Senior Dental Care: Why It's Important and How to Make It Affordable

Dental Issues That Commonly Affect Seniors

Getting older raises the odds of developing a wide range of oral health issues. Among the elderly, dental problems commonly include:

Tooth decay

According to a report from the National Center for Health Statistics, roughly one in five U.S. seniors has untreated tooth decay. That's partly because many older adults with arthritis or other conditions that reduce the dexterity in their hands are not able to brush or floss properly. Poor oral hygiene habits can lead to an accumulation of tartar and plaque, which can eventually cause decay.

To keep your pearly whites healthy, try drinking water after you eat and cutting back on sweets. An electric toothbrush can make it easier to clean your teeth more thoroughly. You may also want to ask a hygienist or dentist for specific tips on how to maintain dental health for seniors who have limited dexterity.

Receding gums

Seniors sometimes find that their gums are gradually shrinking away from their teeth. As the roots become exposed, the teeth become sensitive to touch as well as hot and cold extremes. Exposed roots are even more prone to decay than the top part of the tooth, since roots have no protective enamel.

Receding gums can be a result of genetics, brushing too hard, or grinding your teeth. Without treatment, your risk of gum disease and tooth loss increases. A deep cleaning may take care of the problem, but in some cases a gum graft may be required.

Dry mouth

Age frequently brings a drop in saliva production. That allows acids and sugars to build up in the mouth, making seniors more prone to cavities. It can also lead to a swollen tongue and cracked lips, which can make speaking and swallowing difficult.

Dry mouth is a common side effect of hundreds of different medications, including drugs for asthma, depression, high cholesterol, high blood pressure, obesity, nausea, urinary incontinence, and Parkinson's disease. It can also be caused by medical conditions like anemia, diabetes, rheumatoid arthritis, stroke, and Alzheimer's disease.

To alleviate dry mouth, drink water frequently, use a humidifier to add moisture to the air, and stay away from soft drinks, coffee, and alcohol. Munching on sugar-free chewing gum can also be helpful, since chewing stimulates saliva production.

Darkened teeth

As we get older, the enamel on our teeth thins and allows the underlying dentin (a grayish-yellow bony tissue) to show through. That gives the teeth a darker appearance. In addition, many years of smoking, chewing tobacco, or drinking tea, coffee, or colas can stain the teeth. Chemotherapy treatments and high blood pressure medications can also add to the problem. If you're concerned, ask your dentist about whitening treatments, tooth bondings, or porcelain veneers.

Gum disease

Also known as periodontal disease or periodontitis, gum disease is caused by a buildup of plaque. First, the gums become red and swollen and bleed easily (a condition called gingivitis). Left untreated, pockets form between the gums and the teeth and infection sets in as plaque begins to grow below the gum line. Eventually, the bone and connective tissues supporting the teeth can get destroyed, causing the teeth to fall out. In fact, gum disease is the number one cause of tooth loss in adults. Data from the Centers for Disease Control and Prevention revealed that about 60 percent of American seniors have periodontitis.

Gum disease can be aggravated by smoking, poor diet, and dentures that don't fit properly. Some medical conditions, such as diabetes, anemia, heart disease, and cancer, can also make the condition worse.

Treatment may involve scaling, root planing, or a course of antibiotics. In more advanced cases, bone or tissue grafts may be required.

The best way to prevent gum disease is to follow a healthy diet, brush with a fluoride toothpaste twice a day, floss daily, and get regular professional cleanings.

Oral cancer

Oral cancer can affect your teeth, gums, lips, cheeks, or tongue. (When it affects the tonsils or throat, it's known as oropharyngeal cancer.) Common symptoms include white or red bumps or patches, sores that bleed easily and don't go away after a couple weeks, pain, hoarseness, and difficulty moving the tongue or jaw.

According to the American Cancer Society, the average age of people who are diagnosed with oral cancer is 62. Men are more than twice as likely as women to develop the disease. Smoking, heavy drinking, and a family history of cancer all increase your risk. If you are diagnosed with the condition, you may require surgery, radiation therapy, or chemotherapy.

To help prevent oral cancer, see your dentist regularly and ask him or her to investigate any discolored areas or persistent sores in and around your mouth. If you wear dentures, make sure they fit properly and don't irritate the tissues in your mouth. It's also wise to cut back on or eliminate tobacco and alcohol use.

