Seniors face struggle to get preventive dental care

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

A recent special “Your Money” section in The New York Times looked at American spending habits from a variety of angles. One piece examined geographic patterns in the consumption of luxury goods. Another explored the emotional aspects of bargain hunting. Then there was an article by Ann Carrns that delved into the difficult spending choices retirees may face in obtaining dental care.

Image by  Partha S. Sahana via flickr.

Image by Partha S. Sahana via flickr.

The piece opened with an anecdote about 73-year-old Terry O’Brien, a retired administrative assistant weighing the cost of a $2,000 crown for one of her teeth.

“I always took care of my teeth,” O’Brien told the Times. But since she lacks dental coverage, she opted for a less expensive filling. The call was a tough one that left O’Brien pondering how she will go on paying for her dental care. “I’ll make 100, I bet,” she said.  “But I wonder how long my teeth will last.”

“Older Americans face such situations often, because many people over age 65 lack dental insurance,” Carrns writes. Only a small minority of workers hold onto their private benefits when they retire. Traditional Medicare, the federal health care program for older and disabled adults does not cover routine dental services or dentures. Medicaid dental benefits for poor adults are not mandatory and in many states, they are extremely limited.

“That means most older Americans must pay for dental care out of their pockets,” Carrns observes. Cost concerns cause many elders to skip preventive care.

But then oral health deteriorates. Decayed and missing teeth lead to pain and poor nutrition, leading to even harder choices. Replacing a missing tooth with a dental implant can cost $4,000 or more.

Athena Pappas, co-head of geriatric dentistry at the Tufts University of Dental Medicine tells Carrns that one way to limit costs for replacement teeth is to have implants on the lower jaw and use dentures to replace upper teeth because it is easier to keep upper dentures in place.

Retiree Ed Decker tells Carrns he decided to obtain 10 dental implants, though they cost him about  $50,000. “When you put in an implant, it’s like having a natural tooth,” he says.

Some might question the wisdom of making major dental investments in the later years of life, yet people in their 80s who are still fit and healthy can benefit from advanced types of dental care, Helena Tapias-Perdigon, assistant professor at the Baylor College of Dentistry at Texas A&M Health Science Center tells Carrns, “because it is estimated they will have another 10 –15 years of lifespan.”

Liz Seegert, AHCJ’s topic leader on aging, and I teamed up to create a tip sheet on covering oral health in seniors. It’s worth noting the difficulties of getting dental care to patients in nursing homes. Reporters interested in learning more about the oral health challenges faced by seniors might also want to read Oral Health America’s 2013  State of Decay report.

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