Older people slipping into dental poverty, a hidden crisis with visible consequences
- Joan Ubide
- 6 days ago
- 4 min read
In many parts of the world, the notion of poverty in teeth scarcely registers in the public conscience, yet it is very real. Oral health has long been seen as a luxury rather than a basic right, and for many older adults, including those from once-secure middle-class backgrounds, the cost of maintaining or restoring their dentition simply becomes unaffordable. This neglect is not only a dental issue, as part of the broader push for sustainable health and wellbeing it intersects with the Sustainable Development Goal 3 on good health and well-being, yet remains largely unspoken.
More tooth loss, fewer options, bigger social costOral disease is widespread, in older populations, untreated decay, advanced periodontal disease, and complete dentures are far from rare. For example, one global study estimated that more than 280 million adults aged 70 or over suffered from oral disorders, including tooth-loss. In lower-income countries, the dentist-to-population ratio may be as low as 0.5 per 10,000 people.
What distinguishes the phenomenon of “dental poverty” is that it often hits those who appear economically stable but are underserved in oral care, older working or retired people who cannot afford the escalating costs of major dental treatments (crowns, implants, dentures) and who may have let preventive care lapse. The result, missing teeth, painful untreated infections, ill-fitting dentures, and the visible signal that the individual cannot afford to fix their mouth.
The consequences are deeper than you might assume. Physically, missing teeth reduce chewing efficiency, alter diet, and thus impact nutrition. Psychologically, the sight of poor dentition triggers shame, lowers self-esteem, and may reduce willingness to speak, smile or socialise. Socially, it can lead to withdrawal, poorer job prospects (for those still working), and may compound other vulnerabilities in later life. Studies identify poor oral health as linked to reduced quality of life, and even isolation or depressive symptoms.
Why has this issue remained at the margins?
Traditionally, public-health systems treat dental care as separate from general healthcare, coverage gaps remain. For older adults especially, barriers include cost, transportation, difficulty accessing a dentist trained in geriatric care, and a perception that missing teeth are simply part of ageing. Moreover, the focus on younger generations and preventive care means the treatment needs of older adults, often more complex and costly, get less attention.
Importantly, this issue is not restricted to low-income countries. In developed economies too, older adults on fixed incomes, surviving on pensions, may deprioritise dental care. Once multiple teeth are lost, the options narrow, full dentures, partials, or nothing. The visible marker of fewer or no teeth becomes a symbol of financial marginalisation, even if the person is not destitute in the conventional sense.
Psychological and social scars that don’t healWhen someone cannot afford to restore their teeth, the impact runs beyond pain. A missing smile means a missing sign of health. It affects self-confidence. Social engagements may become sources of anxiety, smiling, laughing, eating in public, all may become fraught. Conversations may shrink. Friends and acquaintances may make assumptions about financial status or general health. The stigma of tooth loss or visible dental neglect is real, and may reinforce a sense of invisibility or exclusion.
In the later stages of life these effects accumulate. Poor oral health contributes to malnutrition (if chewing becomes difficult), chronic pain, and even systemic links (gum disease has associations with cardiovascular disease, diabetes management and more). From a societal perspective we face a hidden burden, older people whose general wellbeing, dignity and inclusion are undermined by something as fundamental as their teeth.
Organisations stepping into the gap
There are a number of non-governmental organisations attempting to address the oral health gap, though many focus mainly on younger cohorts or on underserved regions. A few that stand out:
· Dentaid (UK), a British dental charity that uses mobile dental units to serve people experiencing homelessness, poverty, refugees and other vulnerable groups in the UK and overseas.
· Mercy Ships, though more famous for surgical missions, they include a dental and oral health programme providing free dental treatment, hygiene education and training in communities with little or no access.
· Canadian Dental Relief International (CDRI), a volunteer-based charity sending dental teams to underserved regions to provide free services, including basic extractions, restorations and oral-health education.
These organisations demonstrate the potential of outreach and education, but they also underline how much remains to be done, especially for older populations in middle-income countries or in the “grey zone” of having some resources but insufficient coverage.
To redress dental poverty, several strands of effort are needed. Public health systems should integrate oral care into older-adult programmes, recognising that teeth matter to dignity, nutrition, and social inclusion. Insurance or subsidy schemes must consider the high cost of restorative treatments for older people. Dental education should emphasise geriatric dentistry (an acknowledged shortfall). And critically, society must stop seeing tooth-loss or missing dentures in later life as inevitable and accept it as a preventable marker of inequality.
The issue of older people unable to afford restoring or maintaining their teeth represents a quietly emerging form of poverty, visible, yet largely silent. Tackling it means recognising that good oral health is not cosmetic, it is a key component of human dignity and social inclusion.
Further reading & links
· Dentaid (UK), https://www.dentaid.org
· Canadian Dental Relief International, https://cdri.ca
· Global perspectives on oral health policies for older adults, Frontiers in Oral Health (2021), https://www.frontiersin.org/articles/10.3389/froh.2021.703526/full
· Universal coverage for oral health in low-income countries (2024), Global Health Research and Policy, https://ghrp.biomedcentral.com/articles/10.1186/s41256-024-00376-9