What Happens When You Are Missing Teeth

Dental care for elderly folks is critical because missing one or more teeth can trigger a series of problems. The remaining teeth often drift into the available space, which results in a misaligned bite. The uneven chewing pressure can cause the teeth you have left to fracture more easily and wear down more quickly. It can also strain your temporomandibular joint (the hinge that joins your jawbone and skull) and result in headaches and jaw pain.

Your jawbone can also deteriorate. That's because it needs constant pressure to rebuild itself and stay healthy. The roots of a tooth serve to nourish and stimulate the jawbone, which helps to maintain the bone mass as well as the jaw's natural shape. But when the roots are missing, the jawbone resorbs (i.e., shrinks) and thins.

The resulting bone loss can change the structure of your face. Your mouth may collapse inward, and your chin and jowls may become pointed as the facial muscles weaken and detach. The corners of your mouth may permanently sag, even when you smile.

Your ability to speak clearly can also be affected by missing teeth, especially those in the front. For example, the "sh" and "th" sounds are challenging to produce without teeth.

Missing teeth can also impact your ability to eat. You may find it difficult to bite or chew some types of foods, which might cause you to avoid those foods and possibly develop nutritional deficiencies. In addition, chewing facilitates the digestive process by telling the stomach to produce acid and the pancreas to produce enzymes. If you are unable to chew properly, this process is impaired. Plus, your salivary glands may not activate, making it difficult to swallow. And if you swallow food fragments that are too large, you can experience problems from incomplete digestion.

The Basics of Dentures and Implants

With the fluoridation of community water supplies and advances in dental care for senior citizens, more and more older adults are able to hang on to some or all of their teeth. However, sometimes teeth deteriorate to the point that they must be removed. The National Center for Health Statistics report referenced earlier says that about 20 percent of Americans over age 65 are completely toothless.

If you are missing teeth, dentures or dental implants can make a huge difference to your quality of life.

Dentures

If you've lost more than two or three teeth and the remaining ones are not especially functional, you can have all your teeth pulled and get dentures. (If your dentist recommends this route, make sure you follow his or instructions in order to avoid complications like dry socket, a painful but treatable condition that is a common danger of tooth extraction in elderly people.)

Most people are familiar with dentures because, for many years, they were the only option if you needed to replace natural teeth. Today, there are basically two types: traditional dentures and overdentures.

Traditional dentures

These are removable appliances that sit on the gums. They have a plastic base and stay in place via suction and muscle control, though sometimes creams or adhesives are used. They must be taken out for regular cleanings and are usually left out of the mouth during sleep in order to allow the gums to rest.

Dentures are generally the most cost-effective way to replace multiple teeth and restore basic chewing and speaking functions. A complete set for both the upper and lower jaw typically costs anywhere from $1,000 to $8,000, according to the Dental Implant Cost Guide. However, there are ways to get help with that cost.

Conventional dentures are made after all the teeth have been extracted and the gum tissue has healed. That allows your dentist to make a precise mold of your mouth in order to ensure a perfect fit for your dentures. With proper care, conventional dentures can last for 10 years or more. The downside is that you will be without teeth for two to three months while your gums heal.

Immediate dentures can help with that. They are fabricated in advance so that they can be put in place as soon as all your teeth are removed. That means you can get your teeth pulled and dentures in the same day. However, the fit is not as accurate because the exact dimensions of your mouth will change after your teeth are taken out. Thus, after getting immediate dentures, you must see your dentist or prosthodontist for adjustments more frequently.

Some people choose to stick with immediate dentures for the long term in order to avoid paying for a second set. However, they are best used as a temporary solution until conventional dentures can be made.

Typically, new dentures will hurt for a few weeks. But once the muscles in your mouth become accustomed to holding them in place, the discomfort should go away and eating, speaking, and smiling will become much easier.

There are some disadvantages to traditional dentures. If you use one for your upper jaw, the plastic plate will cover the roof of your mouth and thereby diminish your sense of taste. Plus, because they rest on the gums and do not connect to the underlying jawbone, traditional dentures have only about one-quarter of the bite force of natural teeth. Some denture wearers find it difficult or impossible to eat hard or sticky foods. Traditional dentures also do nothing to slow down bone loss; over time, they must be adjusted or replaced as the jaw changes shape.

Overdentures

Overdentures are partial or complete dentures that are positioned on top of a supporting structure. In most cases, that supporting structure is a series of dental implants.

