Ellen Murphy says she would laugh when her mother would say, "What old ladies really need are good teeth and a facelift."
Now 73, Murphy sees the truth in her mother's comment about dental care.
A retired chemical dependency counselor, Murphy says she gets by almost entirely on Social Security, with medical coverage through Medicare.
She learned after retirement that Medicare doesn't cover routine dental cleanings and procedures, and she can't afford supplemental dental insurance.
"When I think now about what my mother said, I think, 'Gee, Mom, that wasn't really funny," Murphy says.
These days, most seniors are on their own for dental care. Recent cuts to the state's Medicaid program have made dental care even more costly for some low-income seniors. But a growing number of people in the dental community are reaching out to seniors to make sure people who have dental insurance use it, and those who don't have insurance know about the local programs that can provide dental care at a discount.
DENTAL HEALTH KEY TO OVERALL HEALTH
New research shows that taking care of your teeth isn't just for vanity's sake. Diabetes, possibly heart disease, the ability to chew, and access proper nutrition are directly connected to the condition of your teeth and gums.
Large numbers of blood vessels lie close to the surface of the gums, where bacteria in the mouth can cross over into the bloodstream, says Mark Drangsholt, chairman of the Department of Oral Medicine at the University of Washington School of Dentistry.
Drangsholt says the clearest connection is to diabetes: People with diabetes are more likely to have gum disease, and those with gum disease are more likely to have diabetes.
"Oral health is connected to overall health," says Maggie Kriger, coordinator of the Whatcom County Oral Health Coalition, which advocates for dental care for all county residents. "And we're just starting to increase our knowledge of the relationship."
Even some seniors who have insurance are pinched by the cost of dental work not covered by their limited policies. And many dentists require payment at the time of service, so seniors sometimes put off routine dental care until it hurts.
According to the nonprofit Washington Dental Service Foundation, seniors' overall oral health in the state is suffering:
About one-in-five seniors in Washington have untreated cavities.
One-fourth of seniors have lost all of their teeth.
Nearly one-fourth of seniors 65 to 74 have severe gum disease. For low-income seniors, the percentage jumps to 38 percent.
16 percent of seniors have not had a dental appointment in five years.
SENIORS SEEK HELP
Lesley Rigg, who takes calls from seniors at the Senior Information and Assistance call line, part of the Area Agency on Aging at the Northwest Regional Council, says that along with housing, questions about dental care are among the most frequent.
"There's nothing more distressing than getting a call from someone in pain," Rigg says.
In emergency cases, Rigg refers people to the Interfaith Dental clinic or the SeaMar Dental Clinic. In both clinics, people need to show up early and wait for an opening.
To help, dental hygienist Anita Rodriguez has stepped into the breach of dental care. Rodriguez operates Smiles for Life, which offers discount dental cleanings and exams at Bellingham Senior Activity Center. She hopes to expand her program to other senior centers in the county this year.
Rodriguez, who has a portable dental chair she sets up in the senior center, says she charges about 40 percent less than a typical dentist-office cleaning.
Still, as a hygienist, her services are limited. Some of her patients are dealing with issues that need treatment by dentists or denturists. It's sometimes difficult to find the care they need, although Rodriguez tries to link patients with dentists who give discounts or let them pay over time.
Murphy says that when she retired, she thought she could cover her dental expenses out of her own pocket. But with money tight, she waited longer between checkups, since she had to pay the full cost each time.
"When you take care of your teeth that way, it only gets worse," she says.
Murphy prides herself on being fiscally responsible, but even as she watched her pennies her budget was challenged by some major dental problems. In need of several root canals and crowns, she applied for money from Washington Women in Need, a nonprofit organization that offers grants for health care and education to low-income women.
After her dental work, Murphy says a friend told her about Rodriguez's clinics at the Bellingham Senior Center. With the discounted cost, Murphy is now able to get regular cleanings and checkups.
Still, she says, help is needed for seniors who face high-cost dental procedures.
Dentists and hygienists like Rodriguez say that's why regular visits to the dentist are so important for seniors. They can possibly avoid the cost of expensive work, such as root canals, if problems are identified early.
"Some people have put this off for so long," Rodriguez says. "The longer you put it off, the more it haunts you."
DENTAL CARE AT HOME
Seniors face unique problems with their dental care. Health challenges such as arthritis or stroke can make thorough cleaning more difficult and medications can cause mouth dryness that can lead to cavities.
Medications to treat blood pressure, thin blood or ease depression can reduce saliva that normally washes away plaque and bacteria. In a dry mouth, bacteria are left to proliferate, resulting in cavities even in people not previously prone to tooth decay.
"People should discuss their medications with their dentists," says Bellingham dentist Monica Foley.
A dentist might suggest a special mouthwash to lessen dryness, or suggest a fluoride mouthwash to keep bacteria in check. Foley urges people to drink more water - not juice or pop - to ease dry mouth and wash away bacteria. Alcohol and smoking can worsen dry mouth, she adds.
Foley suggests electric toothbrushes for seniors whose muscle weakness makes it harder for them to brush. Some brands are pricey, but battery-powered brushes can sell for less than $10.
Non-electric toothbrushes with bigger handles, or handles fattened with tape, can be easier to hold, especially for people with arthritis. For flossing, there are special floss holders for people unable to hold onto the ends of the floss.
Several insurance companies offer individual dental insurance, including Regence Blue Shield and Spirit Dental. AARP offers association members a supplemental plan through Delta Dental.
For more information, visit the dental plan directory at the National Association of Dental Plans website, nadp.org.
Advice: Many policies have a waiting period before major dental work can be done, so don't wait until you are in pain before signing up. Also, look closely at the policy: some have limited coverage for certain procedures.
Some companies offer dental discount plans, which require a monthly fee in exchange for discounted services at participating dentists. Advice: Be sure your dentist accepts the plan before you enroll. Also, know that the plans are not insurance, and thus are not regulated by the state.
LOW-COST DENTAL CLINICS
SeaMar Dental Clinic, 4455 Cordata Parkway, Bellingham. Phone: 360-738-3016. Opens 7:45 a.m. for adults with dental emergencies. Call for non-emergency care.
Interfaith Dental, 220 Unity St. in Bellingham and 5616 Third St. in Ferndale. Phone: 360-676-6177, ext. 5. Opens 7:45 a.m. for adults with dental emergencies.
Bellingham Technical College Dental Clinic, 3028 Lindbergh Ave. Phone: 360-752-8349, ext. 2. Scheduled to reopen early February. New patients can call to be added to the waiting list.