TGB FORUM: Do You Keep Up with Your Previous Profession?
TGB FORUM: Finding New Friends in Old Age

Elder Dental Care

Perhaps you have already laughed ruefully, recognizing what an oxymoron that headline is.

Unless you are wealthy in your old age, in the United States, dental care beyond much more than an annual cleaning is not personally affordable and traditional Medicare specifically excludes it (although some Advantage plans cover some dental work).

As the website explains:

”Medicare doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.

“Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you're in a hospital. Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isn't covered.”

In a post last week, I tried to make light of the difficulty I've had being in public without my denture. The reason for not wearing it was, as I explained, that

”...the entire length of gum on one side of my mouth swelled to a gargantuan size. The dentist supplied two kinds of antibiotics for the infection and after two weeks, it is nearly cleared up.”

Not completely. Nearly. The small amount of swelling that remains means the denture still doesn't fit yet and I'm stuck with no upper teeth for a few more days - a bummer in any case but particularly so as my Aussie friends, Peter and Norma, arrive this afternoon.

Worse, this turned out to be a great deal more than the simple, though large, infection I thought it was. As the dentist explained, it had traveled to my sinus and could, from there, enter my brain – potentially a life-threatening event.

Before now, I had no idea such a terrible thing exists. Then, still more bad news: There are a couple of smaller infections in my lower jaw and some other problems that require oral surgery, implants and a new (and better) kind of upper denture.

If I don't have this work done, the dentist and perio guy both told me, infections will continue to erupt probably more frequently and I will lose some (or all) of my remaining teeth.

This is not a surprise to me. I've heard it before but have neglected my mouth for several years because the last time I got an estimate for the needed work, the cost was about two-thirds of my annual income.

It's money I don't have lying around and my income obviously is not enough to pay as I go meaning, also, that there is no hope of saving enough in even five years and maybe not ten – obviously not a useful time frame in regard to teeth and infections.

On Tuesday this week, I met with the dentist to determine the work to be done to give me a healthy mouth, what the most cost-effective way to do it is and to come up with a bottom-line price.

The number brought tears to my eyes: It is about the same as a new, low-end BMW and way more than a year's income.

I fibbed three paragraphs up. I do have money that could pay for this but it certainly is not just lying around.

After the 2008 crash decimated my small savings, what is left is what I call my end-of-life fund. If it comes to needing full-time care in a nursing home, this would cover it for two, maybe three years by the end of which I would hope to be dead.

In no way is the fund meant for dental work but it is there, and I can use what would be a large portion of that fund for my teeth. I would just need to hope for a quick death.

Not everyone is that lucky. On the recent post here following up on community elder services, Barbara Rogers left this comment.

“How do you get economical dental care once you use Medicare for your medical needs? I've paid for 2 "initial exams" this year, but can't afford the "plans" either dentist came up with. To go to yet another one, I'll again have to pay for the initial exam.

“I'm not yet eligible for Clinics, for those who have no resources, but if I pay for these plans, in a year I will be broke. Already being 72, I don't see investing all my savings into my teeth. Any suggestions?”

When, on Tuesday, I nearly passed out at hearing the price of the needed work, the dentist told me that I might qualify for low income dental coverage which, he said, only three or four states, including my own, offer.

I spent most of Tuesday afternoon tracking it down only to find that my income is not low enough for me to be eligible. Then I spent another two hours checking an Oregon program for stand-alone dental plans anyone – Medicare subscribers as well as others – can purchase.

There were a couple of plans with premiums I could actually afford but they did not cover any – not even a portion - of the kind of work I need done.

So I am back to the end-of-life fund. I am fully aware of how lucky I am. I may not have much income, but I own my home with no mortgage. I own my ten-year-old car with only 37,000 miles on it. I have no debt. My credit card is a convenience only, paid off each month and I live quite comfortably.

My heart goes out to Barbara and the many thousands of other elders who cannot afford even basic dental care. The best I can suggest is to diligently mine the possibilities.

Does a local dental school take patients for no or minimal cost? Do you live in a state like mine that offers a dental program if your income is low enough? Can you find a stand-alone dental program you can afford?

Does anyone reading this today have other suggestions? Because the fact is, untreated dental problems cause serious health problems.

