Older patients don’t arrive with a single problem. They arrive with a history — and that history belongs to an entire team of providers who, more often than not, have never spoken to each other.
There’s a moment I come back to often in my career. A patient — 78 years old, still living at home, proud of it — sits down in my chair and opens her mouth. What I see isn’t just a dental problem. There are signs of severe dry mouth from a cocktail of antihypertensives and antidepressants, gingival inflammation that tracks almost perfectly onto her diabetes timeline, and a mandibular denture so ill-fitting it has caused mucosal trauma she’d been eating around for months. She hadn’t mentioned any of this to her general practitioner (GP). Her home care nurse had noticed she was “eating less” but assumed it was appetite. Nobody had looked in her mouth.
That case didn’t require a more skilled dentist. It required a better-connected team.
The older patient is not just an older version of a younger patient
General dentists are trained to think procedurally — caries, periodontitis, prosthodontic needs. That training serves us well for most of our working lives. But frail, community-dwelling older adults break the assumptions embedded in our clinical models. They have multimorbidity. They live with polypharmacy. Many have some degree of cognitive decline, which reshapes everything from informed consent to reliability of oral hygiene. And their numbers are growing fast: globally, the population aged 60 and older is expected to double to more than 2.1 billion by 2050, with 82 to 88 million older Americans representing roughly 22–23% of the U.S. population.
“The older adult forgets to visit the dentist, but the dentist also forgets his older patient.”
Here is the structural irony that shapes our daily reality: as patients age, their visits to GPs and home care professionals increase — and their visits to dentists decrease (de Jong et al., 2026). We lose track of them. They lose track of us. In that gap, oral health problems accumulate silently. That quote, from a practitioner in a Dutch qualitative study on interprofessional collaboration, describes a mutual abandonment we’ve normalized without meaning to.
What the barriers actually look like — at every level
There is a persistent temptation to frame collaboration failures as individual failures — the GP who doesn’t ask about teeth, the home care nurse who looks past the mouth, the pharmacist who doesn’t flag dry mouth. But this misreads the problem. The barriers are structural, and they operate at three distinct levels. A recent qualitative study across five disciplines in the Netherlands identified them clearly (de Jong et al., 2026):
The same study that catalogued these barriers was careful to identify what works — and the facilitators map almost perfectly onto the barriers. The solutions exist; they are just not yet the default.
What each profession doesn’t know about the mouth
Part of what makes this problem persistent is how invisible oral health is to other disciplines — not from indifference, but from knowledge gaps baked in at the training stage. A pharmacist in one focus group put it plainly: “We pay little attention to oral health, perhaps because we know too little about it.” A district nurse acknowledged it was “the last thing you think of.” A GP admitted they don’t feel confident identifying oral problems “unless it’s very severe.”
These are not bad clinicians. They are clinicians working at the edges of their training. The same is true of us when we sit across from a patient whose cardiac medications affect clotting or whose cognitive decline shapes whether they can consent. The complexity of frail older adults exceeds any single discipline. That’s not a failure — it’s the argument for teamwork.
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Building the model: what we’re doing at USC
This is precisely the premise that drives interprofessional education (IPE) — defined as learning “with, from, and about” other health professions. It has grown from an educational aspiration into a globally endorsed strategy, strongly supported by the World Health Organization and the Interprofessional Education Collaborative (IPEC). At USC, we have translated that vision into concrete training environments.
Each year, through USC IPE Day, students from ten health professions — Dentistry, Dietetics, Family Nurse Practitioner, Medicine, Occupational Therapy, Pharmacy, Physician Assistant, Physical Therapy, Social Work, and Speech-Language Pathology — work in teams on shared cases. The experience deepens their understanding of each discipline’s unique contribution, raises awareness of social determinants of health, and builds the interprofessional habits that patient care actually requires.
