Lopez: My toothache led to a painful discovery: The dental care system is full of cavities as you age

I had a nagging toothache recently, and it led to an adjacent much achy revelation.

If you X-rayed the authorities of oral wellness attraction successful the United States, peculiarly for radical 65 and older, the representation would beryllium afloat of cavities.

“It’s astir apt worse than you tin adjacent imagine,” said Elizabeth Mertz, a UC San Francisco prof and Healthforce Center researcher who studies barriers to dental attraction for seniors.

Mertz erstwhile referred to the snaggletoothed, gap-filled oral wellness attraction strategy — which isn’t truly a strategy astatine each — arsenic “a mess.”

But fto maine get backmost to my toothache, portion I scope for immoderate painkiller. It had been bothering maine for a mates of weeks, truthful I went to spot my dentist, hoping for the champion and preparing for the worst, having had 2 extractions successful little than 2 years.

Let’s marque it a trifecta.

My dentist said a molar needed to beryllium yanked due to the fact that of a cellular breakdown called resorption, and a periodontist successful his bureau recommended a bony graft and astir apt an implant. The full process would instrumentality respective months and outgo astir the terms of a swell vacation.

I’m fortunate to person a large dentist and dental sum done my employer, but arsenic anyone with a backstage program knows, dental security tin hardly beryllium called insurance. It’s good for cleanings and basal preventive routines. But for much analyzable and costly procedures — which multiply arsenic you property — you tin beryllium connected the hook for fractional the cost, if you’re covered astatine all, with yearly payout caps successful the $1,500 range.

“The No. 1 crushed for delayed dental care,” said Mertz, “is out-of-pocket costs.”

So I wondered if cost-wise, it would beryllium amended to dump my aesculapian and dental sum and power to a Medicare program that costs other — Medicare Advantage — but includes dental attraction options. Almost successful unison, my 2 dentists advised against that due to the fact that Medicare supplemental plans tin beryllium truthful limited.

Sorting it each retired tin beryllium confusing and time-consuming, and cipher warns you successful beforehand that aging itself is simply a job, the benefits are lousy, and the specialty attraction you’ll request astir — dental, vision, proceeding and semipermanent attraction — are not covered successful the basal package. It’s arsenic if Medicare was designed by pranksters, and we’re paying the terms present arsenic the percent of the 65-and-up colonisation explodes.

So what are radical expected to bash arsenic they get older and their teeth get looser?

A retired person told maine that she and her hubby don’t person dental security due to the fact that it costs excessively overmuch and covers excessively little, and it turns retired they’re not alone. By immoderate estimates, fractional of U.S. residents 65 and older person nary dental insurance.

That’s really not a atrocious option, said Mertz, fixed the outgo of security premiums and co-pays, on with the caps. And adjacent if you’ve got insurance, a batch of dentists don’t judge it due to the fact that the reimbursements person stagnated arsenic their costs person spiked.

But without insurance, a batch of radical simply don’t spell to the dentist until they person to, and that tin beryllium dangerous.

“Dental problems are precise intelligibly associated with diabetes,” arsenic good arsenic bosom problems and different wellness issues, said Paul Glassman, subordinate dean of the California Northstate University dentistry school.

There is 1 different option, and Mertz referred to it arsenic dental tourism, saying that Mexico and Costa Rica are fashionable destinations for U.S. residents.

“You tin get a week’s abrogation and dental enactment and inactive travel retired up of what you’d beryllium paying successful the U.S.,” she said.

Tijuana dentist Dr. Oscar Ceballos told maine that astir 80% of his patients are from northbound of the border, and travel from arsenic acold distant arsenic Florida, Wisconsin and Alaska. He has patients successful their 80s and 90s who person been returning for years due to the fact that successful the U.S. their security was expensive, the sum was constricted and out-of-pocket expenses were unaffordable.

“For example, a dental implant successful California is astir $3,000-$5,000,” Ceballos said. At his office, depending connected the specifics, the aforesaid work “is similar $1,500 to $2,500.” The outgo is little due to the fact that personnel, bureau rent and different overhead costs are cheaper than successful the U.S., Ceballos said.

As we spoke by phone, Ceballos peeked into his waiting country and said 3 patients were from the U.S. He handed his cellphone to 1 of them, San Diegan John Lane, who said he’s been going southbound of the borderline for 9 years.

“The superior crushed is the prime of the care,” said Lane, who told maine helium refers to himself arsenic 39, “with astir 40 years of additional” clip connected the clock.

Ceballos is “conscientious and helium has facilities that are arsenic cleanable and sterile and arsenic medically up to day arsenic thing you’d find successful the U.S.,” said Lane, who had driven his woman down from San Diego for a caller crown.

“The outgo is 50% little than what it would beryllium successful the U.S.,” said Lane, and sometimes the savings is adjacent greater than that.

Come this summer, Lane whitethorn beryllium seeing adjacent much Californians successful Ceballos’ waiting room.

“Proposed backing cuts to the Medi-Cal Dental programme would person devastating impacts connected our state’s astir susceptible residents,” said dentist Robert Hanlon, president of the California Dental Assn.

Dental pupil Somkene Okwuego smiles aft completing her enactment connected diligent Jimmy Stewart, 83, who receives affordable dental enactment astatine the Ostrow School of Dentistry of USC connected the USC field successful Los Angeles connected February 26, 2026.

(Genaro Molina / Los Angeles Times)

Under Proposition 56’s baccy taxation successful 2016, supplemental reimbursements to dentists person been successful place, but those increases could beryllium wiped retired nether a budget-cutting proposal. Only astir 40% of the state’s dentists judge Medi-Cal payments arsenic it is, and Hanlon told maine a CDA survey indicates that fractional would halt accepting Medi-Cal patients and galore others volition judge less patients.

“It’s appalling that erstwhile the outgo of providing healthcare is astatine an all-time high, the authorities is considering cutting programme backing backmost to 1990s levels,” Hanlon said. “These cuts … volition unit patients to forgo oregon hold basal dental care, driving wholly preventable emergencies into already overcrowded exigency departments.”

Somkene Okwuego, who arsenic a kid successful South L.A. was occasionally a diligent astatine USC’s Herman Ostrow School of Dentistry clinic, volition postgraduate from the schoolhouse successful conscionable a fewer months.

I archetypal wrote astir Okwuego 3 years ago, aft she got an undergrad grade successful gerontology, and she told maine a fewer days agone that galore of her dental patients are aged and person Medi-Cal oregon nary security astatine all. She has besides worked astatine a Skid Row dental clinic, and plans aft graduation to enactment astatine a session wherever dental attraction is escaped oregon discounted.

Okwuego said “fixing the smiles” of her patients is simply a privilege and boosts their self-image, which tin assistance “when they’re trying to get jobs.” When I dropped by to spot her Thursday, she was with 83-year-old diligent Jimmy Stewart.

Stewart, an Army veteran, told maine helium had occupation getting dental attraction astatine the VA and had gone years without seeing a dentist earlier a person recommended the Ostrow clinic. He said he’s had extractions and top-quality restorative attraction astatine USC, with the enactment covered by his Medi-Cal insurance.

I told Stewart determination could beryllium immoderate Medi-Cal cuts successful the works this summer.

“I’d beryllium screwed,” helium said.

Him and a batch of different people.

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