A Guide to Dental Care for Seniors

Covered in this guide:

• Why Seniors Have an Increased Risk of Dental Problems
• The Most Common Oral Health Problems in Seniors
• Symptoms of Tooth and Gum Problems in Older Adults
• When Should You See a Dentist?
• Paying for Dental Care
• Free Dental Care for Low-Income Seniors

Updated: June 14, 2023 |Reviewed by: Deidre Sommerer, LPN, MS, CMC, CDP

A healthy set of pearly whites helps you express happiness, show off your confidence and put other people at ease, making your smile an important communication tool. Good dental health also makes it easier to eat a variety of foods, ensuring you receive an adequate amount of nutrients. That's why it's so important to receive regular dental care as you get older.

Unfortunately, many seniors lack access to affordable dental care, preventing them from getting routine cleanings and X-rays. Most seniors lose their dental insurance upon retirement because traditional Medicare and other insurance plans do not include dental benefits. Seniors may also have difficulty accessing dental care if they're homebound, disabled or living in nursing homes and other senior communities.

Over time, a lack of dental care increases the risk for tooth decay, gum disease, tooth loss and other serious dental conditions. As a result, nearly 20% of adults aged 65 and older have lost all of their teeth. Approximately 68% of all adults in this age group also have gum disease. These dental problems cause tooth pain, bleeding gums, bad breath and may contribute to cardiac problems and other diseases.

In this guide, you'll find valuable tips to help you maintain your oral health as you age. The guide also includes a detailed list of resources to help you pay for dental care, even if you have limited income.

Why Seniors Have an Increased Risk of Dental Problems

Dental problems can develop at any age, but seniors have some unique circumstances that make them more susceptible to tooth decay, gum disease, tooth loss and dry mouth. You'll find more detailed information about each reason below.

Cost of Dental Services

For many seniors, the cost of dental services is a major barrier to getting regular oral health care. In the United States, a basic cleaning and polish typically costs anywhere between $75 and $200. A set of X-rays costs another $100 to $200. At these prices, it may cost as much as $400 just to get the most basic dental care available.

Seniors on a fixed income can't always afford to pay for preventive care, increasing the risk for cavities, gingivitis and other dental problems. If you need dental work to address one of these problems, your out-of-pocket costs can increase significantly. Your dental insurance plan may also have an annual limit, which is the maximum amount of money it will pay for dental services in a single year. If you need a root canal or a set of dentures, you may exceed this limit quickly, increasing your out-of-pocket expenses.

Lack of Access

Researchers from NYU Langone Dental Medicine and NYU School of Medicine refer to poor oral health as the "national symbol of social inequality." This is because low-income citizens who lack dental coverage are more likely to have oral health problems. Poor oral health is also common among members of rural communities and large groups of immigrants due to a lack of access to high-quality dental care.

In some areas of the country, it's difficult to access dental care due to a shortage of dentists. Shortages are especially common on and around Native American reservations, which are typically located in rural areas that lack convenient access to other services. As a result, Native Americans have the worst oral health of any group living in the United States.

Cumulative Effects of Poor Oral Hygiene

Regular brushing and flossing are essential for preventing cavities, gum disease and other oral health problems. If you don't brush and floss for a few months, your dentist may be able to reverse the negative effects by doing a deep cleaning. Give up on oral hygiene for several years, however, and it may be too late to avoid cavities, receding gums and other dental issues.

Poor oral hygiene is considered one of the crucial risk factors for developing periodontitis, a serious infection of the gums that can damage the bones that hold your teeth in place. According to a study published in Frontiers in Oral Health, poor oral hygiene also makes minimally invasive dental interventions less effective. As a result, it may be more expensive and more time-consuming to address certain dental problems.

Use of Prescription Medications

Nearly 90% of older adults take at least one prescription medication. Some of these medications increase the risk of dental problems by reducing the amount of saliva in the mouth. You need saliva to kill bacteria and protect your tooth enamel, so less saliva in your mouth leads to an increased risk of tooth decay. Medications can also cause dental problems by damaging enamel, the protective covering of your teeth. These are just some of the medications that can increase your risk of oral health problems:

• Antidepressants
• Antihistamines
• Chewable aspirin
• Asthma medications
• Blood pressure medications
• Immunosuppressants
• Chemotherapy drugs
• Medications suspended in syrups
• Antibiotics
• Bisphosphonates used to treat osteoporosis

Chronic Health Conditions

Older adults are also more likely to have chronic health conditions that have a negative impact on their oral health. Diabetes makes it more difficult to fight off infections, increasing the risk of gum disease and other dental infections. Osteoporosis, a weakening of the bones that occurs in some seniors, can affect the bones in the jaw. As a result, seniors with osteoporosis have an increased risk of tooth loss.

