INVENTORY

Your Clients Can Smile Again

Why oral health is critical to senior care outcomes

By Diane Earle & Ann Wells

Despite all we know about the connection between oral hygiene and systemic health, dental care is often a neglected aspect of senior care. Recent data shows that more than a third of adults over 65 haven’t seen a dentist in the past 12 months. For those in nursing homes, the numbers are even more concerning, as only 16% receive regular oral care, according to a 2017 article. As professionals who have spent decades caring for seniors, we have seen what happens when dental care is overlooked: painful infections, avoidable hospital visits and most heartbreaking of all, patients who stop smiling, eating or talking due to embarrassment or pain.

Poor oral health isn’t just about toothaches; it’s linked to increased risk of pneumonia, cardiovascular disease, diabetes and deep social isolation. And yet, traditional Medicare (Parts A and B) still excludes routine dental services, like cleanings, fillings, tooth extractions, dentures and preventive check-ups. Some Medicare Advantage (Part C) plans offer limited dental benefits that vary widely in scope and provider access and can come with caps or restrictions.

With America’s aging population of 65-plus growing every year, we can’t afford to treat oral care as optional. It is time to recognize it for what it truly is: an essential element of dignity, longevity and whole-person care. Here at InnovAge, where we deliver care through the PACE (Program of All-inclusive Care for the Elderly) model, we’ve seen firsthand how addressing oral health can reduce downstream complications, from chronic disease to emotional well-being.

Oral Health & Whole-Body Wellness

A healthy mouth supports a healthy body. Because older adults often face additional barriers, including declining dexterity, cognitive decline and medication side effects that reduce saliva, the risk of oral disease only intensifies with age. For example, gum disease is an infection that can enter the bloodstream and has been linked to other health issues, but when treated, it can improve glycemic control in people with diabetes.

Oral health issues can also have damaging mental health effects. Seniors who suffer from missing teeth, poorly fitted dentures or untreated decay often report feeling embarrassed to speak or smile. This emotional impact frequently leads to social withdrawal, avoidance of family gatherings and decreased participation in day programs or community outings.

For individuals with dementia, the challenge is compounded. From what we and other colleagues have experienced, cognitive decline can make it difficult to express dental discomfort or tolerate cleanings, leading caregivers to deprioritize oral care entirely. When seniors can’t explain what hurts, it’s up to us to notice the signs.

Addressing the Access Gap

While integrated programs like PACE can offer built-in dental support, the vast majority of seniors receive care from home health or personal care providers who may not have the specialized expertise or training needed to identify certain dental issues. Still, there are tangible steps agencies can take to improve access to the appropriate dental care. At InnovAge, each center has dedicated staff and dental suites to make oral care even more accessible through PACE, and we have implemented several steps all senior care providers can take to make oral care part of overall health care.

First, equip caregivers with the knowledge to identify early signs of dental distress, such as persistent bad breath, changes in eating habits or increased irritability and how to provide routine dental care. At InnovAge, clinical teams train caregivers using real-life scenarios to support participants with cognitive impairments. Techniques like using two toothbrushes—one to hold the mouth gently open, another to clean—can be transformative for caregivers who fear causing harm. This sort of hands-on knowledge-sharing is key to building confidence and ensuring participants do not suffer in silence due to preventable oral pain. When caregivers view oral care not as optional, but as part of daily hygiene and health, we have seen outcomes improve dramatically even outside of fully integrated models.

Second, build partnerships with mobile dental units, dental hygiene schools or nonprofit clinics to coordinate low-cost care options and ensure those providers are trained to work with older adults, including those with cognitive or physical limitations.

Third, advocate for state Medicaid benefits where available and help families navigate programs like Donated Dental Services or local dental access funds. Also, expanding Medicare to cover preventive dental services or developing a standalone oral health benefit would unlock access for millions of older adults.

Looking Ahead: Innovation, Integration & Advocacy

The future of senior dental care will depend not only on better tools, but on smarter systems and stronger policies.

New technologies like digital dentures are already making care more efficient by reducing the number of appointments needed to make dentures from five to two or three and providing stronger, more comfortable options for patients. If a denture is lost or damaged, digital files allow it to be reprinted without restarting the process. This kind of innovation has been embraced at InnovAge, where team members coordinate replacements with a dental laboratory to fabricate digital dentures.

Meanwhile, portable X-rays and teledentistry are expanding access for participants who are homebound or living in assisted settings.

Even with better equipment, real change depends on breaking the silos between medical and dental care. At InnovAge, medical and dental care are collaborative: doctors and dentists work side-by-side to support participants’ whole health.

That integration must extend beyond InnovAge and PACE. Moving forward, we need more hands-on, oral-care-focused training embedded in caregiving roles, along with stronger incentives to integrate oral care into all senior settings as a daily need.

Too often, oral health is treated as an elective service or cosmetic concern rather than a fundamental part of aging well. Without meaningful improvements, oral health challenges may continue to unnecessarily impact seniors. With it, we have a chance to raise the standard of care and restore dignity for the seniors we serve.

Whether in a PACE setting or a traditional homecare agency, providers have an opportunity and responsibility to treat oral health as a core element of care. By training staff, building local partnerships and advocating for preventive approaches, we can ensure seniors maintain their smiles, their overall health, independence and dignity. As we look toward the future of aging care, oral health deserves a seat at the table.

Dr. Diane Earle is the vice president of dental care services at Innovage. She is a general dentist with more than 40 years of experience as an oral health care provider and a corporate executive leading dental teams in innovative care delivery settings.

Dr. Ann Wells is the chief quality and population health officer at InnovAge. As a board-certified internal medicine physician with more than 25 years of leadership experience in the medical profession, she applies clinical informatics and data analysis to solve complex quality and population health issues. Visit innovage.com.