Being unable to afford dental care may increase the risk of developing cardiovascular disease or dementia, according to a study led by researchers at Boston University School of Public Health, announced on Apr. 1.
The study, published in The Journals of Gerontology, Series A, found that older adults who skip necessary dental procedures due to financial barriers are more likely to experience heart failure, heart attacks, strokes, or dementia. This finding is significant because it highlights a potentially modifiable factor—affordability—that could help prevent serious health conditions among older populations.
"Cost is one of the main barriers to dental care," said study lead author Ms. Mabeline Velez, an instructor at Boston University School of Public Health and a PhD candidate at Boston University's Henry M. Goldman School of Dental Medicine. "As a result, people often delay critical care or they accept the coverage available, which may be more drastic measures—such as getting a tooth pulled than is clinically indicated. Tooth loss, especially early in life, can cause a whole set of health problems later in life including increased mortality. Finding ways to make dental care more accessible and affordable for everyone is a preventative measure that we can take to improve health outcomes down the line."
Researchers analyzed data from participants aged 55 and older in the All of Us study initiated by the National Institutes of Health in 2017. They examined electronic health records and survey responses from tens of thousands for new diagnoses related to heart failure (86,593 people), heart attacks (88,496), strokes (88,410), and dementia (92,272). The results showed that those who skipped dental visits due to cost had higher rates for all these conditions among older adults; eliminating financial barriers could prevent between two and four percent of each outcome.
Although adjusting for socioeconomic factors weakened some associations—except for stroke—the researchers said this indicates further research is needed into systemic drivers behind chronic diseases.
"Multiple studies have evaluated pieces of this puzzle but this is the first time we can point to financial barriers to care as being linked with the incidence of cardiovascular disease and dementia: two leading causes of disability and death among older adults," said Dr. Kendra Sims, assistant professor at BUSPH and senior author on the paper. "This study serves as an indicator that if we alleviate upstream factors such as financial constraints we can prevent chronic disease."
Currently fewer than thirty percent of US adults over sixty-five have dental insurance while nearly eight percent say they cannot afford needed treatment; Medicare’s coverage excludes many preventive services while Medicaid varies widely by state.
Policies improving access could reduce poor oral health outcomes with benefits extending beyond oral well-being; states expanding coverage under Affordable Care Act saw increases in dentist visits along with better oral functioning according Drs Sims and Velez.
Dental appointments also present opportunities for broader screening: "People who can access and afford routine dental care typically visit the dentist twice a year," Dr. Sims said. "What if insurance could cover screening for cardiovascular risk factors like diabetes or hypertension when a patient is in the chair?"
Ms. Velez added she hopes her ongoing research into periodontitis—a common but treatable gum condition linked with cardiovascular issues—will encourage greater integration between medical doctors’ practices and dentistry.