Arthritis and AIDS may cause lesions to form in the mouth, a painful condition that makes it difficult to keep up with regular brushing and flossing. Seniors with Alzheimer's disease and other types of dementia may even forget to brush their teeth or floss regularly, increasing the risk of dental problems.

The Most Common Oral Health Problems in Seniors

Lack of access to dental care, along with chronic health conditions and the use of certain medications, make seniors more susceptible to certain oral health conditions. The table below lists some of the most common dental problems and explains what can make an older adult susceptible to each one.

Symptoms of Tooth and Gum Problems in Older Adults

Tooth and gum problems cause a variety of symptoms. These are some of the most common:

• Bad breath: If your breath isn't as fresh as it used to be, you may have tooth decay, gum disease or some other type of dental problem.
• Bleeding gums: Gum disease often causes the gums to bleed. This occurs when plaque builds up along the gum line, irritating the sensitive tissue. When you brush your teeth, you may see blood on your toothbrush or in the sink after you spit the toothpaste out of your mouth. If you floss regularly, you may also see blood on each piece of dental floss you use.
• Painful chewing: Tooth decay, loose fillings and cracks in the teeth can also cause sharp pain when you bite into a piece of food.
• Sensitivity to hot or cold foods and beverages: If taking a sip of ice-cold water or a spoonful of hot soup has you wincing with pain, you may have minor tooth decay or a loose filling. Hot and cold sensitivity is also associated with receding gums. If the pain persists for more than 30 seconds, it may indicate that the pulp of the affected tooth has been permanently damaged.
• Loose teeth: Severe gum disease affects the soft tissues and bones that are supposed to hold your teeth in place, causing permanent teeth to become loose.
• Gum recession: If you have receding gums, the pink gum tissue won't cover as much of each tooth as it used to. You may notice that a tooth seems longer or you have a notch where the gum tissue used to be.

When Should You See a Dentist?

You should see a dentist once every 6 months for routine care, but you may need additional visits if you experience any signs or symptoms of dental problems. Schedule an appointment with your dentist if you experience any of the following:

• Pain: Pain anywhere in the mouth is a sign that something is wrong. It could be a dental abscess, a cavity or some other type of dental problem.
• Swollen or bleeding gums: Swelling and bleeding are signs of gum disease, which can lead to tooth loss if it's not treated by a professional.
• Loose fillings: If a filling is loose, bacteria can get in between the filling and the tooth, leading to tooth decay.
• Difficulty chewing: You should be able to chew a variety of foods without discomfort. Difficulty chewing is associated with tooth decay and other dental problems.
• Tooth loss: Once a tooth falls out, there's nothing your dentist can do to fix it, but they may be able to prevent the loss of additional teeth.
• Dry mouth: Your teeth rely on saliva to wash away bacteria. If your mouth is dry, you have an increased risk of tooth decay and cavities. Your dentist can help you avoid these problems by treating your dry mouth appropriately.
• Mouth sores: Not only are mouth sores uncomfortable, but they can also be a sign of oral cancer and other serious conditions. Your dentist can examine the sores, determine the cause and refer you to a specialist if needed.

Paying for Dental Care

Dental care can be expensive, but there are several resources available to help seniors afford preventive services and treatment for a variety of dental conditions. If you've been avoiding the dentist due to the cost, you may qualify for one or more of the following programs.

Medicare

Program Description

Medicare is a federal health insurance program for seniors and some younger adults with disabilities. It also covers individuals with end-stage renal disease (kidney failure). When you sign up for Medicare, you have two options for getting coverage. One is to enroll in Original Medicare; the other is to enroll in Medicare Advantage. Original Medicare is administered by the Centers for Medicare & Medicaid Services, while Medicare Advantage plans are sold by insurance companies throughout the United States.

Medicare Dental Benefits

Original Medicare doesn't cover most dental services, but some Medicare Advantage Plans do. This is because insurance companies are allowed to offer extra benefits to people who enroll in Medicare Advantage instead of Original Medicare. In 2019, about 26% of Medicare Advantage enrollees had access to dental coverage.

What's covered depends on the terms of your specific plan, but Medicare Advantage may cover dental exams, X-rays, routine cleanings, extractions and fillings. You may have to pay a copay for some services, so check your plan documents or contact your insurance company by phone to request an estimate of your out-of-pocket costs.

Eligibility Requirements

You must meet the following requirements to enroll in a Medicare Advantage Plan:

• You already have Medicare Part A and Part B. To qualify for Part A and Part B coverage, you must be at least 65 years old or have a disability that makes you eligible for enrollment at a younger age.
• You're a U.S. citizen or lawful immigrant.
• You live in the plan's service area. Not all Medicare Advantage Plans are offered in all states.

