Commentary: My toothache led to a painful discovery: The dental care system is full of cavities as you age

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I had a nagging toothache recently, and it led to an even more painful revelation.If you X-rayed the state of oral health care in the United States, particularly for people 65 and older, the picture would be full of cavities.“It’s probably worse than you can even imagine,” said Elizabeth Mertz, a UC San Francisco professor and Healthforce Center researcher who studies barriers to dental care for seniors.Mertz once referred to the snaggletoothed, gap-filled oral health care system — which isn’t really a system at all — as “a mess.”But let me get back to my toothache, while I reach for some painkiller.It had been bothering me for a couple of weeks, so I went to see my dentist, hoping for the best and preparing for the worst, having had two extractions in less than two years.Let’s make it a trifecta.My dentist said a molar needed to be yanked because of a cellular breakdown called resorption, and a periodontist in his office recommended a bone graft and probably an implant.

The whole process would take several months and cost roughly the price of a swell vacation.I’m lucky to have a great dentist and dental coverage through my employer, but as anyone with a private plan knows, dental insurance can barely be called insurance.It’s fine for cleanings and basic preventive routines.

But for more complicated and expensive procedures — which multiply as you age — you can be on the hook for half the cost, if you’re covered at all, with annual payout caps in the $1,500 range.“The No.1 reason for delayed dental care,” said Mertz, “is out-of-pocket costs.”A psychiatrist and an attorney in San Diego say an existing statute could address severe mental illness and addiction.So I wondered if cost-wise, it would be better to dump my medical and dental coverage and switch to a Medicare plan that costs extra — Medicare Advantage — but includes dental care opt...