Teeth Extractions - Age 65+ in United States

United States

Complete tooth loss, also known as edentulism, is considered the “ultimate marker of disease burden for oral health.” The most common causes of complete tooth loss are tooth decay and gum disease, which become more likely with age. Having all or some permanent teeth missing is associated with an increased risk of disability, mortality and reduced daily function and quality of life, as well as multiple chronic conditions, including:

• Heart disease.
• Diabetes.
• Arthritis.
• Chronic obstructive pulmonary disease (COPD).

Missing teeth or having dentures can impair one’s ability to eat and socialize and is associated with poor nutrition. Because dentures are less efficient for chewing than natural teeth, people using dentures tend to eat softer foods that are easy to chew and therefore consume fewer fruits and vegetables. Studies find that having an oral health issue that impacts daily life is associated with loneliness and isolation among older adults. 

Due to the high costs and lack of Medicare coverage for routine dental visits, many older adults may have trouble getting proper care for their teeth. Annual dental expenditures in the U.S. are highest among adults age 65 and older — compared with the entire population — costing an average of $451 per patient.

According to America’s Health Rankings analysis, the prevalence of full-mouth teeth extractions due to tooth decay or gum disease is higher among:

• American Indian/Alaska Native and Black older adults compared with Asian, white and Hispanic older adults. 
• Older adults with less than a high school education, who have a prevalence eight times that of college graduates; the prevalence is lower with each increase in education level.
• Older adults with an annual household income less than $25,000, who have a prevalence 5.5 times that of those with an income of $75,000 or more; the prevalence is lower with each increase in income level. 
• Older adults living in non-metropolitan areas compared with those in metropolitan areas.
• Adults who have served in the U.S. armed forces compared with those who have not served. 
• Adults who have difficulty with self-care compared with adults without a disability. 
• Older adults with chronic conditions compared with those without chronic conditions.

The percentage of older adults with remaining natural teeth has increased, likely due to public water-fluoridation programs and reduced smoking rates. However, access to oral health care still remains low. Steps older adults can take to maintain good oral health include:

• Using a fluoride toothpaste.
• Brushing and flossing teeth regularly.
• Avoiding tobacco.
• Limiting alcohol.
• Seeing a dentist annually for preventive care.

Policy recommendations to increase access to oral health care among older adults include adding a new dental benefit under Medicare Part B that meets the needs of low-income beneficiaries. Additionally, creating a separate, voluntary program for dental benefits under a new part of Medicare can help strengthen oral health care for older adults. This approach is similar to Medicare Part D, the prescription drug benefit plan. In a 2021 statement, the American Dental Association (ADA) affirmed the call for more robust dental coverage under Medicare to address unmet needs among low-income older adults. The ADA recommended a separate dental program as well, modeled more closely after the more robust and comprehensive medical care delivery system.

Healthy People 2030 has an objective to reduce the proportion of adults age 45 and older who have lost all of their natural teeth.

Bersell, Catherine H. “Access to Oral Health Care: A National Crisis and Call for Reform.” Journal of Dental Hygiene 91, no. 1 (February 2017): 6–14. https://pubmed.ncbi.nlm.nih.gov/29118145/.

Centers for Disease Control and Prevention. “Ten Great Public Health Achievements -- United States, 1900-1999.” MMWR. Morbidity and Mortality Weekly Report 48, no. 12 (April 2, 1999): 241–43. https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.

Cunha-Cruz, J., P. P. Hujoel, and P. Nadanovsky. “Secular Trends in Socio-Economic Disparities in Edentulism: USA, 1972–2001.” Journal of Dental Research 86, no. 2 (February 2007): 131–36. https://doi.org/10.1177/154405910708600205.

Emami, Elham, Raphael Freitas de Souza, Marla Kabawat, and Jocelyne S. Feine. “The Impact of Edentulism on Oral and General Health.” Edited by Yasuhiro Morimoto. International Journal of Dentistry 2013 (May 8, 2013): 498305. https://doi.org/10.1155/2013/498305.

Holm-Pedersen, Poul, Kirsten Schultz-Larsen, Niels Christiansen, and Kirsten Avlund. “Tooth Loss and Subsequent Disability and Mortality in Old Age.” Journal of the American Geriatrics Society 56, no. 3 (2008): 429–35. https://doi.org/10.1111/j.1532-5415.2007.01602.x.

Hung, Man, Martin S. Lipsky, Ryan Moffat, Evelyn Lauren, Eric S. Hon, Jungweon Park, Gagandeep Gill, et al. “Health and Dental Care Expenditures in the United States from 1996 to 2016.” Edited by Frédéric Denis. PLOS ONE 15, no. 6 (June 11, 2020): e0234459. https://doi.org/10.1371/journal.pone.0234459.

Kramarow, Ellen A. “Dental Care Among Adults Aged 65 and Over, 2017.” NCHS Data Brief No. 337. Hyattsville, MD: National Center for Health Statistics, May 2019. https://www.cdc.gov/nchs/products/databriefs/db337.htm.

Nowjack-Raymer, R. E., and A. Sheiham. “Association of Edentulism and Diet and Nutrition in US Adults.” Journal of Dental Research 82, no. 2 (February 1, 2003): 123–26. https://doi.org/10.1177/154405910308200209.

Parker, Marcia L., Gina Thornton-Evans, Liang Wei, and Susan O. Griffin. “Prevalence of and Changes in Tooth Loss Among Adults Aged ≥50 Years with Selected Chronic Conditions — United States, 1999–2004 and 2011–2016.” MMWR. Morbidity and Mortality Weekly Report 69, no. 21 (May 29, 2020): 641–46. https://doi.org/10.15585/mmwr.mm6921a1.

Rodrigues, Suely Maria, Ana Cristina Oliveira, Andréa Maria Duarte Vargas, Allyson Nogueira Moreira, and Efigênia Ferreira e Ferreira. “Implications of Edentulism on Quality of Life among Elderly.” International Journal of Environmental Research and Public Health 9, no. 1 (January 2012): 100–109. https://doi.org/10.3390/ijerph9010100.

Rouxel, Patrick, Anja Heilmann, Panayotes Demakakos, Jun Aida, Georgios Tsakos, and Richard G. Watt. “Oral Health-Related Quality of Life and Loneliness among Older Adults.” European Journal of Ageing 14, no. 2 (June 1, 2017): 101–9. https://doi.org/10.1007/s10433-016-0392-1.

van Kampen, F. M. C., A. van der Bilt, M. S. Cune, F. A. Fontijn-Tekamp, and F. Bosman. “Masticatory Function with Implant-Supported Overdentures.” Journal of Dental Research 83, no. 9 (September 1, 2004): 708–11. https://doi.org/10.1177/154405910408300910.

Zhang, Yuqing, Suzanne G. Leveille, and Ling Shi. “Multiple Chronic Diseases Associated With Tooth Loss Among the US Adult Population.” Frontiers in Big Data 5 (July 1, 2022): 932618. https://doi.org/10.3389/fdata.2022.932618.