Guide to Senior Dental Care
It can be easy to overlook oral health care until tooth or gum pain becomes overwhelming. However, dental care is an important element of health, and for seniors, it becomes essential. Poor oral health can increase the risk of pneumonia, poorly controlled diabetes and heart issues. Additionally, the discomfort associated with tooth pain can make it hard for seniors to get proper nutrition, and embarrassment about the state of a person's teeth can lead to social isolation.
Unfortunately, many seniors don't get the dental care they need. A 2018 report found that 47% of Medicare beneficiaries didn't visit the dentist within the 12 months prior to the study. Costs are a common barrier, with the same report showing that nearly half of people on Medicare have no dental coverage, and 20% of seniors who visit the dentist pay more than $1,000 in out-of-pocket costs.
Alzheimer's disease and other forms of dementia may heighten the risk of poor oral health. Seniors with these conditions can find it difficult to maintain a dental hygiene routine, and caregivers may struggle to provide regular oral health care. If you or a loved one have recently been diagnosed with a cognitive impairment, it's important to know how to care for your teeth and where to go for help.
This guide has information on oral health risks for seniors and how older adults can manage their own dental care. It also has information on symptoms to look out for, when to go to a dentist and ways to help pay for dental visits.
Why Seniors Are At Higher Risk for Oral Health Problems
The CDC reports that nearly 1 in 5 seniors have lost all their teeth, and 96% have had a cavity. Additionally, about two-thirds of people aged 65 and over have gum disease. The reasons for the high level of dental problems include physical changes that come from growing older, as well as changes in people’s circumstances. Some issues that impact the dental health of older adults include:
- Lack of access to dental care: Rural and inner urban areas are often underserved by dentists, meaning there’s a long journey to find oral health care. This can add extra barriers for seniors who no longer drive and don’t have easy access to transportation.
- Cost: Seniors generally lose their employer-provided health insurance once they leave the workforce. Without this, they must pay for their own dental care. Older adults, especially those on a fixed income, may put off care due to the cost.
- Cumulative effects of poor dental hygiene: The impact of poor dental habits, such as not flossing or skipping dentist appointments, can accumulate over time. People often start to see the effects as they get older.
- Poor diet: Certain foods, such as sugar and coffee, can affect the teeth. Seniors who have been eating these foods for many years may see the effects on their dental health.
- Tobacco use: Tobacco has a large impact on oral health. Seniors who have been smoking or chewing tobacco for much of their lives are likely to feel the negative outcomes on their teeth as they get older.
- Lack of fluoridated water and toothpaste: The benefits of fluoridation were not as well known in the past, and it took time for fluoridated toothpaste and community water to be available throughout the country. This can impact the dental health of seniors who didn’t have access to fluoridated water when they were children.
- Medical conditions: Several diseases can worsen oral health, including cancer, heart disease and diabetes.
- Medications that impact oral health: Many medications can affect oral health. In particular, medications can cause dry mouth syndrome and a lack of saliva increases the chances of tooth decay.
- Natural aging process: Your body can change as you grow older. In particular, a person’s bone structure, including the jaw, can shift. This changes your bite and can lead to tooth decay and tooth loss.
- Inability to provide adequate dental hygiene: As seniors get older, physical limitations may mean they can’t take care of their teeth properly. For example, someone with arthritis may find it difficult to hold a toothbrush. This is a particular concern for people with Alzheimer’s disease or dementia, as carers often find it difficult to provide the care needed. For example, people with cognitive impairment can bite when something is in their mouth, putting carers at risk of injury. In addition, the senior may break objects like a dental pick, which then becomes a choking hazard.
