Senior Oral Health & Hygiene
With all the talk of affordable health care in this country, do you ever hear dental care mentioned? Little if ever, especially when it comes to seniors. In fact, neither Obamacare nor basic Medicare provide dental coverage.
Unfortunately, only about 2% of older Americans have dental insurance. This means that many end up going without. And the older the person, the more likely they are to need dental care for a variety of reasons.
We'll look at the oral health issues facing seniors as well as provide solutions where practicable. In a follow-up article, we'll show you how to get free or reduced cost dental care no matter where you live and no matter what your challenges.
Consider These Facts
- Over 30% of older adults have untreated cavities
- Almost 25% of adults between the ages of 65 and 74 have periodontal disease, which is associated with chronic health issues such as diabetes mellitus, heart disease, stroke, and respiratory disease
- Nearly 30% of older adults lose their teeth
And Did You Know?
- Losing your teeth is NOT an eventuality of aging
- Your mouth changes as you age
- Poor oral health can lead to life-threatening diseases
- The nerves in your teeth can become smaller, making your teeth less sensitive to cavities or other problems.
Oral Health Issues for Seniors
Losing your teeth is not part of growing older, but for many seniors, it's a reality. For a variety of reasons, our older population is at a disproportionate risk for oral health problems. Here are some of the main issues:
- Loss of dental coverage after retiring
- Medicare doesn't cover most dental work
- Medicaid coverage varies by state and is limited
- Can't afford out-of-pocket dental expenses
- Inadequate nutrition because of dry mouth, soreness, tooth loss
- Dry mouth from medications can lead to cavities and gun disease
- Supplemental dental coverage is limited
- Lack of transportation for regular dental visits
- Lack of access/poor care living in nursing homes
- Poor oral health can lead to serious health issues
Medicare & Medicaid
The kind of routine dental care seniors need most—checkups, cleanings and fillings—is not covered by Medicare. According to the Centers for Medicare and Medicaid Services (CMS), Medicare will only pay for:
- Dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for
- Extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw
- Oral examinations preceding kidney transplantation or heart valve replacement, under certain circumstances
- Medicare will not pay for dentures
Medicaid—the joint federal and state program that provides some medical coverage to low income Americans—only provides comprehensive dental care in some cases and in some states. Most states do offer emergency dental care.
See our 10 Free or Low Cost Dental Care Options for Seniors page for programs that can help. Also, see the bottom of the article for a listing of Medicaid dental coverage by state.
A side effect of taking medications—dry mouth—is another problem. Saliva keeps the mouth wet, protects teeth from decay and “prevents infection by controlling bacteria, viruses, and fungi in the mouth.” A dry mouth increases the risk for cavities and gun disease. About 30% of adults 65 and older experience mouth dryness. And there are over 400 medications with dry mouth as a side effect.
As one of the main culprits of a dry mouth is medication, ask your doctor if there are adjustments to help with the dryness.
- Avoid drinks that cause dry mouth such as caffeine, alcohol, acidic juices, and soda
- Don’t smoke
- Drink water throughout the day
- Chewing sugar-free gum or candy will help stimulate saliva
- Avoid mouthwashes unless they are specifically designed for dry mouth
High Out-of-Pocket Costs
Once you retire, finding access to low-cost dental care is difficult. Medicare doesn't cover most dental work; Medicaid coverage is limited. Preventative dental care becomes an out-of-pocket expense unless you have supplemental coverage. Even with supplemental insurance, coverage is often limited to $1,500 a year, which can be eaten up with a few cleanings, x-rays and a couple of fillings. Larger, more expensive procedures can easily run into the thousands. For example, if you lived in Phoenix and needed a cleaning, you’d be looking at $94. A silver filling in Syracuse will cost you $163. A root canal in Tampa will set you back over $1,000.
Between federal and state governments and a number of volunteer networks, there are an array of options for help with dental treatment and costs. In our follow-up article, we'll show you ways to access free or low cost dental care.
This is a two-way street. Eating the wrong things can contribute to cavities, gum disease and other oral health issues. And oral health issues can lead to poor nutrition.
Sugar is the #1 cause of tooth decay. And the worst sugar offenders are sodas, juices, and energy drinks. Other culprits include:
- Hard and sticky candies (lollipops, caramels, gummy bears and the like)
- Starchy foods that get stuck in your teeth such as chips and bread
- Items that dry out your mouth such as coffee and alcohol.
Once your mouth is in poor condition (loss of teeth, cavities, and gum disease) chewing becomes painful and tasting almost non-existent. Difficulty eating means you'll likely eat less and eat less of the right things and more of the wrong things, which all leads to nutritional deficiencies.
Drink lots of water. Eat foods from the five major food groups: whole grains, fruits, vegetables, lean protein sources (lean beef, chicken, beans, peas, etc.), and low-fat dairy foods. For more tips on what to eat, check out the USDA's choosemyplate.gov.
