Americans don’t take dental care seriously enough. While many people now have health insurance that pays for their medical care, dental care is not always included, despite the fact that oral health has a tremendous impact on a person’s total medical health.
Apathy and lack of coverage leads to decay
Untreated tooth decay is a significant issue for elders in the United States. Nearly all adults aged 65 years or older have had a cavity (96%), and one in every five has untreated tooth decay. Almost 20% have lost all their teeth. 26% of elders 75 or older experience complete tooth loss, a number roughly twice as high as the percent of edentulous seniors between 65 and 74. Missing teeth or having dentures affects people’s health, as it can make them avoid fresh fruits and vegetables, which are more difficult for them to eat.1
Even worse, Medicare doesn’t offer dental coverage for seniors. The only exception is for procedures considered medically necessary—nothing wellness-related or preventive is covered. As of 2019, 24 million Medicare beneficiaries (47%) do not have dental coverage, yet dental care is especially critical for retired people and the elderly.2
Periodontal disease and cognitive impairment
Dental care as medical care is especially important for older people, who tend to have more chronic diseases such as arthritis, diabetes, heart disease, and chronic obstructive pulmonary disease (COPD). The CDC says that this population may also be more likely to develop periodontal disease, but they are less likely to get dental care than adults without these chronic conditions.3
Additionally, a 2023 study published in the Journal of Alzheimer’s Disease shows a direct correlation between systemic inflammation and certain brain infections due to periodontal pathogens, which can contribute to brain damage and subsequent cognitive impairment.4
Positive changes and studies
The news is not all bad, however. Studies are beginning to show the importance of dental care as medical care. A review published in Rheumatology Advances in Practice in 2022 concluded that there is evidence that periodontal treatments aid in the treatment of rheumatoid arthritis.5
Other positive changes are appearing. In November 2022, the Centers for Medicare and Medicaid Services (CMS) released a rule change that took effect the following year to expand the definition of “medically necessary.” Now, according to CMS, the new legal verbiage related to what’s medically necessary is “when that service is integral to treating a beneficiary’s medical condition.”6 While still vague, the new wording creates an expansion precedent and leaves room for more benefit coverage in the future.
Dental coverage can be available to seniors who choose Medicare Advantage (MA) plans. An analysis looking at data from a 2016 study shows that MA plans are filling an essential gap in dental coverage, particularly among low- and middle-income beneficiaries. This survey showed that only one-fifth of seniors with traditional Medicare had paid for a stand-alone dental plan. On the other hand, nearly two-thirds of MA enrollees were in plans with a dental benefit.7
Because dental and oral hygiene are so important, elders without insurance coverage need to find affordable options. The first line of defense for many seniors is their caregivers, who can be family members or paid caretakers. The National Institute of Dental and Craniofacial Research (NIDCR) offers free online information sheets to help caregivers assist elders with their dental care, as well as a list detailing how to find low-cost dental services.8
The National Institute on Aging also provides resources for seniors seeking inexpensive care.9 Some dental schools have clinics where students, supervised by qualified dentists, provide dental care for a reduced cost to gain experience treating patients. Some dental hygiene schools also offer supervised cleanings at a discount. Many counties and states provide dental services in community health clinics. United Way also lists similar information, which is available by calling 211.
More oral care options are needed for seniors, but the tide does appear to be turning toward more financial help through Medicare Advantage insurance plans and local low-cost programs. Dental professionals need to make sure that progress continues so that everyone can have good smiles, which often means improved mental health as well.
Editor's note: This article originally appeared in DE Weekend, the newsletter that will elevate your Sunday mornings with practical and innovative practice management and clinical content from experts across the field. Subscribe here.
Resources
- Dye B, Thornton-Evans G, Li X, Iafolla T. Dental caries and tooth loss in adults in the United States, 2011-2012. NCHS Data Brief. 2015;(197):197.
- Freed M, Ochieng N, Sroczynski N, Damico A, Amin K. Medicare and dental coverage: a closer look. KFF. July 28, 2021. Accessed May 6, 2024. https://www.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/
- Patel N, Fils-Aime R, Li CH, Lin M, Robinson V. Prevalence of past-year dental visits among us adults aged 50 years or older, with selected chronic diseases, 2018. Centers for Disease Control and Prevention. April 29, 2021. Accessed May 6, 2024. https://www.cdc.gov/pcd/issues/2021/20_0576.htm
- Salhi L, Al Taep Y, Salmon E, Van Hede D, Lambert F. How Periodontitis or Periodontal Bacteria Can Influence Alzheimer's Disease Features? A Systematic Review of Pre-Clinical Studies. J Alzheimers Dis. 2023;96(3):979-1010. doi:10.3233/JAD-230478
- Mustufvi Z, Twigg J, Kerry J, et al. Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review. Rheumatol Adv Pract. 2022;6(2):rkac061. Published 2022 Aug 17. doi:10.1093/rap/rkac061
- Garvin J. CMS expands Medicare to cover medically necessary conditions requiring dental services. November 8, 2022. Accessed May 6, 2024. https://adanews.ada.org/ada-news/2022/november/cms-expands-medicare-to-cover-medically-necessary-conditions-requiring-dental-services/
- Willink A, Reed NS, Swenor B, Leinbach L, DuGoff EH, Davis K. Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries. Health Aff (Millwood). 2020;39(2):297-304. doi:10.1377/hlthaff.2019.00451
- Finding low-cost dental care. National Institute of Dental and Craniofacial Research. August 2018. Accessed May 6, 2024. https://www.nidcr.nih.gov/sites/default/files/2018-08/FindingLowCostDentalCare-508.pdf
- Taking care of your teeth and mouth. National Institute on Aging. Last reviewed March 13, 2020. Accessed May 6, 2024. https://www.nia.nih.gov/health/teeth-and-mouth/taking-care-your-teeth-and-mouth
