Being unable to afford dental care may increase the risk of serious health conditions such as heart disease and dementia, according to a new study led by researchers at Boston University School of Public Health (BUSPH).
Published in The Journals of Gerontology, Series A, the study highlights that older adults who skip essential dental procedures due to financial constraints are more likely to experience heart failure, heart attacks, strokes, or dementia.
Previous research has linked poor oral health to cardiovascular and neurological conditions, but it largely focused on specific dental problems, such as periodontitis or tooth loss. This study, however, identifies financial barriers to care as a modifiable risk factor that, if addressed, could potentially prevent life-threatening conditions.
“Cost is one of the main barriers to dental care,” said Ms. Mabeline Velez, lead author of the study, instructor of health policy and health services research at BUSPH, and PhD candidate at Boston University’s Henry M. Goldman School of Dental Medicine. “People often delay necessary care or undergo more extreme measures, like tooth extraction, which can lead to long-term health problems, including higher mortality later in life. Making dental care more accessible and affordable is a crucial preventive step.”
For the study, Velez and her colleagues analyzed data from the All of Us research initiative, launched by the National Institutes of Health in 2017 to build a diverse health database. The team examined survey responses and electronic health records of participants aged 55 and older, assessing the links between unmet dental care needs and new diagnoses of heart failure, heart attacks, strokes, and all-cause dementia.
The analysis included 88,496 participants for heart attacks, 86,593 for heart failure, 88,410 for strokes, and 92,272 for dementia. Results showed that participants who skipped dental visits due to cost had higher rates of all these conditions. On a population level, eliminating financial barriers to dental care could potentially prevent 2-4 percent of these outcomes among older adults. While socioeconomic, behavioral, and clinical factors reduced most associations, the link with strokes remained notable, suggesting further research is needed to understand underlying systemic drivers of chronic disease.
“Multiple studies have evaluated parts of this puzzle, but this is the first to identify financial barriers as a factor linked to cardiovascular disease and dementia—two leading causes of disability and death among older adults,” said study senior author Dr. Kendra Sims, assistant professor of epidemiology at BUSPH. “Alleviating upstream factors like financial constraints could help prevent chronic disease.”
Currently, fewer than 30 percent of U.S. adults aged 65 and older have dental insurance, and nearly 8 percent report being unable to afford necessary dental care. While Medicare and Medicaid provide limited dental coverage, preventive services are often excluded, and Medicaid benefits vary by state, sometimes covering only emergency care.
The researchers emphasize that policies improving access to preventive dental care could have broad health benefits beyond oral health, including reductions in cardiovascular and cognitive conditions. States that expanded dental coverage under the Affordable Care Act saw higher dental visit rates, fewer missing teeth, and improved oral functioning. Dental visits also offer opportunities for other health screenings, such as diabetes and hypertension, potentially identifying risk factors for chronic disease.
“People who can access and afford routine dental care typically visit the dentist twice a year,” Dr. Sims said. “Insurance could cover screening for cardiovascular risk factors while patients are in the chair, which could have major public health benefits.”
For her dissertation, Ms. Velez is exploring how periodontitis—a treatable gum disease caused by plaque buildup—can contribute to cardiovascular problems. “Periodontitis is common but treatable,” she said. “We hope these insights encourage the integration of dental care into general healthcare practice.”
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