The real answer to this is, of course, that the United States, like every other civilized, developed nation, needs to offer universal health care including dental. I suspect that won't happen in my lifetime.

At The Elder Storytelling Place today, Arlene Corwin: The Poet Pondered


Thanks for posting about this problem Ronni. I find many others who have the same situation. I posted yesterday about my frustrations on my blog. And am also finding folks who are self employed, or have minimal health plans are also underserved with dental needs.

I know some people go out of the United States to get medical care more affordably, what about dental care? I ask because I may need to investigate this more seriously in the near future.

Mexico. Lots of Americans go there for dental procedures. I haven't but I have an acquaintance who does and has been very well satisfied.

Oh Ronni -- I so understand your situation.

I too have terrible teeth/gums. And for most of the middle years of my life, I went without dental care of any kind beyond an occasional cleaning. When I was under 30, one dentist wanted to pull/replace all my teeth, but fortunately I couldn't afford any of what he suggested.

These days I am lucky enough to be able to afford continuing care that so far has kept most of the originals in my mouth. But going to the dentist remains a terror.

Have you thought of traveling out of the country. My husband was quoted 75K, yes 75K here in Canada for 8 implants and then crowns and veneers for the rest of the mouth to match. I did research on Costa Rica and it was 1/3 of the price including all the air fares for 2 people, multiple trips and hotels. He decided he didn't want to go so now it is being completed in phases - I call it 3 new cars. Costa Rica has a few top notch guys that do more implants than any dentist in North America would, so very experienced.

It's not even about seniors, this happens to people in their 50s and 60s particularly because we didn't have fluoride back in the day.

Dental insurance is worthless today, they say in 1965 insurance would have covered 100% of all the available techniques of the time. Today we are still stuck with 1965 coverage.

Mexico, Thailand, India are all places my friends have gone for dental care. I plan to get dental care in Mexico this winter while I travel there. I think medical tourism is the only viable option for us elders.

P.S. I hope that you find a good dentist soon and that you are able to find relief from these difficulties you are experiencing.

I gamble on good oral hygiene getting me through as I have no dental insurance--the cost is more than two check-ups and one lost filling per year.
My dental office did propose getting rid of all my old amalgam fillings, braces to fix an overbite, veneers--and they would be happy to work out a payment plan!
Let's face it, I will not get near my money's worth out of cosmetic procedures, I said. No thanks.

If you live in or near a city with a medical or dental school, you might want to check and see if you can use their services. We here in Albuquerque have a dental school at the university and people can just go in and have work done at a greatly reduced rate by dental students in their last year (if my info is right). I have two friends who have had dental implants in the last year who are very pleased with the work---AND the price.

I have a full upper plate that was prepared by a dentist here in Abq., and the cost was about $9,000 (much of it traded out for carpentry work in his office). When I needed a lower bridge, he quoted me $8,000 for a 4-tooth bridge. I went to Palomas, Mexico, to a highly recommended dental clinic there and paid $2,600 for five extractions and a 10-tooth bridge. The clinic was so clean you could eat off the floor, all of the dentists there had been trained in the US and all of the equipment was the same as you'd find in a US office. And it took only two visits to do all the work and have the bridge ready. It hasn't been out in 10 years and is still going strong!!!

I live in southern Arizona and most of my friends either go to Algodones, Mexico, which is there pretty much only for Americans seeking dental care, eyeglasses, medications, alcohol and cigarettes, or they go to a nearby university clinic, which also offers low cost services.

I've heard very few complaints about the dentists in Mexico, and even my pickiest of friends and her husband have had lots of work, including implants, done in Algodones. I'm lucky that after years of great dental insurance and lots of work, I'm in good shape for now.

I have had my concerns with the dental profession for years. While medicine and the prevention of disease have advanced by leaps and bounds, the dental business is mired in the 19th century. Dentists are still drilling and pulling teeth for god's sake like Painless Parker. In addition, how many over the counter (cheap) products besides toothpaste and whitening strips are there to prevent or repair dental problems. Look, I hate to appear conspiratorial or paranoid about the dental industry, but I think there needs to be further investigation as to why one group of so-called professionals seem to have a monopoly on your teeth.

