For more than 35 years, the University of Iowa College of Dentistry's Geriatric Mobile Unit has been providing care where nursing home residents need it: at the facility or, if necessary, even at the bedside.
In a van provided by the university, a team of dental faculty and students transports the necessary equipment to deliver comprehensive care to more than 500 patients in ten nursing homes. Common treatments include denture work, cleaning, extractions, crowns, fillings, and root canals performed for patients who are often frail, with multiple medical, cognitive, and/or physical disabilities.
Today, nursing home patients are older and have retained more of their teeth, a combination that makes treatment more complex than when the Geriatric Mobile Unit started in 1979.
"You might think that everyone at a nursing home would have dentures, but that's not the case anymore," says Dr. Howard Cowen, a clinical professor in the Department of Preventive and Community Dentistry and director of the Geriatric and Special Needs Dental Program at the UI. "We now have facilities where not one person is without teeth, which is vastly different than 25 years ago. But for the frail elderly, having so many natural teeth can be problematic."
In addition, more nursing home residents want to receive dental treatment.
"In the beginning, we had a consent ratio of about 30 to 40 percent," Cowen says. "Today, the ratio is 70 percent because over the past 30 to 35 years, people have come to understand the importance of dental care for the elderly."
When the geriatric unit began, faculty and students visited 26 nursing homes, some several hours from Iowa City. To provide comprehensive care to each patient, it took the dental staff about six to eight weeks to treat everyone in a single facility.
"We realized that it took us three years to get back to a home again," Cowen says. "With the average length of stay for residents at two-and-a-half years, we realized we weren't doing a whole lot of good. It was OK for our students, but it wasn't good for the patients."
Eventually, they pared the program down to only those homes within a 40-mile drive, and today, each facility gets a visit every 18 months. A dental hygienist now follows the geriatric unit and travels to each home every six months, cleaning patients' teeth and identifying problems that might require a house call or a trip to the UI dental school's Delta Dental of Iowa Foundation Geriatric & Special Needs Clinic, which opened in 1985.
Eighty percent of senior dental students rotate for five weeks through the Geriatric Mobile Unit and the Geriatric & Special Needs Clinic.
"It's important for our students to understand that when they go back to their communities to begin practicing, there will be patients who need this level of care," Cowen says. "They will be able to provide that care because they learned how to do it as a student."