Implant-supported overdentures are held in place by tiny titanium posts that are surgically implanted into the jawbone. These overdentures can be either fixed (meaning they stay in your mouth and can only be taken out by a dental professional) or removable. Removable ones are sometimes called snap-on dentures.

Overdentures are more secure and more comfortable than traditional dentures. You don't need to worry about them sliding around or accidentally becoming dislodged. More importantly, you don't need to worry about jawbone deterioration. That's because the titanium implants stimulate your jawbone and help prevent progressive bone loss.

Plus, overdentures for the upper jaw are shaped like horseshoes and do not cover the palate like traditional dentures do. That means your speech and sense of taste are less affected.

However, overdentures are more expensive than traditional dentures. The average cost to replace all upper and lower teeth is about $34,000, according to the Dental Implant Cost Guide. Overdentures also typically take longer to implement because they require surgery and an extensive wait time while the implants fuse to the jawbone (see below).

Dental implants

If you want a permanent way to restore the look and function of natural teeth, consider dental implants. For seniors who are missing one or more teeth, implants can be a great solution. In one follow-up study of adults over 60 who received dental implants, 93 percent had successful outcomes.

With implants, titanium screw-like posts are surgically placed in the jawbone in order to act as artificial roots. Over a period of about three to six months, the screws and the bone fuse together through a process called osseointegration. Once that is complete, additional pieces known as abutments are inserted at the gum line. Then the new crowns (the parts of teeth you can see in your mouth) are attached.

Implants are almost as strong as natural teeth and can last a lifetime with proper care (i.e., brushing and flossing). They create a secure bond and allow you to speak easily and eat anything you want. Because they fuse with and stimulate the jawbone, they even help prevent resorption.

However, implants cost considerably more than traditional dentures. The Dental Implant Cost Guide notes that replacing a single tooth with an implant costs around $4,000, on average. And if you have a condition like leukemia or diabetes, you may not be a good candidate for implants because those illnesses can interfere with post-surgical healing.

In addition, you must have enough healthy jawbone to support the dental implants. Seniors sometimes require bone grafts before implants can be anchored properly.

Some older adults who lack the bone density required for full-size implants and who don't wish to get a bone graft may benefit from mini implants. These are generally half the diameter of traditional implants and can be screwed into the jawbone right through the gum tissue. Thus, they cost less than full-size implants and require a less invasive placement procedure. However, some dental professionals believe they are not as durable or as strong.

How to Make Senior Dental Services More Affordable for You

The cost of dental care can be a shock to some older adults who don't realize that Medicare will only cover dental procedures in very limited circumstances. For example, if you need to have a tooth pulled in preparation for radiation treatment for oral cancer, Medicare may pay. However, it will not cover checkups, fillings, cleanings, implants, or dentures.

The good news is that you can get help with dental costs in a variety of ways. Here are a few options:

1. Enroll in a Medicare Advantage plan.

Offered by Medicare-approved private insurance firms, Medicare Advantage plans can help fill in the gaps by covering some of the cost of services like cleanings, x-rays, fillings, tooth extractions, root canals, dentures, and implants. Most plans also come with benefits such as prescription drug coverage.

Under many Medicare Advantage plans, preventive dental services like cleanings and x-rays are fully paid, while other procedures are subject to coinsurance (meaning the plan only pays a certain percentage and you are responsible for the rest). Some plans require you to pay a flat copayment for each service you receive.

Coverage and service limits may apply. For instance, you may be covered for one set of x-rays and two cleanings each year. A Kaiser Family Foundation (KFF) study of dental coverage and costs found that many plans will only cover up to $1,000 worth of elderly dental care costs annually. And you will likely be limited to using dental professionals within your plan's network.

The same study found that roughly 60 percent of Medicare Advantage plans offer dental benefits. (Note that a plan that only provides "Medicare-covered benefits" likely won't cover you for anything beyond traditional Medicare limits.) Those that feature more extensive coverage typically come with higher premiums and high coinsurances for advanced procedures.

Premium costs vary widely; some plans don't charge them at all. But the KFF study noted that on average, Medicare Advantage dental premiums amount to $284 per year, which works out to about $24 per month.