Having worked with many low income clients and from my family's personal experience very few of us have good dental insurance, and if we do it is expensive. Those on Medicaid will find that few dentists will accept that coverage and then only for extractions. Dental care is not considered a "health care problem" by legislators or the general public. Middle class America (whatever that is) can barely afford routine dental care for themselves and their families without good dental insurance. All of this boils down to the point that this is not just an issue for Elders, but a very large portion of the public. But I doubt in this current political climate anything will change.

I am so sorry, Ronnni. I am also grateful that you wrote about it because the helpful answers on going to Mexico may be my solution to needed dental work. I had never thought of that so thank you everyone who wrote about it.

I have had terrible dentists in the U. S. and a Mexican dentist couldn't be worse and is probably much better.

So sorry Ronni; your scenario mirrors mine, except for the massive infection. I am trying to sell my house and to use most of my nest-egg to move from the east coast to the west coast, where all expenses are higher. So spending the rest of my life with my children & grandchildren may have to be traded off for 4 lower teeth! There goes my dream.

Since the dissolution of medical care for seniors in our local HMO, I have ranted when I heard of expensive dental, vision or hearing care that nobody I know could afford.That rant is: "Aren't one's teeth, eyes and ears parts of the human body? And as such, aren't they important to the general health?"

I live in Canada and we have pretty good dental coverage - I think we take it for granted too often. One trick I have, is to do "Oil Pulling," it might help with your infections. Google it, if it helps great - and if it doesn't at least it can't hurt:) It really helps me. Best wishes and hope you have a good visit with your friends.

I know this much. Dental care is tremendously expensive. Tremendously expensive.

My perio in Atlanta taught me that teeth and gums MUST be cared for because of the reasons your dentist pointed out . . . risk of danger to entire system, even death by infection! In Israel, I pay 2/3 the USA cost for dental implants. Yet I live here, and so the procedure, which can drag along for up to a year (all the stages) is feasible.

I recommend medical tourism, and many in the comments have named top clinics in Mexico. The set of "teeth in a hour" is an option that does not require multiple stages and involves four or so implants per jaw on which a permanent bridge is secured with all teeth. If you can possibly swing this, I say, go for it. A dental school is another option as others have mentioned.

Another tip from my Atlanta perio. Research the options and should anyone appear "ambitious" around your mouth, exit immediately. I took the advice and paid for SEVEN consultations until I found two practitioners with identical conservative proposals, and went with the one whose vibes suited me.

This is a huge problem for many people, and of course the sane and sensible thing would be that the government cover essential medical care, from head to toe, and from birth to grave, including vision, hearing, dental, and foot care. I think we would all be shocked if we knew how many people in the U.S. go without this basic care.

I don't know how you would feel about it, but many people are setting up crowd-funding sites for projects like this. There seems to be no other way for many people to get this done, and it is just shameful that, as a country, we don't take better care of everyone.

Wow, you touched a nerve! I liked what everybody said, but I loved what Sidney said....that this dilemma and challenge affects all ages. I hope I don't end up toothless, but I am on my way slowly if I live to be 90 or 100! No money for travel to Mexico. Low interest in trying too hard to do anything but hang on as best I can. There is a dental school in my town that offers affordable care and there is a "free" health clinic where you can get reduced rates based on income. To me what looks worse than a class C mouth, is a Class A set of Hollywood perfect dental implants on a decrepit body!! and I see a LOT of that. Former professionals I worked with who have big 401K's (mine is gone).
I don't think anyone will actually care if I go toothless, but if it makes me keep my mouth shut due to embarrassment there may be those who rejoice and love the new look!
Seriously, I am sorry for the pain and potentially life-threatening problems of of all who have the sort of problem you are having, Ronni. I hope you are taking Emergen-C twice a day to help you bolster your immune system to fight infection.

Yup, this is a number one issue.
I wear a broken partial. At least I have teeth in the space where a dentist pulled a perfectly healthy tooth. I am married to a wonderful man who has dental insurance. My medicare insurance covers almost nothing at an egotistial dentist who treated me like scum. I get mine cleaned by a local dentist I like, and I brush and floss like a superwoman to keep what I have. I now have crowns on top, installed when I could afford them, and they are crookedly delightful.
Yes, seriously thinking about going down to Mexico to a UCLA trained dentist.

