# Oral health status and perceived barriers to care among older adults in Alabama, United States: an observational community case study of prevalence and associated risk factors

## TL;DR

This study examines the oral health of older adults in Alabama and finds high rates of tooth loss and untreated dental issues, especially among Black individuals and those with limited mobility or insurance.

## Contribution

The study provides new insights into oral health disparities and barriers to care among older adults in Alabama through a community-based observational case study.

## Key findings

- 28.3% of older adults in Alabama were edentulous, and 56.6% of those with teeth had untreated dental caries.
- Untreated decay was significantly associated with Black/African American race, inability to drive, and lack of dental insurance.
- Most participants did not visit a dentist in the previous year due to cost, lack of perceived need, or other priorities.

## Abstract

Limited data exists on the oral health status of the older adult population of Alabama. Improved surveillance programs are needed for estimations and planning.

This study describes oral health status and barriers to routine dental services utilization among older adults in central Alabama.

A retrospective analysis was conducted using observational surveillance data from older adults attending senior centers and senior living communities. Data included demographics, oral care behaviors, care utilization and clinical findings from intraoral screenings. Data were summarized using descriptive statistics, and regression models were used to investigate which factors were associated with oral health status (edentulism and untreated dental caries), routine dental care, and oral care needs.

566 respondents were assessed: mean age 73.2, 70.0% female, and most identified as Black or African American (58.6%) or White (39.6%). The prevalence of edentulism was 28.3%, and 56.6% of dentate participants had untreated decay. Edentulous participants were more likely to have longer intervals since their last dental visit. Dentate participants were more likely to require early or urgent care. Untreated decay was significantly associated with Black/African American race, inability to drive, and lack of dental insurance. Younger age and receiving routine care in the past three years were associated with greater retention of natural teeth. Most participants did not visit a dentist in the previous year, citing cost, lack of perceived need, or other priorities. There were no differences in dentate status regarding emergency dental visits or regular dental provider status.

These findings underscore the need for expanded access to oral health services and targeted interventions for older adults in Alabama, especially those facing socioeconomic and mobility barriers. The academic-public health partnership successfully identified key oral health disparities and barriers, providing actionable insights to inform future programmatic and policy efforts for older adults in Alabama.