2. Consider dental insurance.

Senior dental insurance plans are widely available from private companies like UnitedHealthcare, Humana, Cigna, Blue Cross, and Delta Dental. While the details will vary, most plans cover:

• 100 percent of preventive services such as exams and cleanings
• 50 to 80 percent of basic services such as fillings and simple extractions
• 20 to 50 percent of major restorative services such as crowns and dentures

Before purchasing any plan, be sure to research exactly what services are and are not covered, and in what amounts. For example, dental implants are generally considered cosmetic, so many insurance plans won't cover them. And some policies consider a root canal to be a basic service, while others deem it to be a major procedure.

Keep in mind that many dental insurance plans have deductibles (i.e., amounts you must pay before insurance kicks in) and copayments, although both are often waived for preventive services. Many policies also require a waiting period of anywhere from three to 12 months before you can access the benefits. Some do not cover the cost of treatment for dental problems you had before signing up, such as missing teeth. Plus, many plans limit the total payout to about $1,500 per year, which means you will be out of pocket for any costs beyond that amount.

So, do seniors need dental insurance? That depends. Look at the numbers: You can expect to spend anywhere from $7 to $87 a month on dental insurance premiums, depending on the plan and the provider. Basic dental care for seniors without insurance (i.e., two cleanings and one set of x-rays) costs about $350, according to the KFF study. So if you only see the dentist for routine preventive care, insurance really won't save you much money. It might even be more expensive than simply paying out of pocket.

But if you need a couple of root canals, the NerdWallet article points out that the total bill could come to $1,800. If your insurance policy covered 80 percent, your portion would be $360. Even if you paid $300 for the policy, you would still be saving $1,140 overall (assuming there was no deductible or copayment).

However, if your policy had a maximum payout of $1,500, those two root canals would basically max out your coverage. So if later in the same year you ended up needing to get a tooth pulled or a crown installed, you would be responsible for almost 100 percent of the cost.

It's important to dig into the details of each policy and carefully consider what would work best in your situation. Ultimately, the best dental plan for seniors is the one that provides value through appropriate coverage at an affordable price.

3. Sign up for a dental savings or discount plan.

Dental savings plans are available through companies like Careington, Liberty Dental Plan, DentalPlans.com, and 1Dental. With these types of plans, you pay an annual membership fee (generally $100 to $200) and receive discounts of 10 to 60 percent on services from participating dentists. You have to pay for dental treatment straightaway, but you receive a reduced rate. The specific discount you get will vary depending on the procedure and the plan. For example, you might receive 50 percent off on fillings and 25 percent off on root canals.

Dental savings plans have no deductibles or annual spending limits. They also have no waiting periods; the discounts will be available to you as soon as your plan activates, which is usually within 72 hours. That means you can wait until you need pricey dental work before you buy into a plan. Another bonus is that you can get discounts on treatment for pre-existing problems like missing teeth.

Dental savings plans can be a great option for seniors who either lack insurance or need services that insurance won't cover. You can even use a savings plan to reduce your out-of-pocket expenses once you reach your insurance policy's annual payout limit.

4. Investigate free or low-cost options.

There are several ways that seniors can get less-expensive dental care. For instance, dental colleges and dental hygiene schools frequently have clinics where students get hands-on practice by offering their services to the public at greatly reduced prices or even at no charge. All work is supervised by a licensed professional.

In addition, many states have government-funded clinics that provide free or very-low-cost dental care to older adults with limited resources. Such clinics typically offer services like x-rays, cleanings, fillings, root canals, and tooth extractions. If fees are charged, they are generally based on your ability to pay. You can search for affordable clinics offering senior dental care near you through NeedyMeds or your local United Way.

If you receive Medicaid, live in a long-term care facility, and have some applied income, medically necessary dental work may qualify as an incurred medical expense. That means your income would be applied toward the dental bill rather than the care facility bill; your state Medicaid agency would then increase the amount it pays to the nursing facility on your behalf. Basically, you get the dental service at no additional cost to you.

Plus, you can get free dental work through the Donated Dental Services program if you meet certain requirements. You must be over 65, have a disability or be medically fragile, lack the resources to pay for treatment, and be ineligible for public aid. If you qualify, you can receive comprehensive services from a large network of volunteer dentists. You should be aware that availability is limited and wait lists are common. However, if you are a veteran, you can apply for the program even if your county of residence is not accepting general applications.

Take Care of Your Teeth

When you're a senior, dental care should be a high priority. Now that you have a better understanding of the challenges you may face, the treatments you may need, and the payment options you may utilize, you can take charge of your oral health and move forward with greater confidence.