Visits to the dentist decline in old age, especially among minorities

Study also finds disparities in adult dental visits by race, immigration

Visits to the dentist drop significantly after adults turn 80, finds a new study by researchers at NYU Rory Meyers College of Nursing and the University of Hawai‘i at Mānoa.

The study, published online in the journalResearch on Aging, also highlights disparities in dental visits for U.S. adults by race and country of birth, with immigrants and racial and ethnic minorities less likely to access care.

Oral health is increasingly recognized as an essential part of healthy aging. It is closely related to overall health status and quality of life, and regular dental checkups can prevent oral diseases and maintain good oral health. 

However, regularly seeing a dentist is a challenge for many Americans, especially older adults, racial and ethnic minorities, and immigrant populations. Older adults face barriers such as a lack of access to quality dental care, awareness of the importance of oral health, and dental insurance coverage. Medicare does not cover most dental care, and only 12 percent of Medicare beneficiaries report having at least some dental insurance from another source to help pay dental expenses. These roadblocks to dental care increase for racial and ethnic minorities and immigrants, who may experience racial discrimination and language barriers in healthcare settings.

“To promote oral health and close racial and ethnic gaps in oral health disparities, seeing a dentist regularly is critical,” said Wei Zhang, PhD, professor and chair of the Department of Sociology at the University of Hawai‘i at Mānoa and the study’s first author. “Failure to engage in preventive dental care may lead to serious consequences such as tooth decay, pain, tooth loss, and inflammation.”

In this study, the researchers examined how often people see a dentist as they age, focusing on U.S. adults 51 years and older, and explored variations by race and country of birth. While previous studies have looked at recent trends of dental care utilization among adults in the U.S., this study extends these efforts by using longitudinal data to focus on middle-aged and older adults across an extended period of time. 

The researchers used data from the Health and Retirement Study (HRS), a longitudinal study from the University of Michigan that conducts interviews with a national sample of middle-aged and older adults. They analyzed rates of dental care utilization—measured by whether someone had seen a dentist in the past two years—for 20,488 study participants of different races and ethnicities, including 17,661 U.S.-born and 2,827 foreign-born individuals. 

Seventy percent of adults had visited a dentist in the past two years, but this rate decreased significantly beginning around age 80. U.S.-born adults of all races and ethnicities were more likely to see a dentist (71 percent) than immigrants (62 percent). Interestingly, the gap in care between U.S.-born adults and immigrants shrunk as people aged, suggesting that age and acculturation may play a role in decreasing oral health disparities over time.

The researchers also found that White adults had higher rates of service utilization than Black and Hispanic adults, and while the rates of service utilization decreased with age for all groups, the rates of decline for Whites were slower than others. 

“Our study went beyond prior research by confirming that racial and ethnic disparities were substantial and persistent as people became older, regardless of their birthplace and while adjusting for a wide range of factors. This finding is alarming as it indicates that some unmeasured factors beyond the scope of this study, such as oral health literacy, perception of need, barriers to access, and dissatisfaction with dental care, could play important roles in explaining the disparities in dental care as people age,” said Bei Wu, PhD, Dean's Professor in Global Health at NYU Rory Meyers College of Nursing and co-director of the NYU Aging Incubator, as well as the study’s senior author.

The study’s findings highlight the importance of identifying racial and ethnic barriers to dental care for aging adults and developing culturally competent programs to meet the dental needs of the increasingly diverse U.S. population.

In addition to Zhang and Wu, the study was co-authored by Yan Yan Wu, PhD, of the University of Hawai‘i at Mānoa.