One must be very, very cautious in choosing a dentist. There are so many out there who simply want to perform every possible procedure they can, intending to extract not only your teeth but as much of your cash as possible. If they start asking you about cosmetic procedures before you even get past the front desk, run. If they suggest pulling any healthy teeth (or ALL of them), run.

I've been blessed with good teeth and gums and still have all the originals. It's a good thing, too, because I'm terrified of dentists (Valium!). I intend to do whatever is necessary to keep my own teeth for as long as possible.

One new crown and a filling last winter cost $2,000 with no insurance. I'd already looked into insurance plans, and the annual outlay on premiums would have averaged more than my average spent at the dentist (I normally go only every two or three years for a cleaning). The deductibles were such that the insurance simply wasn't worth what it cost -- yet another way the industry gouges us.

I am so very sorry and can relate to much shared.
Always one to take care of her teeth and never fillings or anything until 5 years ago.
I was diagnosed with Sjogrens
and one of the symptoms is no saliva and constant dry mouth.
even with brushing and flossing 3 times a day. Sitting outside in the sun with magnifying mirror, dental floss and tooth pick
to clean my teeth- for the first time in my 70's lost 5.
So a partial was purchased.
So nothing like some of you have experienced but a very low income now - about $25,000 has been spent over the last 5 years... Trying to do all I know at the present to save my teeth...

It is crazy that Medicare doesn't cover dental care, let alone vision and hearing. Problems in these areas cause functional disability, and that's what leads to ending up in a care facility of some kind. Penny wise and pound foolish.

I had good luck with an extraction and implant at our local university's dental program. Each appointment was lengthy and the entire process took about a year with many visits, but I think it cost about 1/3 of private care -- and this was before I was 65 and we still had dental insurance through my husband's work, although that didn't cover implants as I recall. My husband's experience with this treatment plan wasn't as good -- maybe because it was expensive and annoying to take time off work. However, I would do it again, if needed.

Maybe medical tourism is the answer - in this, as in so many areas of medical care, the US is woefully behind.

A side note on passports: for Mexico and Canada, the U.S. passport office does offer a $50 passport -- a regular passport costs hundreds.

Upon retirement I was offered dental and optical insurance for 18 months (Cobra). I took the dental but let the optical go b/c it would be more than 2 years before we would need eye exams. Then, just as the 18 month period was ending, the district decided to allow retirees to keep both dental and optical coverage forever. Unfortunately, should you drop one, you cannot reinstate it.

So, for $87 a month, my husband and I are covered for dental. However, more and more dentists in Fresno are not taking it or only taking part of it. We pay about 50% of each bill, in addition to that monthly fee.

After reading about all of these dental issues, though, i feel fortunate to have something to fall back on as I don't have a fund to pay for my last days that I could rob to pay for dental work.

Like most folks here, I struggle with paying my dental bills. I also have found that most dentists push hard for the implant route, which I can't afford either. I, too, lost a lot of my upper teeth in the front. I opted for a removable partial (cheaper plastic teeth, but they work; light weight and adjustable). But it still ran about $2000. Porcelain teeth are both expensive and heavy and they irritate your gums. I opened a Care Credit account, which gives me up to 2 years, interest-free to pay off a dentist bill. I didn't bother with the missing molars in the bottom back. There are some things, like tomato skins, that my teeth can't grind. I just cut the skins off and make sure I eat the things my teeth can handle. At my age I don't worry about the cosmetics of my teeth. At home, I often take out the partial and let my gums breathe. And, of course, I take them out at night. I have had terrible teeth all of my life, so I'm used to the bother. I'll never get used to the expense.

Adding my voice to all those above. I have a reverse mortgage, whose interest, and hence extended life, ended with the crash in 2008. In about 2011 I was told I had to choose between watching my teeth turn to powder, having them all extracted and replaced with a denture, or having them *all* crowned, which is by far the healthiest choice. I made it. I used a large fraction of my reverse mortgage principal to do it. I don't regret it, but if I live longer than that money I may. And only this week I have been advised to have two extractions and one implant. I'll probably do it. But if I actually do run through that reverse mortgage, I'm going to be panhandling in downtown Berkeley for food to chew.

I'm glad to know I have so much company! I've been wondering for years who dentists thought was out there needing perio care--Donald Trump?

