Seniors like Brice face a daunting reality every day.
“With no income -- literally zero -- I just could not pay for dental care, so I put it off for years,” says Brice of his experience receiving subsidized dental care after many years of neglect.
Entering his 70s, Brice’s oral health was in peril.
“The problems I had that were minor four or five years ago became much more serious. I would have lost my teeth instead of fixing them had I waited any longer,” he explained.
Navigating the oral healthcare system had become one of his greatest challenges -- a struggle that unfortunately reflects a broader crisis impacting seniors nationwide.
The U.S. is confronting a "silver tsunami," with adults over 65 projected to outnumber children within the next 10 years. According to U.S. Census data, 1 in 5 Americans will be age 65 or older by 2030.
While our healthcare system is bracing for this demographic shift, oral care -- a critical component of overall health -- remains neglected for seniors.
Only half of U.S. adults age 55 and older have any kind of insurance for oral health care, as dental is not included in Medicare, the main source of health coverage for this population. For low-income populations especially, this lack of coverage does not just begin when they turn 65. In many cases, state Medicaid programs do not include an adult dental benefit, meaning many older adults have gone years or decades without dental insurance.
Without suitable oral care, seniors face increased risks of heart disease, cognitive decline, and other serious conditions. We have seen this firsthand.
The unique challenges seniors face
Brice’s story reflects the profound barriers seniors face when accessing oral healthcare, both at our clinics and nationwide. Dental care is one of the largest out-of-pocket expenses for older adults, many of whom live on fixed incomes without dental insurance. Coverage limitations under Medicare and Medicaid further exacerbate seniors’ access to care.
In Washington, DC, specifically, the statistics underscore the urgency of the oral health crisis. For many, oral healthcare feels like an unaffordable luxury, a fact confirmed by data from the Howard University College of Dentistry's clinic.
Here, 20% of patients report that a lack of transportation and difficulty affording food prevent them from scheduling or attending appointments. With 20% of the city’s older adults living in poverty, the struggle to prioritize dental care over other basic needs is a constant reality.
Federally qualified health centers (FQHCs) and other safety net clinics provide a needed lifeline to older adults. Take Caroline, a 67-year-old retired, disabled stroke survivor, who was in urgent need of partial dentures. Her Medicare coverage did not extend to dental treatments, and finding affordable treatment in her area was not possible. So, she opted to travel nearly two hours to attend her appointments at Mary's Center.
Establishing partnerships in local communities to drive change
In 2022, Mary’s Center, an FQHC, and Howard University College of Dentistry joined forces with the Delta Dental Community Care Foundation, the philanthropic arm of Delta Dental of California and affiliates, to confront these challenges in the Washington, DC, area -- the beginnings of the Community Care Foundation’s Senior Oral Health Partnership Program. This collaboration started by working together to address oral health inequities among seniors in Washington, DC.
Since the launch of the partnership, the impact has been profound. In the first three years, our partnership has served more than 5,000 patients age 60 and older. Eighty-two percent of these patients have now established a dental home within our clinics, meaning they have had two visits in the last 12 months.
We provide our patients with comprehensive dental care regardless of one's ability to pay, including emergency, restorative, endodontic, periodontic, and oral surgery, as well as extensive oral health education, cavity risk assessments, and preventive care.
New technological advancements, such as a digital denture program, which uses emerging 3D modeling and printing technology for in-house prosthetics, have reduced the number of in-person visits needed and decreased waiting times. This has made treatment more accessible to older adults with mobility, access, or transportation challenges.
This fall, students at Howard University College of Dentistry will begin rotations within Mary’s Center dental clinics, with a focus on engaging and treating the older adult population. The goal of this initiative is to educate emerging clinicians on the importance of serving populations in need and learning about the specific barriers they face. The training programs also encourage new providers to enter careers in underserved communities, helping to alleviate dental health professional shortage areas.
Investment in care has a positive cost-benefit: The ADA estimates that without the adult dental benefit, healthcare costs would go up in the district by roughly $50 million over five years, which does not even account for the quality of life and related health issues that would arise without access to oral healthcare.
A blueprint for wider progress
Our community-driven approach in Washington, DC, has proven itself to be a blueprint for addressing the senior oral health crisis head-on: local collaborations. By fostering local partnerships and leaning on the strengths and assets of diverse community stakeholders like academia, community health centers, and senior-serving organizations, we are better able to address systemic barriers. Our experience has demonstrated what is possible when organizations work together to solve complex challenges.
What makes this program especially powerful is its scalability. Its core strategies -- such as strengthening clinical capacity, breaking down barriers to access, and integrating education and advocacy -- can be replicated in communities nationwide. Since its launch in 2022, the Senior Oral Health Partnership Program has expanded to Santa Cruz County, San Diego County, and the Mississippi Delta region.
To date, over 15,000 seniors have received services through these partnerships, creating a testing ground for different approaches and interventions to meet the needs and prove the effectiveness of these investments across diverse communities. These efforts have not only improved oral health outcomes but also enhanced overall well-being, proving that comprehensive solutions are within reach.
Change starts at the local level. We call on community organizations, healthcare providers, and industry leaders to collaborate on this blueprint and improve lives, one patient, one program, and one community at a time. Oral health is overall health, and ignoring this truth has serious consequences for our seniors and society at large.
Editor's note: Learn more in our exclusive interview below.
Dr. Monique Powell-Davis is the chief medical officer at Mary’s Center near Washington, DC; Dr. Richard Gesker, MBA, is the chief operating officer and former vice president of dental services at Mary’s Center; Dr. Candace Mitchell is the associate dean of clinical affairs at Howard University College of Dentistry in Washington, DC.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