Common Oral Problems in Seniors
These risk factors make seniors more susceptible to several oral problems. Understanding the issues that may occur can help you get treatment in a timely manner.
| Oral Problem | What It Is | Why Seniors Are Susceptible |
|---|---|---|
| Cavities | Also known as tooth decay or caries, cavities are damaged areas in the hard surface of teeth that develop into small holes. If left untreated, they can cause toothache, infection and tooth loss. | The cumulative effects of poor dental hygiene, smoking and sipping sugary drinks often impacts people as they reach retirement age. Lack of access to dental health care can worsen the problem. |
| Gum disease | Gums become irritated, inflamed and can bleed. If left untreated, it can cause tooth loss. | A buildup of plaque and tartar over a lifetime can make seniors more susceptible to gum disease. |
| Receding gums | Gum tissue pulls away from the base of the tooth, exposing the root to bacteria. This leads to inflammation and decay. | In some people, this may be a part of aging. Receding gums are also caused by a lifetime of brushing too hard or gum disease. |
| Tooth loss | Teeth become loose and unanchored from the jaw. They may also need to be pulled due to cavities or other damage. | Untreated gum disease and poor dental hygiene can lead to tooth loss. Receding gums also increase the risk of tooth loss. |
| Oral cancer | This is any cancer in the mouth, including cancers of the lips, tongue, palate, sinuses and throat. | Smoking, tobacco use and excess alcohol all greatly increase the risk of oral cancer, and these risks build up over a lifetime. Seniors take some medicines that increase the risk. In addition, rubbing from dentures or fillings over a long period can increase the risk of oral cancer. |
| Xerostomia | Also called dry mouth, this can lead to cracked lips, tooth decay and fissures or sores on the tongue and mouth. | Often caused by taking multiple medications. Can also result from other diseases, including Alzheimer’s disease, Parkinson’s disease and diabetes. |
Signs of Unhealthy Teeth and Gums in Seniors
Understanding the early symptoms of poor oral health can help you or your loved one resolve dental issues quickly.
| Oral Problem | What It Is | Possible Causes |
|---|---|---|
| Toothache | Pain in the teeth and around the jaw | Tooth decay, shifting jaw or loose teeth |
| Bleeding gums | Blood and soreness when brushing or flossing, or soreness when eating | Mild gum disease, known as gingivitis, or serious gum disease, known as periodontal disease |
| Mouth sores | Sores in the inner cheeks, palate or lips that don’t heal within a week | This may be a sign of dry mouth, oral thrush or oral cancer |
| Tooth discoloration | A change of color to yellow, gray or brown; can affect one or many teeth | A sudden change affecting only one tooth is likely caused by dental trauma. Overall staining in older adults may be a sign of the deterioration of tooth enamel. |
| Bad breath | An unpleasant odor when exhaling | Can be caused by gum disease or denture stomatitis, a fungal infection |
| Sensitive teeth | Sharp pain when drinking hot or cold drinks or when putting pressure on the tooth | Commonly caused by worn tooth enamel, exposed roots or receding gums |
| Jaw popping | Pain at the hinge of the jaw when talking, eating or opening the mouth | Can be caused by teeth grinding or joint issues. Can also be a sign of tooth decay, sinus issues and inflammation. |
Oral Hygiene Tips for Seniors
When Is It Time To See a Dentist?
These signs can help you decide if you or your loved one should see a dentist.
| Signal | Description | Concern |
|---|---|---|
| Physical symptoms | Pain, sores, bad breath, bleeding gums, dry mouth and other physical symptoms | May be signs of different oral health problems, including tooth decay and gum disease |
| Existing dental work | If you have fillings, crowns, implants or dentures | These must be checked regularly |
| Ongoing medical issues | Diabetes, heart disease and eating disorders | These can damage teeth and impact oral health |
| Ongoing medical treatment | Treatments such as radiotherapy and chemotherapy | Ask your doctor or specialist if any treatment you’re undergoing can impact dental health |
| Trouble eating | Difficulty chewing or swallowing, or pain when eating and drinking | Can be a sign of tooth decay or sensitivity. Resolving the issue helps seniors get proper nutrition. |
| Tobacco use | If you smoke or chew tobacco | Can be harmful to oral health and tobacco; users should have their teeth checked regularly |
| Hiding smile | Trying not to smile due to missing, cracked or discolored teeth | Can impact a senior’s social life, leading to feelings of isolation |
| Time for a checkup | If it’s been more than six months since your last dental visit | Regular checkups ensure problems are resolved early and your dental health is maintained |
Special Considerations for People with Memory Impairment
Dental care can be difficult for people with Alzheimer’s disease and other forms of dementia. People often lose the ability to maintain their own dental hygiene, and caregivers may struggle to clean and floss teeth. Additionally, dentist visits may be distressing.
