Older adults who cannot afford needed dental care may face a higher risk of developing serious health conditions such as cardiovascular disease and dementia, according to new research led by Boston University School of Public Health.
The study, published in The Journals of Gerontology, Series A, found that adults aged 55 and older who skipped dental checkups or procedures because of cost were more likely to later develop heart failure, heart attack, stroke, or dementia.
Researchers say the findings add to growing evidence that oral health is closely tied to overall health, while also highlighting affordability as a potentially preventable barrier with long-term consequences.
Financial Barriers May Delay Critical Dental Treatment
Poor oral health has long been associated with heart and neurological conditions, but previous studies have often focused on specific dental problems such as tooth loss or gum disease. This latest research instead examined whether the inability to pay for dental care itself may contribute to broader health risks.
“Cost is one of the main barriers to dental care,” said Mabeline Velez, the study’s lead author, an instructor of health policy and health services research at BUSPH and a Ph.D. candidate at Boston University’s Henry M. Goldman School of Dental Medicine.
Velez said financial limitations often force patients to delay necessary care or accept more invasive treatment than may be clinically ideal.
“As a result, people often delay critical care or they accept the coverage available, which may be more drastic measures—such as getting a tooth pulled than is clinically indicated,” she said. “Tooth loss, especially early in life, can cause a whole set of health problems later in life, including increased mortality.”
She added that improving affordability and access to dental care could serve as an important preventive health measure.
Large Study Examined Older Adults Across Multiple Health Outcomes
For the study, researchers from Boston University and the University of California, San Francisco analyzed survey responses and electronic health records from participants in the National Institutes of Health’s All of Us research initiative, which was launched in 2017 to build a diverse health database.
The analysis focused on adults aged 55 and older and assessed whether unmet dental care needs due to cost were associated with new diagnoses of heart failure, heart attack, stroke, and all-cause dementia.
- 88,496 participants for heart attack analysis
- 86,593 participants for heart failure analysis
- 88,410 participants for stroke analysis
- 92,272 participants for dementia analysis
Across all four outcomes, researchers found a higher incidence among people who reported skipping dental care because they could not afford it.
Researchers Say Better Access Could Prevent Some Cases
The study estimated that removing financial barriers to dental care could prevent roughly 2% to 4% of these conditions among older adults at the population level.
However, researchers also noted that the strength of some associations weakened after adjusting for socioeconomic, behavioral, and clinical factors, except in the case of stroke. That suggests broader structural and health-related influences may also be contributing to the elevated risks.
“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,” said Dr. Kendra Sims, senior author of the study and assistant professor of epidemiology at BUSPH.
“This study serves as an indicator that if we alleviate upstream factors such as financial constraints, we can prevent chronic disease,” Sims said.
Dental Coverage Remains Limited for Many Older Americans
The findings arrive as many older Americans continue to face gaps in dental insurance coverage.
According to the researchers, fewer than 30% of U.S. adults aged 65 and older have dental insurance, while nearly 8% report being unable to afford necessary dental care.
Although Medicare and Medicaid offer some dental benefits, coverage is often limited and may not include preventive services. Medicaid dental benefits also vary significantly by state and in some cases only cover emergency treatment.
Researchers said expanding preventive dental access could improve not only oral health outcomes, but also broader cardiovascular and cognitive health.
They pointed to evidence showing that states which expanded dental care under the Affordable Care Act saw increases in dental visits, fewer missing teeth, and better oral function.
Dentists Could Also Play a Bigger Role in Preventive Health Screening
The study also raises the possibility of using routine dental visits as opportunities to screen for other chronic disease risks.
“People who can access and afford routine dental care typically visit the dentist twice a year,” Sims said. “What if insurance could cover screening for cardiovascular risk factors like diabetes or hypertension when a patient is in the chair?”
Velez, whose dissertation focuses on the connection between periodontitis and cardiovascular disease, said the findings support a more integrated approach to oral and medical care.
“Periodontitis is very common, but it is a treatable disease,” she said. “I hope this new insight will encourage doctors to integrate dental care into general practice.”
Growing Evidence Supports Oral Health as Part of Whole-Body Care
The researchers say the study reinforces the idea that dental care should be viewed as part of comprehensive health care rather than as a separate or optional service.
As policymakers continue to debate how to improve health outcomes and reduce chronic disease in aging populations, the authors suggest that making dental care more affordable may be one practical step with benefits extending far beyond the mouth.
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