Cost Barriers to Dental Care Linked to Later Brain and Heart Risks in Older Adults

Having unmet dental care needs due to cost is associated with an increased incidence of cardiovascular disease (CVD) and dementia, according to a study published in the April issue of The Journals of Gerontology, Series A.

Mabeline Velez, from the Boston University School of Public Health, and colleagues examined whether having unmet dental care needs is associated with subsequent incidence of CVD or dementia among adults aged 55 years or older from the All of Us cohort. A total of 98,787 participants who responded to a survey question on dental care needs that were unmet due to cost were followed for 5.3 years.

The researchers found that individuals who reported unmet dental needs due to cost had a relatively higher incidence of heart failure, myocardial infarction, stroke, and dementia (hazard ratios, 1.45, 1.37, 1.45, and 1.37, respectively), after adjustment for demographic factors. After further adjusting for socioeconomic, behavioral, and clinical factors, these associations were attenuated. Differences were not observed by gender, race, ethnic identity, or periodontitis diagnosis. Eliminating financial barriers to dental care could prevent 2 to 4 percent of each outcome among older adults, based on the estimated population attributable fraction.

“This study serves as an indicator that if we alleviate upstream factors such as financial constraints, we can prevent chronic disease,” senior author Kendra Sims, Ph.D., also from the Boston University School of Public Health, said in a statement.

Why Oral Health Belongs in Whole-Person Geriatric Care

Oral health is important at all stages of life, but especially for older adults. About 60 percent of adults aged 65 and older can develop periodontal disease or periodontitis. The systemic inflammation from periodontal disease can increase a patient’s risk of developing other health problems, such as high blood pressure, heart disease, stroke, and diabetes. 

Gum disease is especially of concern for older adults, with research showing that root caries, tooth loss, and worsening masticatory ability can further impact their speech, nutrition, and overall quality of life. Periodontal disease can also lead to cognitive impairment, disability, and decreased physical function.

Why This Matters for Older Black Patients

Research shows that older Black adults with higher education and income levels still have a significantly higher prevalence and severity of periodontitis than older white and Mexican-American adults. Several factors may contribute to this disparity, including limited access to preventive dental care, higher rates of diabetes, and longstanding systemic inequities. These barriers can amplify the downstream consequences of missed dental care in later life.

What Clinicians Should Screen for in Primary and Specialty Care

Providers can help reduce gaps in dental care for older Black adults by implementing targeted screening questions into routine visits:

• Ask whether patients have delayed dental visits because of cost.
• Assess for difficulty chewing, loose teeth, bleeding gums, or denture problems.
• Review medications that may contribute to xerostomia (dry mouth).
• Consider oral health status during chronic disease management visits.

Screening alone is insufficient. Improving outcomes for older Black adults will require a multidisciplinary approach across the care continuum — from primary care to dentistry.

Opportunities for Care Coordination

Here’s how providers can coordinate care to support a patient’s oral health:

• Refer patients to community dentists, federally qualified health centers (FQHCs), and dental schools.
• Implement dental resources into case management or social work workflows.
• Encourage communication between medical and dental teams for patients at high risk of periodontitis.
• Use annual wellness visits to identify and address any unmet oral health needs.

Policy and Coverage Gaps Providers Should Be Aware Of

Original Medicare typically doesn’t cover routine dental care, including cleanings, fillings, tooth extractions, dentures, or implants. Some Medicare Advantage plans offer supplemental dental benefits that may help lower costs, but access remains uneven.

Medicaid coverage for adult dental services varies by state, as comprehensive dental benefits are not federally mandated for beneficiaries over the age of 21. In some states, coverage may be limited to emergency services, extractions, or dentures.

Understanding what dental coverage looks like for older adults — particularly older Black adults — can help clinicians guide patients to the right support for protecting their oral health.

The Takeaway

Unmet dental care can increase an older adult’s risk for dementia and heart disease. For older Black adults, in particular, addressing barriers to quality dental care may better support and potentially improve their cardiovascular health, cognitive function, and overall aging outcomes. Regardless of specialty, all providers should treat access to oral health care as an essential part of preventive medicine.

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