If you or a loved one have recently been diagnosed with a form of cognitive impairment, make an appointment with the dentist as soon as possible. They will be able to advise you of any work that needs to be done and make arrangements to perform it quickly. This allows a person with dementia to have any complex dental care done during the disease's early stage. Then, as the condition progresses, dentist visits will mostly be for maintenance.
Mouth Care Without a Battle is an initiative of the University of North Carolina that has more information about dental care and oral health for people with dementia.
Paying for Dental Care
Several resources can help seniors pay for dental and oral health care. However, coverage may be limited. It can help to understand what different programs pay for.
Medicare
What Is It?
Medicare is federal health insurance available to eligible seniors aged 65 and over, as well as some younger people with disabilities. Part A covers hospital care, while Part B covers services from doctors and other health providers. It does not generally cover dental care.
What Is Covered?
| Care | Coverage |
|---|---|
| Routine dental care such as cleaning, fillings or root canals | Not covered |
| Dental emergencies | Not covered |
| Implants and dentures | Not covered |
| Dental treatment related to other health emergencies (e.g., tooth extraction prior to surgery) | Covered |
How To Get Help
You can apply for Medicare online at Medicare.gov. Alternatively, contact your state’s senior health insurance assistance program for help enrolling in Medicare.
Medicare Advantage
What Is It?
Also known as Medicare Part C, Medicare Advantage is an alternative way for seniors to access Medicare. Private companies provide the insurance and must offer the same level of coverage as original Medicare. In addition, these policies can offer additional coverage, including dental care. Each policy is different, so make sure you understand what’s included when you choose a policy.
What Is Covered?
| Care | Coverage |
|---|---|
| Routine dental care such as cleaning, fillings or root canals | Depends on the policy |
| Dental emergencies | Depends on the policy |
| Implants and dentures | Depends on the policy |
| Dental treatment related to other health emergencies (e.g., tooth extraction prior to surgery) | Covered |
How To Get Help
Your state’s senior health insurance assistance program can help you understand the different policies available through Medicare Advantage.
Medicaid
What Is It?
Medicaid is a government program that provides health care to eligible low-income people, including the elderly. Both the federal and state governments fund it, but the states administer it. This means that eligibility and coverage differ depending on where you live.
What Is Covered?
| Care | Coverage |
|---|---|
| Routine dental care such as cleaning, fillings or root canals | Depends on the state; less than half the states provide comprehensive dental care |
| Dental emergencies | Depends on the state; most states provide emergency dental services |
| Implants and dentures | Depends on the state |
| Dental treatment related to other health emergencies (e.g., tooth extraction prior to surgery) | Likely to be covered as part of other health care services |
There are no minimum requirements for adult dental coverage, but many states offer some assistance. It’s important to note that even within states, coverage can differ depending on the program you’re enrolled in. For example, the care available through Medicaid waivers may vary from that available through regular Medicaid.
Medicaid does pay for nursing home care for eligible people in all states. Any skilled nursing facility that accepts Medicaid is directly responsible for residents' dental care, so any oral health concerns should be accessible if you live in one of these facilities.
How To Get Help
Most states offer multiple avenues of application, including online or in person; however, the exact application procedure may differ depending on the type of coverage you’re applying for. Contact your state’s agency for more information.
Veterans Benefits
What Is It?
Veterans Affairs provides a range of services and benefits to people who served in the U.S. military, including health benefits. Some veterans qualify for free dental care through VA health care; however, this isn’t universal. Veterans can also access the VA Dental Insurance Program (VADIP), which provides low-cost private dental insurance. People enrolled in VADIP must pay premiums and copays for their care; the cost depends on the insurance company and plan.
| Care | VA Health Benefits | VADIP |
|---|---|---|
| Diagnostic services | Depends on circumstances | Yes, for most plans |
| Preventive dental care | Depends on circumstances | Yes, for most plans |
| Routine services such as root canals | Depends on circumstances | Yes, for most plans |
| Dental surgery | Depends on circumstances | Yes, for most plans |
| Emergency dental care | Depends on circumstances | Yes, for most plans |
If you’re enrolled with a VADIP plan, it’s important to check your policy to see what’s covered. Although coverage is intended to be extensive, different policies provide different coverage levels, and your costs can also vary.
