Toothache and Troubling Truths About Dental Care for Seniors

Recently, I found myself dealing with a persistent toothache, which, as it turns out, opened up a whole new level of discomfort—a reality check about dental care in the U.S. for those 65 and up.

If you could see the overall state of oral health care for seniors, it’d be hard not to notice a plethora of issues—specifically, cavities everywhere. Elizabeth Mertz, a professor at UC San Francisco, described the situation as possibly worse than one might think. She remarked that the oral health care system is actually more of a chaotic mess than anything organized.

But back to my toothache. It had been nagging at me for weeks. So, naturally, I scheduled an appointment with my dentist. I approached it with some hope but also a little dread, as I had experienced extractions recently.

Turns out, my dentist said a molar had to go due to a cellular issue—resorption, to be exact. He mentioned that I’d likely need a bone graft and possibly an implant, which would take months and cost about as much as a nice vacation.

I’m fortunate; my dentist is great, and I have decent dental coverage from my job. But, as many know, dental insurance isn’t quite what it seems. It covers cleanings and basic routines, sure. Yet for more complex procedures—especially as we age—you’re often stuck covering half the cost or more, with annual limits around $1,500.

Mertz pointed out that “the No. 1 reason for delayed dental care is out-of-pocket costs.” This got me thinking—maybe I should just ditch my current medical and dental plans for a Medicare Advantage plan that offers better dental options. But both my dentists quickly advised against it, citing the limitations in supplemental plans.

Honestly, navigating all this can feel incredibly overwhelming. It’s like no one tells you that getting older is a full-time job, the perks are minimal, and vital specialties like dental, vision, and hearing often aren’t included in the basic Medicare package. It’s almost as if Medicare was devised by pranksters, and now we’re facing the consequences as the older population swells.

So, what’s the alternative for those aging and experiencing dental issues?

A retired friend of mine shared that she and her husband have opted not to carry dental insurance due to its high cost and limited coverage. They’re not alone; estimates suggest that about half of U.S. residents over 65 lack dental insurance.

Mertz noted that foregoing insurance might be a reasonable choice given the premiums and the reimbursement woes many dentists face—it can be tough to find one that accepts your plan. Still, many delay seeking dental care until absolutely necessary, which can lead to serious health risks.

“Dental issues are closely linked to diabetes and various heart conditions,” remarked Paul Glassman, an associate dean at California Northstate University’s dentistry school.

There’s another option some consider: dental tourism. Mertz referred to places like Mexico and Costa Rica, where many U.S. residents seek dental care. “You can have a vacation and get dental work done, often for less overall than you’d pay here,” she mentioned.

Dr. Oscar Ceballos from Tijuana noted that about 80% of his clientele comes from the U.S., some traveling from states as far as Florida and Alaska. Many of his elderly patients have returned repeatedly because, in the U.S., insurance can be pricey and often inadequate.

For comparison, Ceballos said a dental implant in California might run between $3,000 and $5,000, while his costs range from $1,500 to $2,500. He explained that lower overhead costs help keep prices down.

During our phone call, Ceballos mentioned three U.S. patients currently in his waiting room. One of them, John Lane from San Diego, has been visiting for nearly a decade. “The main reason is the quality of care,” he said, humorously claiming to be “39, with almost 40 years extra.” He also praised Ceballos for his conscientiousness and the cleanliness of the facilities.

Lane pointed out that the costs are often half what they would be in the U.S., sometimes even more. As summer approaches, he might see even more fellow Californians in Ceballos’ clinic.

Concerns are rising about potential funding cuts to the Medi-Cal Dental program, which could severely impact vulnerable populations. Robert Hanlon, president of the California Dental Association, remarked that fewer dentists could accept Medi-Cal patients if budget cuts enact.

Under Proposition 56’s tobacco tax from 2016, supplemental reimbursements for dentists have been provided, but those increases might vanish if budget cuts proceed. Currently, only about 40% of dentists in California accept Medi-Cal, and a survey noted many would cease to accept such patients altogether.

Hanlon voiced his concern, stating, “It’s shocking that as healthcare costs reach new heights, the state considers reverting program funding to 1990s levels. These cuts will push patients to forgo or delay essential dental care, leading to preventable emergencies in already crowded emergency rooms.”

Somkene Okwuego, a dental student set to graduate from USC soon, shared her experiences with elderly patients who often have Medi-Cal or no insurance. After working at a clinic that offers free or discounted care, she feels privileged to help “fix the smiles” of her elderly patients, boosting their self-esteem, especially when job hunting.

When I visited her recently, she was attending to 83-year-old patient Jimmy Stewart, who mentioned his struggles to receive dental care through the VA, not seeing a dentist for years until a friend recommended the Ostrow clinic. Fortunately for him, his restorative treatments were covered by Medi-Cal.

When I mentioned the looming Medi-Cal cuts, Stewart responded, “I’d be screwed.”

Sadly, he’s not alone in that sentiment.