Op-Ed: Dental care is essential health care

Congress must act boldly to pass a Medicare expansion bill that includes comprehensive dental services.

By Bradley Morgan

A growing body of literature proves an undeniable link between oral and overall health, but unfortunately for our nation’s seniors, our current Medicare system still refuses to guarantee dental coverage for its nearly 40 million beneficiaries, leaving millions without the dental care they desperately need. In the half-century since its enactment, the federal Medicare program has expanded health insurance coverage to virtually 100% of seniors over age 65 but has failed to provide coverage for the single most prevalent chronic disease affecting this age group–not cardiovascular disease, nor diabetes or cancer–but rather, dental caries, or “tooth decay” as it is known colloquially. As a fourth-year dental student at the University of California San Francisco (UCSF), I witness the devastating effects of untreated dental disease in my patients on a daily basis.

We at UCSF are often the last line of defense for so many vulnerable patients living in and around the San Francisco Bay Area. The majority of patients who visit our clinics are low-income and/or elderly with complex medical, dental and social needs, and many exist at the intersection of multiple public health crises–a global COVID-19 pandemic, structural racism, xenophobia and homophobia, a lack of nutritious food and stable housing, and few resources to successfully care for their teeth on their own. It is not uncommon for elderly patients I am meeting for the first time to report that they haven’t had a dental exam or cleaning since they were a teenager on their parents’ insurance plan.

Historically, about 93% of seniors 65 and older experience tooth decay in their lifetime, and 18% of seniors live with active, untreated decay. A shocking 40% of all adults report experiencing pain in their mouth in the past year, which is most often associated with deep cavities that infect the nerves and blood vessels deep inside the teeth. The high numbers of older adults living with active dental pain and cavities gains context when considering that tens of millions of seniors on Medicare currently have no active dental insurance coverage. According to a Kaiser Family Foundation study, nearly half (47% or 23.6 million) of all Medicare beneficiaries did not have any form of dental coverage in 2019. This is especially concerning for senior citizens when considering that dental disease is cumulative and tends to worsen over the lifespan, especially when left untreated. The result? Elderly patients as a cohort have some of the most complex (and expensive) dental needs–needs that often affect vital activities of daily living such as eating and speaking–with minimal to no financial assistance or cost-sharing available to them. 

Failure to provide treatment coverage for a medical condition that affects more patients than any other chronic disease may seem like an unforgivable design flaw for one of America’s largest health insurance providers. However, historical accounts detail how the Medicare program was enacted with specific exclusions for dental services, due in large part to opposition from the American Dental Association (ADA), then and now the nation’s largest professional dental organization. Five decades later, the ADA’s stance on inclusion of dental services in the traditional Medicare program does not appear to have evolved in any meaningful way.

Now is the time to fight hard for justice in oral health care benefits for older adults and to reaffirm our country’s values and commitment to protecting the holistic health and wellbeing of our nation’s senior citizens.

The most frustrating part of my professional work is that the most significant barrier to providing treatment for my patients’ dental disease is rarely ever a lack of research or knowledge about what the best treatment options are, unlike some medical conditions. Dentists have an array of solutions and technologies available for any given dental diagnosis, and through my professional education I have acquired the knowledge and technical skills required to administer many of those treatments to my patients. Rather, the biggest roadblock we encounter between providing comprehensive treatment to patients is financial and, ultimately, political constraints. 

The dental profession has done an incredible job of funding and advancing research into new and evolving treatment options for patients with complex dental and medical conditions. UCSF School of Dentistry alone received over twenty-five million dollars in federal research funding last year to continue this important work. But what good are all these treatment options if they remain inaccessible to our nation’s most vulnerable patients?

It was a mistake to exclude dental services from the original Medicare program, and it would be an even bigger mistake to fail to correct this decades-long injustice now when so many seniors are forced to choose between living with chronic dental disease or experiencing financial ruin. Congress must act boldly to pass a Medicare expansion bill that includes comprehensive dental services with reasonable cost-sharing for seniors–so that my grandpa can go back to golfing in retirement instead of obsessing over a toothache.