Since most Americans lose their dental insurance benefits when they retire, the majority of people over 65 pay out of pocket every time they visit a dentist. Medicare does not cover routine dental care (nor does Medicaid in most states) and more than 80 percent of older Americans have no private dental insurance, according to a recent report by nonprofit advocacy group Oral Health America.
Yet, older adults may need dental care more than any other age group.
"Patients age 65 and over will have potentially an increase in cavities or decay on the root surfaces of the teeth," said Dr. Matthew Messina, an American Dental Association consumer adviser and practicing dentist in Cleveland. "And that comes secondary to the medical condition of dry mouth -- a decrease in the amount of production of saliva because of age and certain medications.... We also see periodontal disease in patients of that population."
Messina advises his older patients to see a dentist at least once every six months for an oral cancer screening and recommends an annual visit for denture wearers.
So what's a person with no dental insurance to do? If you can pay out of pocket, ask your dentist if he or she will offer a discount or work out a payment plan.
"A lot of times for patients paying in full at the time of service, some offices will offer some degree of bookkeeping courtesy," Messina said. "There are a number of ways that offices are creatively handling finances for patients of all ages to make dentistry affordable."
Local dental schools are another option for reduced-cost care -- if you're not in a hurry.
"Our fees can be about half the cost of private practitioners," said Dr. Janet Yellowitz, director of geriatric dentistry at the University of Maryland Dental School in Baltimore. "The downside is that because it's a training program, it takes time -- you're working with students who are being supervised."
She suggests contacting schools with graduate training programs for slightly more costly but quicker treatment, or looking into clinical trials at your local dental school.
Neighborhood health clinics sometimes offer dental services, according to Yellowitz and Oral Health America's Elizabeth Rogers. However, they are not always widely publicized. Of course, people in extreme pain can go to the closest hospital emergency room, where they most likely will be given painkillers and get their tooth pulled, Rogers said.
"But that is by no means a solution," she added.
If this doesn't sound like a lot of options for those without dental coverage, it's not. But a few organizations around the country are trying to change that. One is Minneapolis-area Apple Tree Dental, a nonprofit clinic that aims to improve access to dental care for underserved populations, including seniors. The full-service clinic -- which treats more than 30,000 patients each year in the Twin Cities area, including on-site visits with patients in long-term care facilities -- has been cited as a national model for dental care and has received requests from all over the country and Canada to present on their model.
"What I'm interested in is ensuring that we have programs in place that at least get primary care needs met for seniors," said Dr. Carl Ebert of Apple Tree Dental. "Because when you look at the demographics and the fact that more people are keeping more of their teeth as they get older, you're going to be facing a huge dilemma.... Then add to that the nationwide problem of the significant decrease in the sheer numbers of dentists ... and the sort of seller's marketplace we have right now in dentistry where dentists can pick and choose who they see -- some exclude all insurance patients, some just cater to high-end patients seeking cosmetic services. When you start to multiply all these factors, you're looking at a tremendous problem."
Abigail Green is a freelance writer and editor based in Baltimore.