Another problem is transportation. An Alliance for Aging Research report indicated that “about 30 percent of older adults face difficulties in getting to a dental office: they may be frail, dependent or homebound, or live in nursing homes.”
If transportation is an issue for you, getting to your next dental check-up will rank lower on your list than getting to your next colonoscopy. Don't let this be the reason you can’t get to the dentist.
The Eldercare Locator can help you find transportation options in your area. You can also call 800-677-1116.
Finally, your local Area Agency on Aging can help with transportation as well.
Oral Care in Nursing Homes
If you or your loved one is a nursing home resident, oral health should be a particular area of concern. Many residents arrive with poor oral health. Another issue is that residents' teeth are often overlooked in nursing homes. Among the duties of staff, brushing teeth may rank way down the list, even though doing so is federally mandated for those who can't do it themselves. Activities such as feeding, dressing, bathing and other ADLs tend to take priority. As a result, daily oral care is often neglected.
- A University of Texas study found that 29% of nursing home residents from a U.S. sample had broken or carious teeth, inflamed bleeding gums, oral abscess, chewing problems or mouth pain.
- Kansas Smiles 2012, a report on oral health in nursing homes, stated that 26% of residents had “severe gingival inflammation” and over one-third had “untreated dental decay.”
Another issue is that residents are often resistant to having their teeth brushed. One New York nursing home study found that 63% of patients were “resistive” to a Certified Nursing Assistant (CNA) attempts at oral care. The resistance usually stems from patients who are in some stage of dementia.
The Dangers of Poor Oral Health
Your mouth is called the gateway to the body. Non-regular teeth cleanings causes bacteria to build up in the mouth making gums and teeth more susceptible to decay. This bacteria can also have more serious effects.
Pneumonia and Oral Health
There are many published findings that link poor oral health and pneumonia, particularly in older adults. It is thought to be caused by breathing in bacterial droplets from the mouth to the lungs. Those in nursing homes and hospitals can be most susceptible to pneumonia. A Journal of the American Dental Association study concluded that good hygiene practices may prevent the death of about one in 10 elderly residents of nursing homes from health care–associated pneumonia.
Good regular oral hygiene will prevent bacteria from forming in the mouth and potentially getting in the lungs. This is particularly important in nursing homes where many residents are unable to care for their teeth, having to rely on staff.
Diabetes and Oral Health
Severe gum disease (periodontitis) hinders your body's ability to use insulin. And high blood sugar—an effect of diabetes—can worsen gum infection.
The American Diabetes Association recommends:
- Controlling your blood glucose level.
- Keep your dentist and hygienist informed of any changes in your condition and any medication you might be taking.
- Don't smoke.
- Get dental checkups/cleanings every six months.
Heart Disease and Oral Health
There is controversy with this connection. A number of past medical studies have indicated that there is a connection between gum disease and heart disease. However, a recent WebMD article says hold your horses on this:
“After reviewing more than 60 years of research on heart and gum disease, experts say that although the two problems are clearly related, it is unlikely that gum disease causes heart disease.”
In other words, experts aren't entirely sure whether there is or isn't a connection. But maintaining your gums and teeth is important for a many reasons.
Maintain & Improve Your Oral Health
The following are tips from the American Dental Association's Mouthhealthy.org.
- Brush twice a day with a toothbrush with soft bristles. You may also benefit from using an electric toothbrush.
- Clean between your teeth once a day with floss or another interdental cleaner.
- If you wear full or partial dentures, remember to clean them on a daily basis. Take your dentures out of your mouth for at least four hours every day. It's best to remove them at night.
- Drink tap water. Since most contains fluoride, it helps prevent tooth decay no matter how old you are.
- Quit smoking. Besides putting you at greater risk for lung and other cancers, smoking increases problems with gum disease, tooth decay and tooth loss.
- Visit your dentist. Visit your dentist regularly for a complete dental check-up.
How Much Will Dental Care Cost?
Do you have a tooth that's sensitive to hot and cold? You may have a cavity. You, could however, need more extensive work such as a root canal. Whether you're insured or not, knowing what to expect for that cleaning or filling can help you avoid sticker shock. It will also help you budget for services you know you'll need even if it's just x-rays and a cleaning. The site FAIR Health is a non-profit established to “bring transparency to healthcare costs.” FAIR collects cost data from private insurers that healthcare providers report to insurers as part of the claims process. You can find average prices in your area for an entire menu of oral procedures including cleanings, fillings, root canals, implants, x-rays, dentures and more.
Medicaid Coverage by State
The following list from the Kaiser Family Foundation show which state's Medicaid program offers dental coverage of any kind. Some coverage is emergency only.
|District of Columbia||Yes|
|Northern Mariana Islands||Yes|