For many people, a trip to the dentist is far from enjoyable.
“Because of all the drilling and injections, it’s not fun,” admitted Suchitra Nelson, associate dean and professor at Case Western Reserve University’s School of Dental Medicine.
Nelson is leading a new study aimed at improving dental care for older adults—especially those living in subsidized housing with limited access to care because of financial barriers, lack of dental insurance, transportation issues, and mobility challenges.
The five-year, $5 million project, funded by the Patient-Centered Outcomes Research Institute (PCORI), builds on Nelson’s earlier research showing that two drill-free treatments—Silver Diamine Fluoride (SDF) and Atraumatic Restorative Treatment (ART)—are equally effective in preventing cavities.
SDF is a liquid medication brushed onto cavities to stop decay, kill bacteria, and harden tooth enamel without pain or anesthesia. ART uses simple hand tools to remove decayed tissue before applying a restorative material—no drilling required.
“Long-term evidence for these treatments is lacking,” Nelson explained. “This follow-up study will help determine which methods work best for patients and providers.”
The new study will revisit 480 older adults across 33 subsidized housing communities in Northeast Ohio. Participants will receive up to three dental visits in a year, with SDF or ART used for any new cavities.
National data from the CDC show that 96% of older adults have had cavities, while one-third of low-income, non-Hispanic Black, and Hispanic seniors live with untreated decay—largely due to limited access to affordable dental insurance and care.
Untreated cavities can cause pain, infections, and tooth loss, while also worsening chronic illnesses such as heart disease, lung disease, and diabetes.
In Nelson’s previous PCORI-funded study involving 568 older adults, both treatments prevented cavities equally well. Importantly, the research also showed that dental hygienists could successfully provide care on-site at residential facilities, improving access for those unable to visit dental offices.
Nelson believes these minimally invasive methods could benefit patients of all ages. “Our partners—from local agencies to national organizations—have expressed strong interest in using our findings to expand access, improve clinical care, and influence Medicaid reimbursement policies,” she said.
The study aims to do more than reduce pain—it seeks to prove that effective, low-cost dental care shouldn’t depend on whether someone has insurance.