will pop up there. So just to recap a bet on our earlier podcast, Leo and I had a conversation about learning about special care dentistry. Could you just explain briefly again with this is

Dr. Leo Marchini 02:19
absolutely bad, great question. Special aged African special needs, then there is the area of dentistry that is to study and provide care for frail, and dependent older adults as well as adults with special needs. So as people age they, thankfully most people age gracefully, which means that they are aging, healthy and enjoying life. But some of us would age with some important chronic disease that will bring these abilities and they might become frail, and dependent on others for many activities of their daily living. So for those patients, some dentists have advanced training to provide appropriate care for that population. That’s it in a nutshell,

Rev. Beth Long-Higgins 03:22
okay. And obviously, there’s a lot more to that. And if you’d like more information, you can listen to our other podcast conversations for our listeners. So when we were prepping, though, for our podcast conversation, I was really surprised. That ageism is something that is recognized as an issue in oral health care. I know that ageism exists in healthcare in general, but I just had not thought about how that manifests itself in dentistry. So can you break this down a little bit for us? Where do we see ageist behaviors and just remind our listeners, ageism is how we think, feel and act towards ourselves or others, negatively based on age?

Dr. Leo Marchini 04:09
Yes, Beth, this is such an important topic that the World Health Organization considers it one of the most important barriers for older adults to receive age appropriate care. It’s a big purchase. It’s everywhere in the way, you know, older adults are depicted in the media, the way people talk about older adults, the way older adults are treated in the workplace. In no way, it’s no difference. No different in the healthcare system. Then oral health care is part of the healthcare system. And it happens in the dental office as well. How does it manifest in the dental office? Well, in the dental office, it can come in very subtle ways. Like instead of presenting implants for an older adult, we can present only complete danger options for older adults, because we don’t think they would have the finances to, you know, pay for implants, just based on age alone, right? Sometimes we can inadvertently, you know, not offer aesthetic options, cosmetic options for older adults, because we might think they are not interested because they are older. Right? So, options that wouldn’t be here that would have been offered to younger adults are not offered to older adults just because of their age, right. So those are sub two ways that it can manifest in oral health care, or other ways, it might make more explicit ways it can manifest in oral health care is that is that, you know, some sometimes when older adults are seeking care, they, the the dentist may not want to keep treating those patients because they feel that as they are getting older, they are not able to cope with them, health conditions and medications that the patient or take care because they think the those patients are not being able to comply with advice anymore, or things of that nature, which you know, becomes like more visible, but at the same time includes a component of dental education to it, knowing how to do knowing how to do it. That brings us to another way of age, manufacturing or health, because a lot of dental students, once they graduate, don’t seek advanced training on how to treat frail and older adults, sometimes unconsciously, just because they don’t want to deal with that population. Not because you know, they have a, you know, cautious prejudice about it. But because of the unconscious part of ageism, that’s also very prevalent in society, and they are not even aware of it. That’s why it’s important to raise awareness about ageism among dental students.

Rev. Beth Long-Higgins 07:49
Absolutely. And, you know, that’s an important step. And so glad you’re doing that. Since we last had our conversation, I came across an article that was highlighting the significant work that’s going on right now. And popular in the culture amongst folks in their 20s and 30s. Do you think that this trend is to whiten the teeth or have cosmetic procedures done to the teeth? When we’re younger? Do you think that’s based on ageism? Because we because they know that you know our teeth yellow as we age and so they’re wanting them to look as white as possible? Do you think that’s all it’s all connected?

Dr. Leo Marchini 08:33
I think that certainly there is a connection there. There is a link there as you think about all the anti wrinkle all the you know all them you know, hair dyeing, you know, products and all that so, there is certainly a link there. But there is also a very pervasive beauty stereotype that has been presented to society for a long period of time. So just to put it in context, I remember when I was a kid and one of the most beautiful actresses and actors we will have is miles that were characteristic of them. They were so chill. You know, consider it as astonishingly beautiful but they had, you know, small tweaks to their teeth, you know a tooth that’s a little bit smaller than the other. The counterpart on the other side called a you know how wide it was a part of it but not so concerning. Now, if you look at the so-called celebrities around, they all have the same teeth. I mean, if you get a smile from this person, put on that other person it is the same And that shade is the same. And why is that? Well, because there is a standardized smile as there is a standardized leap. Now, I mean, all, you know, all people try to have a similar leap culture if that’s not reality, and I am a little concerned about that excessive concern about statistics, right? And that may bring unintended consequences to the future. Because no procedure is riskless, there is always a risk to anything we do. So all I’m gonna do is contact lenses in my teeth that are fenced away to small veneers that require no drilling, okay? But do you still need to prepare the service and bone it? And in a few years, if that person has a reduced manual dexterity, that may become a leaky margin, that leaky margin may become a cavity, that cavity may become a root canal. So, you know, no, the procedure is riskless. So we need to be a little bit more attentive to the long haul. Because now when someone does something in their 20s, that means that something needs to last 80 more years, eight decades, right? Well,

Rev. Beth Long-Higgins 11:48
which may not. Which reminds me of our previous conversation, when you were talking about your own experience of aging and how repetitive things that you did younger in life are having physical consequences now, and when you were younger, you never thought that that would have a consequence. You know that some of this, these things are gonna have a consequence. And the ironic thing to me is when I look at it, it’s the smile that everyone’s supposed to have. I look at those folks. And I think it looks like you’re wearing dentures, which then I automatically associate with somebody who is older, which isn’t a just thing I realized, but I think they’re definitely not achieving the thing that they think that they’re achieving. So it’s just kind of ironic, right?