Due to fluctuating insurance and several moves, I just couldn't keep up with the ridiculously pricey recommended procedures and ended up with dentures.

Don't shudder--I love them, eat anything I want, and smile more than I had in 20 years. Total was about $3,500 for an upper and partial lower at a local dental chain in the northwest.

I had "insurance" at the time (five years ago) but it was more like a coupon and knocked maybe $500 off.

If you're leaving every dental visit with your stomach in knots of dread, limited in what you can eat, struggling with chronic infections and pain, and never smiling in public, it might be something to think about.

Sometimes "saving your teeth" at any cost feels more like wrecking what's left of your life.

I have great sympathy for everyone who is struggling with dental problems and costs. I guess this is one area in which I am more fortunate than most. Having retired from the State university system, I have excellent medical and dental insurance. The health insurance covers virtually everything with no premium cost to me. The dental coverage is somewhat less comprehensive, covering two cleanings with x-rays annually plus 50% of all other costs.

I learned the importance of dental health at a young age when I was a dental assistant trainee. I decided that I hated the job, but I learned some valuable lessons. First, put some effort into finding a good dentist. This is not an area on which to economize. Secondly, without preventive dentistry you are screwed, no matter what kind of dentist or coverage you have. Those two (not one) deep cleanings a year, combined with a home dental regimen, are absolutely necessary and worth the money.

The connection between dental health and general health was further impressed on me when I had a quadruple bypass. Heart health and dental health are inextricably joined. Since I was already convinced, the only thing that was added was a large dose of antibiotics each and every time I had a dental procedure of any kind, including cleaning. Dental health means gum health. As my favorite dentist told me: "(floss and)brush your gums and your teeth will take care of themselves."

This will probably sound like preaching, but if you still have your teeth and have practiced reasonably good dental hygiene, it's possible to reclaim good dental health even in your 50's or 60's if you have a regimen and stick to it. The three watchwords are: floss, floss, and floss. Toothpaste is largely cosmetic except for the fluoride and perhaps some whitening effect. Which is why I carry our my daily regimen every evening while watching TV, by first using a dental pick, then flossing, then thoroughly brushing each area, front and back, with a dampened power toothbrush. This means no dribbling and no mirror required, plus no boredom. Oral fluoride rinses plus periodic brushing with baking soda take care of the fluoride and whitening aspects. But even this daily regimen will not work unless you never, never, never give yourself a "day off."

Preventive dental care isn't easy, but it is a whole lot easier and more cost-effective than coping with the pain of extractions or implants or dentures or infections or any of the myriad of painful and debilitating conditions which are the alternative.

I had to chuckle, EmmaJay, at your statement that two deep cleanings a year were absolutely necessary and "worth the money," right after you told us you got two cleanings a year free with your free insurance. Good for you, but not everyone is so fortunate.

I'm probably missing something. If implants are not in the budget ... what about old fashioned top and bottom dentures?

Ronni, This has been the MOST depressing and frightening article I have read in ages. Most of all I send you all sorts of good wishes for healing and health. How absolutely horrible for you.
While visiting the dentist has always been one of life's more aggravating experiences I have been completely clueless as to all the more ghastly and dangerous aspects of it. What a dope!
As far as going without teeth absolutely not--bad in every way health, nutrition and general well-being.
So great getting older!
Best luck to all and especially you, Ronni.

Chart of current US Passport Fees

Reading this I share your pain..there is mess in my mouth...and with just having more debt then $$$$$, I am in need of a benefactor.Oye vay is all I can say.

Do you have periodontitys, Ronnie.
In this case, as in my case, implants are not going to work, because the periodontitis come back. I intend to do is when it will be necessary have a pair of dentures of a good material ans start to wear them. Dentists can profit a lot from older people. Best wishes


Please consider that everything is neogotiable. That's everything.
Including dental work.
So I recommend if you need dental procedures ask the dentist if he can work with you to lower the cost.
In addition when you are going for consultations bring your x-rays (you are entitled to a set no charge, after the first time you have them taken and pay for them) and let the next dentist understand that HE or SHE is auditioning for the job rather than you are desperate for the work. There should be no charge for an estimate on work you already know you need.
You are allowed to shop for a compatable service provider and you do not have to pay for him or her to give you an estimate.
You'd be surprised how workable they can be when they know you're knowledgable.
When making the appointment I told the receptionist what my requirements were and I was never turned down for an estimate appointment.
It is also amazing when you come in with x-rays how little they look at them when they're not charging you for them.
Dentist are always wanting and needing new patients and 50% of something is better than 100% of nothing.
I did this and received excellent treatment for what I considered an appropriate cost after shopping it around and that's in NYC.

