Oral biology professor discusses challenges facing older patients

BUFFALO, N.Y. — While older adults are keeping more of their natural teeth than previous generations, they still face greater oral health challenges than their younger counterparts. And this can negatively impact their overall health.

Untreated decay and periodontal disease may contribute to serious health problems that affect the body, including heart disease, pneumonia, chronic obstructive pulmonary disease (COPD), diabetes, and even Alzheimer’s disease, notes Frank Scannapieco, DMD, PhD, SUNY Distinguished Professor of Oral Biology in the University at Buffalo School of Dental Medicine.

For more than 30 years, Scannapieco has studied the connection between oral bacteria and systemic disease, especially in older adults.

Scannapieco, who recently received the 2025 International Association for Dental, Oral and Craniofacial Research (IADR) Distinguished Scientist Award in Geriatric Oral Research, maintains that providing basic dental care for elderly Americans would improve outcomes for a variety of systemic diseases and reduce health care costs.

To bring this idea closer to reality, Scannapieco is working with a national organization advocating for Medicare to cover dental care.

Scannapieco discusses his research, his advocacy work, and the importance of providing dental care throughout the later years.

When did you first become interested in older adults’ dental care?

It wasn’t intentional. I started my career as a microbiologist and then decided to become a periodontist.

When I came to the oral biology PhD program at UB in the 1980s, I was studying the oral cavity and how bacteria colonize the mouth. I put two and two together and thought the mouth might be a reservoir by which bacteria could enter the lungs to cause pneumonia. This was a time when physicians weren’t really looking at the mouth as a reservoir for infection.

When I started studying the connection between the two, it led to my appreciation of how oral health can really impact elderly people.

I practiced periodontics at the dental school for 30 years, and most of my patients were in their 60s or older. This is because periodontal disease is a cumulative disease. By the time you know you have it, you’re typically in your later years.

How do periodontal disease and tooth decay lead to other diseases?

Cardiovascular disease, diabetes, and Alzheimer’s disease all have inflammatory components that propel them. Also, if you have gum disease, you have ulceration of your gingival tissue, which permits bacteria into your blood.

There are plausible explanations that connect periodontal disease with cognitive impairment and Alzheimer’s disease. The association may be direct, such as invasion of the brain by oral bacteria or decreased central neuron signaling from periodontal ligaments, or they may be indirect, such as elevated systemic inflammatory load or dietary effects that arise from the inability to chew due to compromised teeth.

There are multiple risk factors for all of these diseases, however. I would never argue that it’s gum disease alone that’s causing these problems.

What is your current research with Alzheimer’s disease?

I’m a co-investigator on a five-year project funded by the National Institutes of Health (NIH) awarded to Irene Yang, a nursing professor at Emory University, looking at the connection between oral bacteria and Alzheimer’s disease.

I’m helping develop oral examination and sampling protocols from the patients she’s recruiting with early stages of the disease. The study will compare the oral microbiome of individuals with and without periodontal disease and identify associations among periodontal disease, microbiome features, systemic inflammation, neuroinflammation, and cognition.

It was always thought the brain was sterile, that the blood brain barrier served as this roadblock to anything getting into the brain. Now, there is some suggestion that bacteria or products of bacteria can get into the brain to stimulate inflammation, which can lead to Alzheimer’s.

What are the biggest barriers to dental care for older adults?

It mostly comes down to money. When people retire and no longer have health insurance through their employer, they usually lose their access to professional dental care unless they can afford to pay out of pocket.

Medicare, which you qualify for at age 65, does not cover dental care. I’m involved with  the Coalition for Oral Health Policy, which is a group of people from multiple arenas who are interested in bringing dental care to older adults. . We’re focusing on trying to get Medicare to help pay for it. When Medicare was founded in the 1960s, dentistry was not included. The dental community wasn’t at the table.

If Medicare would pay for two cleanings a year, an X-ray, and simple fillings, this would save money and help older people’s quality of life. There have been studies using insurance databases that show that people who have gotten more dental care have lower risk for various poor health outcomes, which can save money.

Also, lack of basic dental care is a big issue for seniors living in facilities such as nursing homes. Many patients often don’t even have their teeth brushed because there’s little training for nurses and nursing assistants who are already pressed for time.

This is more than just a hygiene problem. Bacteria that make a home in the mouth can then be aspirated or inhaled into the lungs causing serious infections, including pneumonia.

Tooth brushing and regular dental care sound like simple preventative strategies, but they require widespread education and buy-in not only from caregivers like nurses and nursing aides, but also from attending physicians, nursing home managers, and ultimately, insurance providers.

Overall, we know that poor oral hygiene is a major problem for older adults. Yet for many reasons, it’s often ignored.