Get Mad Before You Get Old: Seniors’ Oral Health Care—Nothing to Smile About

Oral Health Care Important to Well-Being

Oral health is important to the overall well-being of older Americans. Preventive dental care can head off more expensive dental work and help prevent severe diseases. Unfortunately, dental costs are primarily out-of-pocket for those over 65, and when financially strapped, they may forego regular visits to the dentist. This decision to “do without” can have serious consequences, because the elderly suffer a disproportionate and debilitating amount of oral disease. The facts: [i]

• Nearly one-third of older adults have untreated tooth decay (dental caries). Fifty percent of those over 75 years of age have root caries. Untreated caries can progress to the pulp of the tooth, causing pain and dental abscess, which may lead to more serious infections, such as bacteremia and septicemia.

• Nearly a quarter of 65- to 74-year-olds have severe periodontal (gum) disease, which is associated with chronic disease and severe health events including:

- Diabetes mellitus

- Heart disease

- Stroke

- Respiratory disease. Oral bacteria have been positively linked to aspiration pneumonia in institutionalized patients.

• Oral cancer is primarily diagnosed in the elderly.30,000 new cases of oral and pharyngeal cancers are diagnosed annually, and about 8,000 individuals die from these diseases each year. But early cancers are painless and difficult to identify: periodic oral exams by a professional are needed.

• Mouth dryness is experienced by 30% of those ages 65+. Dry mouth, which contributes to more rapidly advancing tooth decay and gum disease, is often caused by medications taken by the elderly: there are some 400 drugs with dryness as a side effect, such as high blood pressure medications, cholesterol-lowering drugs, and medicines for Alzheimer’s disease.

The tragedy is that oral disease is largely preventable. With the exception of damage due to an accident, dental treatment begins with relatively low-cost diagnostic procedures, such as exams and x-rays. If decay or disease is detected, the sooner it is treated, the less expensive that treatment will be.

“Poor oral health puts seniors at significant risk of experiencing severe health events,” says Barbara J. Smith, manager, Geriatric & Special Needs Populations of the American Dental Association (ADA). She offers as an example the case of a nursing home resident who needed a tooth extracted, a relatively simple procedure that would have cost $100. However, the tooth was not taken care of, the resident became septic from the dental infection, and as a consequence his heart stopped. He spent two days in an intensive care unit, had surgery, and spent 15 days in the hospital. The estimated cost of his medical treatment: $45,000. Clearly, the lack of dental care for the vulnerable elderly can have catastrophic health and financial consequences.

Medicare and Medicaid “Toothless”

The shortfall in oral health care for the elderly in the United States is huge, and will only increase, as the number of seniors doubles by 2030. In 2005, an estimated 25 million adults – pre- and post-retirement – went without dental care because they couldn’t afford it.[ii]

Even if they had dental insurance on the job, many lose it when they retire. The situation is worse for older women, who generally have lower incomes; many never have had dental insurance.

One of the glaring gaps in Medicare coverage is the lack of dental care. Medicare doesn’t cover most dental procedures, such as fillings, extractions, and dentures. Currently Medicare will pay only for dental services that are crucial to another covered procedure, such as jaw reconstruction following accidental injury. Congress has not amended the dental exclusion in Medicare since 1980.

Medicaid, a joint program between the federal government and the states, provides health insurance coverage to the nation’s poor, disabled, and impoverished elderly people. Medicaid pays for dental care of qualifying children under age 21, but funds dental care for impoverished seniors only in a few states, and those reimbursements are low.

Mobility Issues Also Limit Access to Dental Care

Even if expense is not an issue, about 30 percent of older adults face difficulties in getting to a dental office: they may be frail, dependent or homebound, or live in nursing homes. In 1997, only 19% of all nursing home residents received dental services.[iii]

One of the goals of Healthy People 2010, a Department of Health and Human Services report on national health objectives, states that every long-term care facility resident needs to have access to oral health assessment and treatment.

Taking the Case to Congress

We know that oral health care is an important component of overall health and that older Americans frequently lack access to dental care. When seniors don’t receive regular dental care they risk serious health problems with potentially high public costs. The Alliance for Aging Research, ADA and other organizations are working to raise awareness about the problems caused by seniors’ lack of access to dental care. Together we can bring this issue “out of the shadows” and to the attention of policymakers.