To Janet: I guess I should have added: even if you have to pay for them yourself. Because that's what I mean. I know I'm lucky, but many years ago, when I had more gum problems than my insurance would pay for, I willingly paid for two EXTRA cleanings a year because I was told they were crucial. What I'm trying to say is that you don't save money by avoiding essential dental work now, and then later spending far more to repair the damage---if it CAN be repaired.

I know my comment was a little preachy, but trial and too much error has educated me on the costs (in money and effort) and benefits of dental prevention. I'm aware, of course, how little preaching helps. My daughter, 21 years younger, has a full set of dentures and has discovered, as many people do, that even getting your teeth pulled doesn't provide immunity from gum infections. I'd bite my tongue off before saying "I told you so" but that is exactly what happened and it makes me very sad when I see how unhappy this has made her.

I am so angry! It is absolutely ridiculous that dental care is not included in health insurance and that the dental insurance that is available is a laughing stock.

I am so sorry for all the pain, frustration, and money spent that all of you have shared.

The question is, why can't we do anything a about it? What do we have to do to change the situation?

While a trip to Costa Rica or Mexico sounds lovely, you shouldn't have to travel out of this country for affordable care.
I am curious about the comment on crowdsourcing and would like to learn more.
I have practiced excellent dental hygiene my entire life - a big flosser. But as you get older, that only goes so far.
Like many of you I have had major dental work this summer - an abscess (had to ride on a plane from Colorado to Minneapolis and that was not fun )and now in process of several crowns. My gums are good so far, but I am only 63 and have no false illusions. Had six cavities filled since June
I became aware of the problem with teeth and seniors in the early 2000s when I was freelancing for the Chicago Tribune and interviewed a woman in her 90's who had just gotten invisilign braces. She explained that one of the issues of older age is that your teeth shift and her once beutiful teeth were crooked, making her embarassed to smile. She felt her smile was all she had left because a disease was taking away her eyesight. She could still see some, enough to know her teeth were crooked, but she was headed to blindness.

I think of her often and all the baby boomers who spent their youth in braces. it seems that many seniors will need to be in braces once again.

I do have some energy around this topic and if anyone wants to contact me, please do!

Ronni thanks giving your perspective on yet another relevant topic (to me) that helps me understand things better. I have a relative that I has been telling me for some time of the dental work they need but cannot possibility afford. I need to see if I can help explore the possibilities.

I've had dental work, including a root canal with crown and three caps, all to my upper front teeth, done in Progreso, Tamaulipas, Mexico. Five years later, I'm still happy with the work. The cost was a quarter of the estimate at home. This was done during a yearly winter season RV trip. Progreso is in the Rio Grande Valley.

EmmaJay - appreciate your reminders and suggestions for maintaining good dental care and preventing any/further problems. So little information is given out by the dental profession and suppliers for preventative dental care, to the public, to parents. I remember getting a sucker for being such a good patient!

when the revolution comes (and it will) dentists go up against the wall, along with those in many other professions.

Coincidentally, here in Newfoundland & Labrador Canada, I was just informed that because of my low income I am now eligible for the dental programme covered under the universal health care system.
Services, of course, are limited to examinations every 3 years, all fillings, 2 xrays and extractions and once every 8 years dentures are paid for.
I am delighted as I just couldn't afford even the maintenance.
I feel so sorry Ronni for your dental horrors and wish we could spread this low income health/dental plan everywhere it is needed.

Thailand and Costa Rica are excellent options for dental treatments. One of my relatives traveled to Thailand for her dental procedure and the entire process was hassle free. By choosing to travel, she could beat the long waiting times here and give immediate attention to her aching tooth. To add to that, she ended up saving about 50% of the cost she would have incurred here in the US. Also, the doctors in Thailand are well qualified and all clinics are updated with modern procedures.

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