Healthy aging begins with a healthy smile: An interview with Leonardo Marchini, D.D.S., M.S.D., Ph.D.

By Maren Lenhart, Community Impact Analyst at Delta Dental of Iowa

More than one in seven Americans are older adults, defined as people 65 years of age and older, and this demographic is growing rapidly. By 2060, the U.S. Census Bureau projects older adults will account for almost one-quarter of the U.S. population. Older adults face a variety of oral and overall health challenges: nearly one in five have lost all of their teeth, leading to a significant decline in quality of life, while over two-thirds have gum disease, which is linked to heart disease and dementia. In the last year, older adults, especially those in long-term care facilities, have been hit particularly hard by the coronavirus pandemic, and as a result have faced increased barriers to accessing the routine dental care that is important to good overall health.

I recently spoke with Dr. Leonardo Marchini, Associate Professor at the University of Iowa College of Dentistry and Dental Clinics and geriatric dentistry expert, to learn more about oral health among older adults:

Q: Oral health is essential to overall health for everyone. How does this impact older adults?

Dr. Marchini: For older adults, oral health can have an even greater impact on quality of life and well-being. This is because older adults usually present with some chronic conditions, such as diabetes and cardiovascular diseases, which can be worsened by oral diseases.

Q: What are the unique oral health challenges and barriers that older adults, including those in long-term care facilities, face?

Dr. Marchini: Barriers include, but are not limited to, complex systemic conditions, heavily restored dentitions [multiple teeth with large restorations or crowns], ageism, lack of access to dental benefits, and the reduced number of dentists with advanced training in geriatric dentistry. Older adults living in long-term care facilities also depend on caregivers for oral hygiene routines and have transportation barriers to go to a dental office.

Q: What kind of attention and resources have these challenges and barriers received?

Dr. Marchini: There are some good initiatives led by universities and non-profit organizations, such as the Delta Dental member companies and their foundations. One example is the University of Iowa's partnership with the Delta Dental of Iowa Foundation on developing and maintaining a geriatric and special needs program. However, more initiatives are necessary to address the issue of providing age-appropriate care for an ever-growing older adult population.

Q: How has the COVID-19 pandemic impacted these challenges and barriers?

Dr. Marchini: COVID-19 has made it even more difficult for older adults to access appropriate dental care. Older adults who live in the community are sheltering at home and avoiding health care settings. Institutionalized older adults are confined to their institutions, where external health care team members (including dentists and dental hygienists) are restricted.

Q: How are oral health care professionals providing treatment to older adults during the pandemic?

Dr. Marchini: In private practices, older adults can safely receive appropriate dental care, as dentists are using heightened infection control precautions that have been in place at dental practices for months. As long-term care facilities start to lift restrictions to external health care team members, dentists will also be able to provide safe and appropriate care in those settings.

Q: Tell us about your recent research. What have been some of the most compelling findings?

Dr. Marchini: Our most compelling findings, for example "Coronavirus disease 2019 and dental care for older adults," published December 2020 in the Journal of the American Dental Association, point out that older adults still face many barriers to receiving age-appropriate oral health care. There is a need for a comprehensive oral health care model for both community-dwelling and institutionalized older adults that can overcome these barriers. Some of our research focuses on preparing the future dental workforce to help reduce these barriers.

Q: How can this research be translated to help the general public, including older adults, understand what it means for them?

Dr. Marchini: The takeaway message for the average person is that dental care becomes more challenging as we age, and we all need to support initiatives that improve access to age-appropriate oral health care for older adults.

Q: What is the current state of geriatric oral health research?

Dr. Marchini: Geriatric oral health research has provided many important answers that can guide policies and initiatives to improve access to age-appropriate oral health care for older adults. However, there are many other questions that remain unanswered and more research is needed.

Q: Can you tell us about your research on how oral health care professionals and students can best serve older adults? What is the role of education and training in this preparation?

Dr. Marchini: Education and training of health care professionals are crucial for providing age-appropriate care for older adults, and one important aspect of geriatric dentistry training is combatting ageism, which is the prejudice against a person on the basis of age. Ageism is ubiquitous and has been shown to negatively impact health care outcomes for older adults. Therefore, the World Health Organization has stated that ageism has harmful effects on the health of older adults. Geriatric dentistry training should also focus on changing students' attitudes and beliefs about age, aging, and aged persons.

Q: How can people who are not oral health care professionals aid in advancing older adults' oral health?

Dr. Marchini: People should be aware that access to appropriate dental care may become more challenging as we age and should also support initiatives aimed at improving access to oral health care for older adults.


Leonardo Marchini, D.D.S., M.S.D., Ph.D., is an Associate Professor, Department of Preventive & Community Dentistry, at the University of Iowa College of Dentistry and Dental Clinics and a Delta Dental of Iowa research grant recipient.

Maren Lenhart is the Community Impact Analyst at Delta Dental of Iowa.

The Delta Dental of Iowa Foundation has a longstanding commitment to improving the oral and overall health of older adults. We are a member of the Lifelong Smiles Coalition, which aims to ensure optimal oral health for aging Iowans and has donated over $1.5 million in this pursuit since 2014. We also supported the expansion of the University of Iowa Geriatric and Special Needs Clinic with a $1.5 million gift and established a professorship in Geriatric and Special Needs Dentistry at the school's College of Dentistry through a $750,000 gift.