Many Older Adults Can’t Afford to See a Dentist and Suffer the Consequences of Poor Oral Health

Every day, 10,000 Americans turn 65, but many seniors don’t have a good reason to smile.


Access to dental care is the No. 1 unmet health need for low-income adults in Ohio, said David Maywhoor, director of Universal Health Care Action Network Ohio’s programme to increase access to dental care.

It’s a particularly bad problem for seniors who live on limited incomes, and especially for people who are disabled or unable to leave their homes.

“Many people have to choose between dental care and other daily living expenses — and dental care is often sacrificed,” Maywhoor said.

Nearly 37 per cent of Ohio’s poorest seniors have had all their teeth removed due to tooth decay or gum disease. And more than half of low-income older Americans have not seen a dentist in the past year, with most citing cost or lack of dental insurance as the reason, according to a recent Harris Poll.

Left untreated, an unhealthy mouth can lead to a lifetime of poor health and increased risk of diabetes, stroke and heart disease, Maywhoor said.

The federal Medicare programme for people 65 or older rarely pays for dental care, leaving many seniors with sizeable out-of-pocket costs, he said. Some coverage can be obtained through supplemental plans, but those services often are limited.

As a result, many older adults turn to hospital emergency departments, he said. But that can be a costly and ineffective option.

Despite all the challenges, there is some good news, state officials said.

Ohio is one of 11 states with a Medicaid programme that provides adult dental benefits that the American Dental Association considers “extensive”. Providing such a benefit is optional, said Ohio Medicaid spokesman Sam Rossi, and many states have cut their programmes amid budgetary pressures.

Among Ohioans at least 65 years old, 53,598 received dental benefits through Medicaid at the end of 2014, the most recent year for which the state provided data.

The downside is that about 30 per cent of Ohio dentists participate in the programmes, advocates say, and many who do have criticised the state for reimbursing them too little.

Until recently, Ohio Medicaid rates for dental services hadn’t been increased since January 2000, with the average maximum payment equal to only about 36 per cent of what dentists nationwide charged in 2011, according to an American Dental Association survey.

Aware of the gap, state lawmakers last year approved a 1 per cent boost in federal and state reimbursements to dentists — a $1.5 million increase in 2016 and $3 million bump in 2017, all of which, officials say, will be offset by savings.

To tackle the shortfall, Maywhoor and other advocates are pushing for Ohio to allow the licensing of dental therapists, essentially dentistry’s version of physician assistants. In the handful of states where they are legally approved, dental therapists — who generally get two years of intensive training before going out in the field — can provide basic services in underserved areas.

The Ohio Department of Health also has a partnership with the Ohio Dental Association to assist mostly working poor adults and elderly residents who don’t qualify for Medicaid but whose household income falls below 200 per cent of the federal poverty level.

In the first six months of the current fiscal year, 41 per cent of the Dental OPTIONS patients are 65 or older, said Carrie Farquhar, oral health programme administrator for the state agency.

“Eligible patients are matched with volunteer dentists who charge discounted fees,” she said.

Each dentist decides what treatment is needed and determines the fee and payment arrangements, Farquhar said. People typically pay 50 per cent or less of the dentist’s normal fee.

In addition to financial constraints, misunderstanding or misinformation about the importance of dental care is another reason why seniors don’t go to the dentist, said Dr. Patrick M. Lloyd, dean of Ohio State University’s College of Dentistry.

“Even today, some people think tooth loss is a normal part of getting old, even though it doesn’t have to be,” he said.

As people age, the nerves inside their teeth become smaller and less sensitive, he said. By the time they feel pain from a cavity or other problem, it could be too late and they might lose a tooth.

Receding gums also can expose tooth roots, causing sensitivity and vulnerability to decay, Lloyd said. And many prescription drugs — for such common conditions as high blood pressure, depression, allergies and pain — can cause dry mouth in older adults.

Without intervention, these problems can lead to potentially serious health conditions, he said. – Encarnacion Pyle, The Columbus Dispatch