BOSTON, Mass. – When Sanjog Kaur could no longer bear the pain around her upper molar that had been bothering her for months, she took a needle-nose pliers from her husband’s toolbox one recent day, sterilized it in boiling water, rocked the offending tooth back and forth a few times and yanked it out of her mouth. Then she put a sterilized cotton ball in the gap to suck up the blood.
“I was scared, but I had no other option,” said the 70-year-old Indian American resident of the Bay Area, who asked that her real name not be used. “A visit to the dentist has always set us back by hundreds of dollars. I took care of my problem without spending any money.”
She said she kept her do-it-yourself job to herself because her husband, a store salesman, would not have approved. Luckily, the extraction did not lead to complications.
For Kaur and the 59 million or so seniors and people with disabilities who rely on Medicare, the federal health insurance program for those 65 and older and people with disabilities, resorting to self-help when it comes to oral care is not uncommon because the program has never covered even the most routine dental care. And dental coverage offered by Medicare Advantage plans don’t cover such expensive procedures as gum surgery, root canals and implants.
But all that could change if Sen. Benjamin Cardin gets his way. Earlier this month, the Maryland Democratic lawmaker, who is a member of the Senate Finance Health Care Subcommittee, introduced a bill that will create a Medicare dental benefit.
The Medicare Dental Benefit Act of 2019 would allow Medicare beneficiaries to receive oral health care under Medicare Part B. Even those enrolled in Medicare Advantage plans could benefit.
Cardin’s bill will cover dental and oral health services including routine cleanings and exams, fillings and crowns, major services such as root canals and extractions, and emergency dental care.
Supporting the bill are such groups as Justice in Aging, Families USA, Oral Health America and Center for Medicare Advocacy.
Dr. Stephen Shuman of the University of Minnesota School of Dentistry and chair of the Gerontological Society of America Oral Health Workshop said he was doubtful that it will because of the current political climate.
“Right now everyone is concerned about the economic impact the bill will have,” said Shuman, who facilitated discussions on oral health at the GSA’s Annual Scientific Meeting in Boston last November.
Nearly one in five adults over the age of 65 have lost all of their teeth, according to the Centers for Disease Control and Prevention. Also, about 68 percent of adults 65 and older have gum disease. Yet, fewer than half of Medicare beneficiaries have visited a dentist in the past year, and among low-income beneficiaries, some of whom may also be on the state-federal health insurance program called Medicaid (known as Medi-Cal in California), the rate is even lower.
According to AAPIdata.com, there are around 258,000 Indian Americans like Kaur nationwide who are 65 and over. No data were available on how many of them are on Medicare.
Even though Kaur and her husband are on Medi-Cal as well, so few dentists in their area are in the network that the couple has stopped trying to find one.
Studies have shown that oral health is an important part of overall health. Poor oral health can contribute to conditions ranging from diabetes to respiratory diseases, impacts nutrition and leads to social isolation.
“For those with severe dental problems, not only does their health get affected if they can’t chew, their basic nutritional needs are not taken care of,” said Dr. Nelofer Ansari, who works at a community health care center in the East Bay.
Yet, dental health care has consistently been given stepchild treatment.
Why this is so is that from a “historical perspective,” when Medicare was launched in 1965, the relationship between general health and dental health had not been established, pointed out Dr. Bei Wu, who is the director of Global Health and Aging Research at the NYURory Meyers College of Nursing. Wu presented at an oral health panels at the 2018 GSA Annual Scientific Meeting in Boston last November.
Wu’s research suggests that there could also be a link between poor oral hygiene and cognitive decline in people as they age, though more research needs to be done to definitively establish that, she said.
About 70 percent of seniors lack or have limited dental insurance, and fewer than half access dental care each year, according to OHA’s Wisdom Tooth Project. The gap in coverage leads to high out-of-pocket costs for those who do see a dentist. Wu said providing people affordable dental care could lead to huge savings in health care dollars.
A survey of dentists by the American Dental Association’s Health Policy Institute found that about 71 percent of dentists agreed that Medicare should include comprehensive health benefits.
The concept of regular dental checkups is foreign to many older first-generation Indian Americans, both back in their homeland and here in the U.S., as well. Many of them tend to try grandma’s home remedies when it comes to dental care. They always have a supply of clove oil and turmeric in their medicine cabinet. Some resort to frequent salt water gargling and oil pulling.
Kaur said she has tried all of that. Whenever she gets a tooth pain, she thrusts a clove into her mouth. When she had that rotten molar in her mouth, she said, the clove gave her relief but only for a few days.
Many older immigrants go back to their home countries for medical and dental work, contributing to a robust medical and dental tourism industry there.
Surinder Kumar, 68, was one of them. After getting estimates from a slew of California dentist for implants and bridges, and spending a fair amount of money to get his teeth fixed, Kumar flew to his hometown of Chandigarh in India last year and got seven implants and one bridge put into his mouth. His airfare and the cost of that dental work were far less than the estimates given for his dental work alone by California dentists, he said.
Until he got all the procedures done, he worried that if his oral health worsened, he wouldn’t be able to smile and be sociable.
“Now, I’m always smiling,” the Livingston, Calif., resident said. “And I’m able to eat my favorite snacks – potato chips.”
(This article was written with the support of a journalism fellowship from the Gerontological Society of America, Journalists Network on Generations and the Retirement Research Foundation.)