Medicare Application Instructions

If you haven't enrolled in Medicare Part A and Part B yet, fill out the Medicare application on the Social Security Administration website. Once you're enrolled, use the Medicare Plan Finder to look for a Medicare Advantage Plan in your area. To sign up for Medicare Advantage, call (800) 633-4227, fill out a paper enrollment form or contact the plan provider directly.

Medicaid

Program Description

Medicaid provides health coverage to individuals with limited financial resources. This allows millions of Americans to access preventive services and receive treatment for acute and chronic health conditions.

Medicaid Dental Benefits

Under the rules set by the Centers for Medicare & Medicaid Services, dental services are an optional benefit. Medicaid is administered at the state level, so the availability of dental coverage depends on where you live. Alabama, Delaware, Maryland and Tennessee are the only states that provide absolutely no dental coverage for adults enrolled in Medicaid. In other states, the availability of dental services can be classified as emergency, limited or extensive.

Emergency dental benefits are only available when treatment is necessary to relieve pain, prevent the spread of infection, control bleeding or treat an injury. For example, Oklahoma Medicaid only covers emergency tooth extractions. States with limited coverage may limit the number of covered services or set low limits on the amount of money spent on dental services. One example is Vermont, which offers a limited dental benefit of $510 per year. In states with extensive coverage, Medicaid covers a wide variety of preventive services and dental treatments.

Eligibility Requirements

Since Medicaid is administered at the state level, each state has its own set of eligibility requirements. In most cases, you need to reside in the state where you're applying for benefits. You must also be a U.S. citizen or lawful immigrant. Medicaid is intended for low-income Americans, so you'll also have to meet your state's requirements regarding income and assets.

Medicaid Application Instructions

Each state has its own Medicaid application, so contact your state Medicaid agency for more information on how to apply. You can find your state agency by visiting Medicaid's Contact Us page and selecting your state from the dropdown box.

Veterans Benefits

Program Description

The U.S. Department of Veterans Affairs offers health benefits to veterans meeting certain eligibility requirements. These services are provided at hospitals and clinics throughout the United States.

Dental Benefits from the VA

The VA operates more than 200 dental clinics, giving eligible veterans access to preventive care, dental surgery and restorative dental procedures. Available services include routine cleanings, tooth extractions, fillings and root canals.

Eligibility Requirements

Your veteran status determines what type of care you're eligible to receive. If at least one of the following applies, your benefits will cover any of the services available at a VA dental clinic:

• You have a service-connected compensable dental condition or disability.
• You're a former prisoner of war.
• You have a service-connected disability with a 100% rating or you can't work and are paid at the 100% rate due to your service-connected conditions.

If you don't meet any of those requirements, your VA benefits won't provide comprehensive dental coverage.

Application Instructions for VA Dental Benefits

To apply for dental benefits, fill out VA Form 10-10EZ, Enrollment Application for Health Benefits, on the VA website. You'll need your military discharge information, current health insurance cards, last year's deductible expenses and last year's gross income.

Dental Clinics

Many dental schools provide low-cost care to community members who are willing to have students work on their teeth and gums. These programs provide valuable learning opportunities for dental students and make dental care more affordable to seniors and other individuals who can't afford to pay full price for the services they need. The following dental schools provide low-cost care to those in need:

Free Dental Care for Low-Income Seniors

For some seniors, even reduced-fee dental services are too expensive. If you have limited financial resources, contact one of the organizations below to find out if you qualify for free dental care.

Dental Lifeline Network

Dental Lifeline Network is a nonprofit organization offering free dental care to eligible residents of all 50 states and the District of Columbia. The eligibility requirements are the same in every state. You must lack adequate income to pay for dental care and meet at least one of the following criteria:

• You're 65 or older.
• You have a permanent disability.
• You meet the definition of a "medically fragile" individual.

The table below lists the website and telephone number for the Dental Lifeline program in each state.

If you don't qualify for services through the Dental Lifeline Network, contact one of the following programs in your area to determine if you meet their eligibility requirements.

Expert Reviewer

Deidre Sommerer, LPN, MS, CMC, CDP

Deidre has worked in the healthcare field for over 35 years and specializes in Geriatrics. Deidre is a nurse who holds a certification from the National Academy of Certified Care Managers and is a Certified Dementia Practitioner. She has worked across all healthcare settings, with a concentration on the community and helping older and disabled adults age in place. She has worked on NIH grant-funded program evaluation projects and considers herself a life-long learner. Deidre is a valued team member at The Hartford HealthCare Center for Healthy Aging in Hartford, CT.