At Herman Ostrow School of Dentistry, we go further through direct clinical exposure. At the Union Rescue Mission (URM) and Special Patients Clinic (SPC), dental students interact with GP/PA teams and nurses through live medical consultations, and Social Work faculty and interns are embedded in the care team — helping patients navigate the very micro, meso, and macro barriers described above. At Hollenbeck Palms Retirement Community and our Los Angeles General Medical Center Geriatric Clinic, students learn to coordinate directly with physicians, nurses, physician assistants, and social workers in the settings where vulnerable older adults live. Oral health here is not a referral endpoint — it is embedded in the care environment from the start.
This is the model: oral health expertise integrated into the setting where older adults are already receiving care, delivered by teams who understand the medical, social, and functional context of each patient.
Who belongs on the team
An effective interprofessional geriatric care team is not a consultation network — it is a co-equal care unit operating from shared pathways with defined roles. (Shivakumar et al., 2026)
IPE should be understood not as an educational add-on but as a transformation lever — capable of redesigning professional identity if embedded in accreditation and licensing from the start.
The clinical pharmacist’s role deserves particular emphasis. In a frail older patient, the line between dental problem and medication side effect is often indistinguishable without someone who reads the full drug list. Dry mouth, gingival overgrowth, altered healing, bleeding risk — these are pharmacological consequences that shape what we can safely do in the chair. Having a pharmacist as a team member rather than a separate referral fundamentally changes the quality of decisions we can make, and we are hoping to integrate them in our dental clinics.
What actually works — facilitators in practice
Joint training and education. Short educational sessions and case-based discussions that bring dental and non-dental providers into the same learning space change how each profession perceives the other’s role.
Clear referral pathways. Knowing who to call — and having a reason to call — is the most basic infrastructure of collaboration. A named contact in a local dental practice is a starting point any GP or home care team can implement today.
Oral health in care plans. Including oral health as a standard item in geriatric assessments normalizes it without requiring additional time. Three questions about pain, function, and hygiene can surface problems that would otherwise go unnoticed for months.
Tele-dentistry and shared records. Digital consultation via photographs or video brings dental expertise into home care settings without requiring a physical visit. Where shared electronic records exist, advocating for inclusion of oral health professionals is a step worth taking.
Home visits as planned care, not last resort. Portable dental equipment is increasingly accessible. Structuring home visits as a deliberate care pathway component — with caregiver involvement, documented findings, and follow-up protocols — transforms them from ad hoc kindness into systematic practice.
Regional coordination. A designated coordinator within a geriatric care network who takes explicit responsibility for oral health integration — facilitating introductions, scheduling multidisciplinary meetings, tracking referral outcomes — holds the system together where goodwill alone cannot.
The patient in the chair is never just dental
The woman I described at the start needed a new denture. She also needed her GP to know about her oral pain, because it was affecting her appetite, which was affecting her glycemic control. She needed her home care nurse to understand that daily oral hygiene was not less important than wound care — in some ways, it was more urgent. And she needed me to understand her full medication list before I did anything irreversible.
What she needed, in short, was a team. Not a formal curriculum, not a policy reform, not a shared electronic record — though all of those things would have helped. She needed the professionals around her to know each other well enough to ask.
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Are you looking for improved ways to diagnose, treat, and manage the oral healthcare of older patients? Explore our online master’s and certificate program in Geriatric Dentistry.
References
de Jong MHS et al. Improving Oral Health Care for Frail, Community-Dwelling Older People: Exploring Barriers and Facilitators for Interprofessional Collaboration. International Dental Journal. 2026;76:109346.
Jenifer HD, Boloor V, Belim W. Strengthening geriatric oral health care through interprofessional education: policy and practice implications. Frontiers in Dental Medicine. 2026;7:1784205.
Schapmire TJ et al. Overcoming barriers to interprofessional education in gerontology: the Interprofessional Curriculum for the Care of Older Adults. Advances in Medical Education and Practice. 2018;9:109–118.
Shivakumar AT, Srinivas S, Kalgeri SH, Kishor M, Avarebeel S. A transformative interprofessional model for geriatric oral health care: a proposed working model. Frontiers in Dental Medicine. 2026;7:1757007.
