By David A. Albert, D.D.S., M.P.H.
Columbia University College of Dental Medicine

During the last 15 years, the oral health of older Americans has improved dramatically.

Data recently released by the Centers for Disease Control and Prevention show the change. Older adults had fewer missing teeth, cavities and fillings than their peers of the early 1990s. Periodontal (gum) health also improved remarkably. Oral health got better for people ages 60 to 84, and also for those 85 and older. Progress spanned all racial, ethnic and income groups.

Older Americans now can expect to keep their teeth. Losing them is no longer the "norm."

The best oral health is found in people with the highest incomes. However, many factors can be involved. A healthy diet helps to keep your teeth and gums healthy. Oral hygiene also matters. You are more likely to maintain healthy teeth and gums if you brush, floss and get regular dental checkups and cleanings.

With all this good news, why be concerned? Why can't the majority of Americans expect to be able to keep their teeth after they reach age 65?

The big improvements in oral health that we see today are in large part the result of access to dental health care. There were rapid increases in the number of Americans who had dental insurance in the 1960s, 1970s and 1980s. More modest increases have occurred in recent years. About 170 million Americans currently have dental insurance.

This year, 2008, the first of the baby boomers will become eligible for Social Security benefits. This is the generation born between 1946 and 1964.

When the boomers retire, can they expect to be able to maintain their teeth under the care of their dental professional team? The answer, unfortunately, is probably not. That's because access to affordable dental care is in jeopardy for older adults.

Until recently, it was not unusual for large companies to provide both dental and medical benefits to their employees after retirement. Now most companies have stopped offering dental benefits to retirees. Many are canceling medical benefits as well.

What health insurance do older Americans then have? At age 65, people become eligible for Medicare. This is the government-funded medical insurance program. All Americans are eligible, no matter what their income.

Medicare has several parts. Part A pays for hospital care. Part B pays for doctors' visits. People pay a fee for Part B. Recently, Medicare added coverage for prescription drugs. This is known as Part D. Older Americans, therefore, have a fairly comprehensive medical benefits plan.

Unfortunately, dentistry is not included in Medicare. This means that most older Americans have no insurance for dental services. It's possible to buy dental coverage, but these plans are not offered to all seniors. Many plans also are limited in the treatments they cover. The good news is that Americans' oral health has improved. The fact that we have less gum disease and fewer cavities is certainly something we should applaud. However, if we have more teeth we will need to maintain them. This means older Americans will need more dental services, to prevent and treat problems.

Many older Americans have chronic diseases such as diabetes and heart disease. These diseases also may increase the need for dental services. Many studies have shown that people with these long-term (chronic) diseases have more oral and dental disease. But studies show that diabetics who maintain their oral health can expect to have better control of their diabetes. Good oral health translates into good overall health.

Taking medicines also can affect oral health, and older adults tend to take more pills than younger adults. A common side affect of some medicines is a dry mouth. Saliva flow also decreases as we age. Saliva protects the teeth and oral tissues and helps to keep them healthy. If you have a dry mouth you are more likely to have dental disease.

All of these factors put older adults at an increased risk for cavities and periodontal disease.

Clearly, older Americans need better access to dental services after they retire. Providing dental health insurance in the same way as we provide medical insurance under Medicare can do this. Seniors have more dental treatment needs than younger adults. Adding dentistry to Medicare would give seniors the coverage they need at a time when they most need it.

David A. Albert, D.D.S., M.P.H., is an associate professor and associate director of Community Health at the Columbia University College of Dental Medicine. He also holds an appointment in the Joseph Mailman School of Public Health at Columbia University. He maintains a practice within the ambulatory care network of the Columbia DentCare program in the community of Washington Heights/Inwood in Northern Manhattan.