Teeth have an expiration date

Karen Michel

In the next few months, what I’ll be spending on fixing my teeth will eat up much of what I’ll earn this year, including Social Security benefits. I’m not alone in this dental distress. Those of us 65 and older will, for the most part, need more maintenance and replacement versus younger folks in that most visible part of our anatomy.

Nearly half of us don’t have dental insurance, according to a 2020 University of Michigan poll. Yet issues like dry mouth, root decay and gum disease are more common in older adults, researchers at the American Dental Association found. And the use of multiple medications can also lead to or exacerbate these conditions. That can mean older adults with chronic diseases like diabetes, heart disease or arthritis may be more prone to gum disease and other oral problems, but less likely to get dental care than their peers without these conditions, according to the CDC.

Cost concerns

Since traditional Medicare doesn’t cover most oral care, regular dental care and treatment can mean some serious out-of-pocket costs. Without insurance, many dental needs often go unmet, a 2021 Kaiser Family Foundation analysis found. Even when Medicare Advantage plans or private insurance do cover dental services, co-pays, deductibles or coinsurance can mean a big hit to the budget; that’s particularly tough for those on a fixed or limited income. A 2016 Pew survey found that low income and Black seniors are least likely to have access to dental care, while two-thirds of seniors with annual incomes under $35,000 said they could not afford important oral care like fillings, crowns or bridges.

However, dental health is not something we should ignore, since it can lead to serious health consequences from obesity — often related to choosing easy-to-chew, higher-fat foods — to even dementia. In 2020, the American Dental Association issued an endorsement about providing “dental care to promote improved health and well-being in elderly patients.” What’s key here is linking the mouth with the rest of the body, in all ways. We’re told to beware of social isolation, but who’s going to be smiling with a bunch of missing teeth?

Like a can of beans, teeth have a best before date.

We come into the world toothless and a whole lot of us exit the same. In between, as adults, most of us get 28 useful teeth and another poorly named quartet of wisdom teeth that don’t tend to stick around. They are — as I’ve now learned to call it — amputated; in this case, pulled and otherwise extracted from the body.

According to the National Institute of Dental and Craniofacial Research, a whopping 17.3% of people 65 and older have no natural teeth. Many are older, Black, smoke, are less educated and poorer. The rest of those 65 and older have around 21 teeth until they hit 75, when the number goes down even further.

I asked my new dentist how many teeth I have: 27 and three-quarters he said, counting the post that’s waiting for the rest of the implant. And that’s darn good. At my former dentist’s direction, I went to the tooth extractor and subsequently freaked out in the chair. I’m extremely sensitive to pain and sound, and I have high dental anxiety. So, I re-booked. Meanwhile, I went back to my now-former dentist for work on the other side of my mouth. However, the proposed treatment didn’t make good sense to me. This led to comparative shopping for a dentist.

I went for another opinion, to a different practice where a friend had worked for 20 years. They did everything there, were conservative in approach, honest, knew their stuff, and were like family, my friend said. Good move.

It turned out, my tooth didn’t need pulling, just a cap. And where the former dentist wanted to replace a bridge that had come loose, I’m instead getting an implant and two crowns. The new practice makes the crowns in-house. I don’t have to travel or return multiple times. And they take a dental discount plan. It’s still crazy, crazy expensive. But I’ll still have most of my teeth, and I’ll get my smile back.

The can of beans can wait a chunk of time longer.

Journalists: while not everyone may be willing to share their tales of oral woes, a good story can help highlight the need to include oral care as health care, and why traditional Medicare coverage of dental services is so important.