Dr. Leo Marchini 12:36
Beth? We had a color shade scale for teeth. Okay. That starts with a one a two b one, b two C one C two, D one, D two and so far, okay. Well, that has been like that for decades. In the last few years. There were additions to that scale with our BL BL to bleach it. So now you have you we need to add to the natural scale to the scale of natural teeth shades an official scale, that’s way whiter. That is for bleached teeth. I mean, why? You know, why? Why did then what’s the white is normal? Right? I have, I always questioned that type of thing. I think we need to be going. I think we need to be cautious about it. However, we of course need to honor the person’s wishes as long as they are fully aware of the risks. Right. But again, the influence that people have from the media may be taking away a little bit of their critical thinking about the consequences of it in the long run. And, and therefore, you know, that’s a really complex issue because you don’t want to not offer the services equally across the different groups. But you also want to counsel people about what’s healthier and what’s best, without including any biases. So how do we deal with it? I think the best way to deal with it is knowing your patient as a person. Get that frank conversation among two people that are embedded in the best interest for the patient and, you know, reaching an agreement that is good for The patient, right? Absolutely. That’s the only way to go.

Rev. Beth Long-Higgins 15:04
So are there other things that you’re doing as a professor in dentistry to to help, besides helping to have dentists be aware of their own ageism that they’ve absorbed? Are there other things that are happening in the dentistry world to help raise awareness and to help pull down some of the ageist barriers?

Dr. Leo Marchini 15:26
There is a lot being done back? That’s a great question. So the first thing, we started with creating a specific AGS mosquito for dental students, because of the characteristics of what we do, the peculiarities of dentistry, it would be important to have a scale that measures things that are meaningful to the profession and touches AGS issues. So we use that scale to figure it out. Current ageism believes among the interest students or ageist attitudes among dental students, and then we tailor interventions during our educational process during the dental training to reduce that, that ageism, so we bring exercises that simulate certain conditions that are prevalent among older adults, we, we raise scenarios with different types of aging circumstances. So people can understand why there are different attitudes regarding the same stimulus, right? Why people will react differently, because they see the same circumstance, other different lands, so we try to bring those lands to the students, and simulate them. We also use standardized patients that, you know, actor patients that would bring certain circumstances, certain life scenarios that they shouldn’t see to navigate. And then we assess how the students did it, and try to help the students have more tools to deal with the different aspects of it. So we do a lot of what we call simulation clinics for our students to experience a How it is to leave with a certain type of disability, how easy it is to go to the dental office with a certain type of disability, right. And we also bring information about the consequences of ageism in health care, that we also bring our awareness about, you know, the fact that for many drugs that are commonly used, there are no clinical trials that were done among older adults. Therefore, we need to use them with caution, because we don’t know the long term consequences of those drugs and therapies. And same thing in dentistry, a lot of the clinical trials that have been done for restoration materials are not being tested among this population. So we need to look at it more cautiously. And many times, we need to think about possible modifications of technique and that would provide better results among that population. Which brings us to more research about geriatric dentistry. That’s another thing that we do here as we have a clinic that is oriented towards this group. We have data, long term data about it that we can also use for research.

Rev. Beth Long-Higgins 19:09
Well, Leo, thank you so much for all you’re doing in the world of oral health and especially all you’re doing to help address the issue of ageism. And thank you to our listeners for listening to this episode of The Art of aging part of the abundant aging podcast series at United Church homes. We want to hear from you. What’s changed about you as you’ve aged that you love? What has surprised you most? And how do you define abundant aging or who is your abundant aging influence or hero? Join us at WWW DOT abundant aging podcast all one word.com to share your ideas. You can also give us feedback when you visit the Ruth frost Parker Center website at www.UnitedChurchHomes.org all one word. Leo, tell us again where can people find you?

Dr. Leo Marchini 19:59
People can find me here at the University of Iowa College of Dentistry and Dental Clinics, and I will be more than happy to take questions and help people finding providers in their area. Especial care dentistry association is another resource for that, too. People can contact SEC DEA, and they have a list of providers across the country that can provide specific care that people need as they age, especially if they become frail and dependent.

Rev. Beth Long-Higgins 20:43
Thank you very much, Leo. This has been great.

Dr. Leo Marchini 20:46
Thank you very much, Beth, and thank you for your team who keeps the podcast going behind the scenes. And thank you also to our listeners. Without you guys, we would not be able to keep this going. Right. Thank you.

Rev. Beth Long-Higgins 21:04
Thank you.