How To Get Help
You can get help applying for VA health care and find out what dental coverage you have by talking to an officer at a VA medical center or clinic. You can also apply online or over the phone by calling (877) 222-8387. You can download paper application forms from the VA website and return them to the main office.
For VADIP, you must enroll through the individual provider. You can find information on plans and providers and a link to enrolment instructions on the VADIP page.
Stand-Alone Dental Insurance
What Is It?
Although Medicare or Medicare doesn't cover most dental care, it is possible to purchase a stand-alone dental insurance policy. Similar to plans offered by employers, independent dental insurance provides different tiers of coverage. Policies with high levels of coverage are likely to have more expensive premiums or copays.
What Is Covered?
| Care | Available |
|---|---|
| Diagnostic services | Yes |
| Preventive dental care | Yes |
| Routine services such as root canals | Yes |
| Dental surgery | Yes |
| Emergency dental care | Yes |
It’s important to note that while it’s possible to find plans that cover all types of dental care, the exact services you can access depend on your plan. Always read policy documents carefully to understand what your plan covers, whether it covers preexisting conditions and what your share of the costs will be.
How To Get Help
You can find information on separate dental plans available in your area on the Health Insurance Marketplace.
Options To Lower Dental Care Costs
Lower Cost Options at the Dentist: What Are They?
Your dentist may offer several options to help seniors or low-income patients afford their dental care. These could include:
- Financing: A loan through a credit company with low-interest terms
- In-house membership: These may be run differently at different dentist offices, but generally you pay a monthly amount that provides you with routine care at discounted prices. You may also receive discounts for complex care.
- Cash pay incentives: Your dentist may offer a discount for people who pay in cash on the day of service.
- Senior discounts: Many dentists offer discounts to people aged 65 and over.
How To Get Help
Speak to your dentist about any payment options or assistance they can provide.
Lower Cost Options at Dental Schools: What Are They?
Dental schools and dental hygiene programs often have on-campus dental clinics that provide low-cost care to people from the public. This enables students to practice their skills while under a teacher's supervision. As these students are often graded for their work, the quality is high although appointments may be longer than those with a fully qualified dentist. There are a limited number of dental schools and appointment times, so you may also encounter a lengthy waiting period before you can make an appointment.
What Is Available?
| Care | Available |
|---|---|
| Diagnostic services | Yes |
| Preventive dental care | Yes |
| Routine services such as root canals | Yes |
| Dental surgery | Depends on the school |
| Emergency dental care | Depends on the school |
Although the above services are typically available, you may find that not all services are available at all times. In many cases, the procedures offered are limited to what is currently being taught. This means that if the class is practicing fillings and you need a root canal, you’ll need to wait until they reach the root canal portion of their studies.
How To Get Help
To find out more about dental clinics, contact the dentistry school closest to you. The Commission on Dental Accreditation maintains a list of all accredited schools in the country.
Free Dental Care for Low-income Seniors
Although many resources are available to help seniors pay for dental care, for many, the services they require are still beyond their reach. Thankfully, some organizations offer free oral health care to seniors who can’t pay for services in any other way.
Dental Lifeline Network
Dental Lifeline Network is a nationwide nonprofit organization that provides comprehensive dental care to adults in need. Around 15,000 dentists and 3,400 dental laboratories are part of the Donated Dental Services (DDS) program and donate their time and skills to serve eligible people across the country. The Dental Lifeline Network also has the Will You See One Veteran (WYSOV) program that connects volunteers with eligible veterans.
To qualify for the services, you must not have any other means to afford or receive dental care. You must also be in one of the following categories:
- Aged 65 and over
- Have a permanent mental or physical disability
- Be medically fragile
Medically fragile refers to people who need life-saving care but can’t access it due to dental complications. For example, infection or gum disease may delay the start of chemotherapy. In these cases, the Dental Lifeline Network can offer free services.
