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Dental Health

Heart Attack, Stroke, and Dementia Risk May Be Higher for Older People Who Can’t Afford Dental Care

Boston University researchers find skipping dental procedures due to cost linked to range of health issues

The typical dental appointment will usually involve some scraping and polishing, a gum and tooth inspection, maybe an X-ray. While all pretty routine, sitting in that dentist’s chair could save your life—if you can afford the appointment.

A new Boston University–led study has found that older people who forgo necessary dental procedures because of cost may be at higher risk for heart failure, heart attack, stroke, or dementia. They concluded that eliminating the financial barriers that prevented people from receiving dental care could prevent 2 to 4 percent of each outcome among older adults. The results were published in The Journals of Gerontology, Series A.

Fewer than 30 percent of US adults 65 and older have dental insurance and nearly 8 percent say they are unable to afford necessary dental care. Medicare and Medicaid do provide dental coverage, but that coverage is limited and often excludes preventive services. Medicaid dental coverage also varies widely by state, and in some instances only covers emergency care. 

“Cost is one of the main barriers to dental care,” says the study’s lead author Mabeline Velez (SPH’27), a BU School of Public Health PhD candidate and BU Henry M. Goldman School of Dental Medicine instructor of health policy and health services research. “In older populations, insurance often does not cover preventive dental care; this represents a critical unmet healthcare need. For those who cannot pay out of pocket, this can lead to delays in treating oral disease.”

The new study isn’t the first to tie poor oral health to heart disease and brain disorders. But most prior research focuses on specific oral health issues, such as periodontitis or tooth loss—not affordability of care.

“Dental care affordability differs from other socioeconomic factors because it represents a specific modifiable risk factor tied to healthcare delivery,” says Velez. “Finding ways to make dental care more accessible and affordable for everyone is a preventive measure that we can take to improve health outcomes down the line.”

Improving Dental Affordability Could Prevent Disease

For the study, Velez and colleagues from BU and the University of California, San Francisco used survey data from participants ages 55 and older in the All of Us study, a National Institutes of Health initiative to develop one of the largest health information databases of its kind.

Analyzing electronic health records and survey responses, the team examined the associations of unmet dental care needs due to cost with new diagnoses of heart failure, heart attacks, strokes, and all-cause dementia. They found that people who skipped dental checkups and procedures because they could not afford them had higher incidences of all of those conditions.

“This study adds important new information on the potential causal links between oral health and overall health,” says Raul Garcia, a professor and chair of health policy and health services research at BU’s dental school. “The findings are particularly timely given the federal government’s drastic reductions in Medicaid funding, a major source of dental care payments for low-income adults in the US.”

In their paper, the researchers said they “did not observe differences by gender, racial and ethnic identity, or periodontitis [severe gum infection] diagnosis.”

“Multiple studies have evaluated pieces of this puzzle, but this is the first time we can point to financial barriers to care as being linked with the incidence of cardiovascular disease and dementia, two leading causes of disability and death among older adults,” says Kendra Sims, an SPH assistant professor of epidemiology and the study’s senior author. “This study serves as an indicator that if we alleviate upstream factors, such as financial constraints, we can prevent chronic disease.”

Using Dental Visits for Broader Health Screening

According to the researchers, their findings suggest that policies that facilitate access to preventive dental care could have major positive health impacts. For example, states that extended dental care under the Affordable Care Act reported an increase in dental visits, fewer missing teeth, and better overall oral functioning. 

These dental visits also present an opportunity to conduct other health screenings, according to the researchers.

“People who can access and afford routine dental care typically visit the dentist twice a year,” Sims says. “What if insurance could cover screening for cardiovascular risk factors like diabetes or hypertension when a patient is in the chair?”

Velez hopes her focus on the connection between poor oral health and a range of other conditions among older people can help turn attention to prevention.

“Although most oral conditions are preventable and treatable, from my experience, many older adults delay care until problems are severe,” she says. “These people present to the emergency department, are often given temporary relief, and then referred back to a dentist. This cycle leads to ongoing untreated disease and higher costs to individuals, family members, and the healthcare system.”

For her dissertation, Velez is exploring how periodontitis, a condition where plaque built up on the gums causes inflammation and infection, can eventually lead to cardiovascular issues. 

“Periodontitis is very common, but it is a treatable disease,” she says. “I hope this new insight will encourage doctors to integrate dental care into general practice.”

This research received funding support from the National Institutes of Health.

Andrew Thurston contributed reporting to this article. A version of this story originally appeared on the SPH News site.