Financial decay: Dental care can threaten retirement budget’s bottom line

Turns out, daily oral care for your pearly whites past age 50 can pay dividends beyond a strong bite and bright smile.

People approaching retirement don’t always think about dental care costs adding to the bottom line of living expenses, and it’s a common misconception that basic Medicare covers regular trips to the dentist and certain oral procedures. It doesn’t.

Kathy Finley, 68, got that surprise after she retired from teaching religious studies at Gonzaga University. Until about three years ago, Finley had medical and dental insurance through her employer and assumed Medicare would cover similar expenses.

“I didn’t realize until I got to that point that there was no coverage at all for dental under Medicare,” Finley said. “With the supplemental (Medicare) stuff, it didn’t change how much we’d be paying per year out of pocket.”

Costs of dental visits already have stacked up. While her husband recently secured some dental coverage through Veterans Affairs, she’s had to pay cash for fillings and dental checkups twice a year.

“I’m trying to do that at full cost,” Finley said. “Even though the dentist does a 10 percent discount for seniors, it’s still awfully expensive for our budget. My understanding is there’s a connection between oral health and my overall health. If you don’t take care of your teeth, it can cause other health issues.”

A May 2015, Washington Dental Service Foundation survey of 375 adults in Spokane found that 51 percent of respondents said that they either believe Medicare covers preventive dental care or they didn’t know if it did.

While basic Medicare doesn’t include such provisions, some Medicare Advantage plans cover preventive dental services. But the extra coverage varies by the plan and may not cover such expenses as X-rays, fillings and crowns, says Aging and Long Term Care of Eastern Washington.

In another 2012 state survey among 4,400 respondents ages 55 and older, nearly 30 percent of lower income older adults reported painful aching in the mouth “very often” or “occasionally.” The survey also found that 38 percent of respondents ages 75 to 84 didn’t have any dental insurance.

Sometimes, a daily oral health regiment isn’t enough to prevent a huge bill. Joyce McNamee is a 74-year-old widow of a dentist who regularly talks to Spokane seniors about oral health. An advocate of fluoride, she follows a rigorous routine for cleaning teeth and gums to the point that her hygienist spends about 15 minutes for cleanings. Despite that, she faced recent unexpected dental expenses.

She recently found out that a cavity had formed between two of her teeth in a space under a crown that was hard to detect. She needed a root canal, followed by restorative work on the tooth that included removal and replacement of the crown. It all adds up to $2,000 out of pocket.

“From a standpoint of good financial reasoning, I have to have that lower tooth fixed because of the investment I have made in my health,” McNamee said. “I felt it was important to have a good chewing surface.”

“I’m not happy about spending $2,000,” she added. “I firmly believe if we had fluoride in water, I would not have had that decay. Most people would pull their tooth because they couldn’t afford it.”

Jerrie Allard, 58, works with Smile Spokane, a partnership of community leaders and oral health experts developing strategies to improve oral health in the community. She said more than 30 percent of Spokane adults have lost one or more teeth because of decay, based on Spokane Regional Health District reports.

“Oral health is connected to overall health,” Allard said. “Gum disease is linked to chronic diseases including diabetes, heart disease and stroke. Medicare doesn’t cover dental, so protecting oral health is especially important as we get older.”

Allard said she and her husband are thinking they should set aside more savings now for any dental emergencies later in life. “Many of our neighbors are retired, and I’ve personally seen them struggle with having to pay for emerging dental needs. In many cases, it’s an unanticipated expense.”

Dr. Nick Freuen, a Spokane oral surgeon at Cascade Oral & Maxillofacial Surgery, is someone who sees patients regularly juggling those expenses. A large number of them are ages 60 and older who seek care for implants or restorative work because of tooth or gum loss.

In addition to regular oral care at home, he recommends people planning for retirement do save specifically for future dental costs. Even people with insurance often misunderstand what is needed to cover major work, he added.

“People think they’ll be fine, but you run out of $1,000 real quick when you start to do restorative work,” Freuen said. “The biggest problem I see in the elderly is they have a whole lot more risk of dental decay.”

Risk reasons include aging-related dry mouth conditions and lessened dexterity for oral hygiene such as regular flossing, he said.

“You probably should see your dentist even more often for oral hygiene,” said Freuen, who also recommends fluoride treatments at the dentist. “People should look back on work they’ve had done in the past, and they should anticipate similar work. If you’re losing dexterity in your hands, consider getting a ultrasonic toothbrush. Drink lots of water, and consider getting some saliva substitutes.”

For examples of costs, a dental implant for an individual tooth can reach $3,000 to $4,000 when including fees for a surgeon, the procedure itself and then paying a dentist for a crown, he said. Implant-supported dentures can easily reach $25,000.

Tooth loss impacts nutrition and quality of life, Freuen said. There’s also a psychological component of feeling good, he said, and more people are making the choice of implant-supported dentures because the option is “practically indistinguishable from real teeth.”

“It’s important from a functional standpoint because of the nutrition you can get. With conventional dentures, there’s not a lot of chewing power, so you have softer food diet.”

Seniors who have talked to McNamee share stories about how loss of teeth and other dental problems link to overall health.

“So many of them don’t have their own teeth because they couldn’t afford to have root canal or whatever it took, so that leads to poor nutrition,” she said. “You can’t chew meat; you can’t bite into a crisp apple. If you can’t eat, your health suffers.”

“People don’t think about the mouth as being something that also will fall apart like the rest of our body,” she added. “With today’s technology in dentistry, there’s no reason why a person can’t die with the teeth they’re born with.”

Other health problems also can interact with dental concerns. McNamee’s second husband Ron McNamee, 70, developed Type 2 diabetes and now sees a dentist every three months because the condition can cause faster decay in the mouth, she said. A recent visit to the dentist found he had four cavities, despite nightly use of a fluoride rinse along with regular flossing and brushing.

Jim Sledge, 71, a retired Spokane dentist, says that while fluoridation, fluoride toothpaste, and better oral care have gone a long way toward baby boomers keeping their own teeth, that dental longevity poses another challenge.

“How do people continue taking care of their teeth?” Sledge said. “When people are approaching retirement, as a dentist, I encouraged them to get any major dentist work done a couple of years before retirement, then put some money away to continue to come to the dentist.”

“I told them to spend extra time and effort on oral health.”

Editor’s note: This story was updated to correct the number of Spokane residents surveyed by the Washington Dental Service Foundation in May 2015.