As there is a high demand for services, there may be a waiting list for appointments. In addition, some states may have limited availability in certain cities or counties based on the number of volunteers and patients at the time. The below information is accurate as of August 2022. Availability may change, so check each state’s page before applying.
| State | Contact | Current Availability |
|---|---|---|
| Alabama | (334) 834-1114 | Limited counties |
| Alaska | (877) 977-3802 | Limited counties |
| Arizona | (480) 850-1474 | Limited counties |
| Arkansas | (501) 993-8245 | Limited counties |
| California | (530) 241-4222 | All counties closed |
| Colorado | (303) 534-3931 | Limited counties |
| Connecticut | (959) 999-0860 | Limited counties |
| Delaware | (855) 293-0119 | All counties closed |
| Florida | (850) 577-1466 | Limited counties |
| Georgia | (404) 993-4003 | Limited counties |
| Hawaii | (888) 449-9670 | Limited counties |
| Idaho | (888) 623-2780 | All counties closed |
| Illinois | (309) 691-5938 | Limited counties |
| Indiana | (317) 733-0585 | Limited counties |
| Iowa | (515) 251-8000 | All counties open |
| Kansas | (785) 273-1900 | Limited counties |
| Kentucky | (502) 337-5426 | Limited counties |
| Louisiana | (225) 926-8062 | Limited counties |
| Maine | (207) 620-8276 | Limited counties |
| Maryland | (410) 964-1944 | All counties open |
| Massachusetts | (978) 881-8558 | Limited counties |
| Michigan | (517) 347-0054 | All counties open |
| Minnesota | (651) 454-6290 | Limited counties |
| Mississippi | (601) 932-2200 | Limited counties |
| Missouri | (573) 636-4440 | Limited counties |
| Montana | (406) 449-9670 | Limited counties |
| Nebraska | (855) 293-0119 | Limited counties |
| Nevada | (702) 984-9419 | All counties closed |
| New Hampshire | (603) 826-6408 | All counties closed |
| New Jersey | (973) 967-9171 | All counties open |
| New Mexico | (505) 298-7206 x204 | All counties open |
| New York | (212) 598-9000 | Limited counties |
| North Carolina | (919) 677-9001 | Limited counties |
| North Dakota | (701) 729-2731 | Limited counties |
| Ohio | (614) 379-1115 | All counties closed |
| Oklahoma | (800) 452-6022 | Limited counties |
| Oregon | (503) 594-0837 | All counties open |
| Pennsylvania | Philadelphia and surrounding counties: (724) 568-4343 Rest of the state: (717) 776-3262 | Limited counties |
| Rhode Island | (401) 821-8656 | All counties open |
| South Carolina | (888) 322-9527 | Limited counties |
| South Dakota | (605) 224-4012 | All counties open |
| Tennessee | (615) 983-2601 | Limited counties |
| Texas | (855) 293-0119 | All counties closed |
| Utah | (801) 499-6504 | Limited counties |
| Vermont | (802) 829-3376 | All counties open |
| Virginia | (804) 523-2182 | Limited counties |
| Washington | (206) 441-8777 | All counties closed |
| Washington, D.C. | (855) 293-0119 | All counties closed |
| West Virginia | (304) 919-1579 | Limited counties |
| Wisconsin | (414) 755-4188 or (888) 338-6852 | All counties open |
| Wyoming | (855) 582-7896 | Limited counties |
Community Health Centers
The Health Services and Resources Administration (HRSA) runs a health center program that provides primary health care to vulnerable people around the country. This includes oral health services. It offers care regardless of a person’s ability to pay, though it may charge fees on a sliding scale. You can find your nearest community health center on the HRSA website.
National Association of Free & Charitable Clinics
The National Association of Free & Charitable Clinics is a nonprofit organization that supports the country’s free and charitable clinics and charitable pharmacies. It has a database of clinics around the country, including free and charitable dentist clinics. You can use the clinic finder to find a dentist near you.
