As baby boomers age, need for geriatric dentistry training grows

Marco Rouman CWRUOne of only 200 experts in the country, Marco Rouman has seen the horrific side of what happens when the elderly go without dental care.

Rouman, who is launching and directing geriatric-focused graduate and predoctoral training programs at Case Western Reserve University’s School of Dental Medicine this fall, described a patient who left a partial denture in so long it had become overgrown by the soft tissues around it. The partial had to be surgically removed.

Another had her dentures for 50 years without maintenance. The blackened false teeth eventually caused her jawbones to deteriorate, calling for bone grafting and implants to stabilize her removable prosthesis.

From simple dental problems to advanced oral cancer, geriatric dentists treat a wide spectrum of conditions. The issue of geriatric dental care is a growing concern for an aging population. And, as Rouman sees it, shifting demographics also provides an opportunity for dental schools.

“At Case Western [Reserve], we are performing a facelift to geriatric dentistry by redefining the scope of this program to include complex full-mouth reconstructions and maxillofacial rehabilitation. Our model will be copied nationwide,” he said.

“Ten years ago,” he explained, “someone could graduate from dental school and ignore elderly patients. Graying baby boomers now make that impossible. Their numbers have driven the need for this special care.”

According to the Institute of Oral Health’s whitepaper “Oral Health Needs for Seniors,” 20 percent of the population will be older than 65 by 2030. The same report called for a projected need for 2,000 geriatric dental faculty members to train a workforce of 7,000 to adequately care for this growing population. In 2005, only 200 dentists had this postdoctoral geriatric training.

Rouman, who arrived at Case Western Reserve last fall to re-structure the geriatric curriculum, is designing a program that combines dental education and medical and pharmacology because of the many medications prescribed to older patients.

Elder dental care is especially important, he said. The same bacteria that cause gum disease, for example, can also cause aspiration pneumonia, a common health threat for the frail elderly.

Rouman has found that many dental students without special geriatric training or much exposure to older patients often shy away from treating them after graduation.

Rouman was born in Egypt and received his diploma in dental surgery from the Royal College of Surgeons in Edinburgh, Scotland. He moved to the United States for advanced geriatric training at the University of Minnesota School of Dentistry.

He then joined the dental school faculty at the University of Iowa, where he directed the special care and geriatric dentistry graduate program.

Rouman is building at Case Western Reserve what he considers a model for geriatric dental care that draws from some of the best practices of his former universities. For instance, students will make “house calls” to nursing homes to treat patients who otherwise could not make it to the dentist.

His program also involves developing inter-professional teams of dentists, doctors and nurses well versed in how oral health is linked to physical health. Additionally, a geriatric rotation will be integrated into the senior-year clinical experience.

Rouman also hopes to capitalize on his relationship with the University of Glasgow in Scotland and other universities to forge an international collaboration in geriatric dental research.