About 12 years ago, Carrie Lemon started losing teeth. One by one, to curb pain, Lemon had most of her teeth extracted.
Today, at 72, she has only six left. Eating has become a daily chore, and Lemon wants desperately to be fitted for a set of dentures.
"I've just been going from one dentist to another, but all of them tell me that our medical system doesn't cover it," Lemon said. "I don't have the money to get them."
With the number of Americans over age 60 expected to increase by 70 percent by 2025, experts say dental care for seniors is a major issue - one that will only become more acute as the population ages.
"In some surveys, older Americans are getting cavities at twice the rate of teenagers," said Dr. Richard H. Price, a spokesman for the American Dental Association. "As you age, you need to see the dentist more often, not less."
About a quarter of adults age 60 and older no longer have their natural teeth, experts say, and many older adults who do keep their teeth suffer from health problems such as Thankspain, cavities, shifting teeth and receding gums, to name a few.
This month, the General Assembly increased state funding in an effort to expand dental care for poor children. But on the other end of the spectrum, many older adults are not getting the care they need.
Some seniors wrongly believe that they don't need to see a dentist as often as they once did. Others have trouble affording dental care because they are on fixed incomes or lost their health insurance when they retired. Or they have trouble getting to the dentist because of a disability or a lack of transportation.
"Twenty-five million adults forgo dental care because they can't afford it," Price said. "A goodly amount are seniors."
In some states, Medicaid covers limited dental care for low-income and disabled elderly people, but the reimbursement is low, so many dentists don't accept patients with coverage from that program. And Medicare, which provides health insurance for people 65 and older, generally covers only dental work in conjunction with a medical procedure, such as reconstruction of the jaw after an accidental injury. That leaves basic dental services such as cleanings, fillings and removal or replacement of teeth uncovered.
After the death of a 12-year-old Prince George's County boy whose tooth infection spread to his brain, Maryland lawmakers recently set aside millions of dollars to expand dental care for children.
The added funds, which will be used to boost payments to dentists who treat Medicaid children and help expand public dental care in underserved areas, are part of a long-term strategy to provide more dental care to poor children throughout the state.
But, for the most part, dental care for seniors has not been a high priority.
"Access to oral health services for seniors continues to be a challenge in Maryland," said Harry Goodman, who directs the Office of Oral Health for the state Department of Health and Mental Hygiene.
He said the state does a number of things to try to address the challenges, including the funding of clinical services at many local health departments that make payment arrangements based on income.
Another concern, experts say, is the shortage of dentists who specialize in the treatment of older people.
Historically, a "very low percentage" of dental students go into geriatric dentistry, said Dr. Christian Stohler, dean of the University of Maryland Dental School.
"You can count them on one hand," he said.
Stohler called seniors a "clearly underserved" population and said dental schools have previously "not articulated [senior care] as a challenge."
But that may be changing, Stohler said, as those in the health care field recognize that older people will occupy more and more chairs in dentists' offices.
The UM Dental School, for example, has begun talks with Govans Ecumenical Development Corp. (GEDCO), a nonprofit organization that built Stadium Place - a mixed-income retirement community in the Ednor Gardens-Lakeside neighborhood - about opening a dental clinic on the site. The aim is to help meet the needs of the seniors who live there and also to provide hands-on training for students in geriatric dentistry.
"It would give the dental school the ability to have a unique environment where we specifically focus on the elderly," Stohler said. "We would actually enrich education and provide our students with the competency to be able to deal with the elderly, because this is going to be a major part of what they do in the coming years."
Some senior communities, such as those run by Erickson Retirement Communities, do have dental suites on site or provide "on-call" dentists who visit to provide regular care. And Erickson also offers its residents a supplemental insurance program that includes a dental component.
"There's been increasing literature over the last decade demonstrating that dental care is important among seniors," said Dr. Matt Narrett, executive vice president and chief medical officer at the Catonsville-based company. "It is a fundamental and essential part of good health and wellness."
Recent studies have shown, for example, an association between oral health and overall health, including heart problems, fever, diabetes and pneumonia.
And those who are missing several teeth may have trouble chewing, which can lead to poor nutritional choices.
Lemon, who lives at Stadium Place, has restricted her diet to mostly mashed potatoes and soft vegetables, she said, because other foods are too hard to chew.
"That's why I need a set of dentures bad," she said.
Lemon could try to come up with the money for dentures out-of-pocket, but prior dental visits - mostly for extractions - have left her financially strapped, she said.
"When you're on a fixed income and you gotta put out that kind of money, you have to let a bill go and then you have to double up the next month," she said. "It's too much money."
Educating seniors about proper dental care is another important way to help curb the problem, experts say.
Last fall, the ADA and Glaxo-SmithKline Consumer Healthcare launched the Oral Longevity Initiative, a program designed to increase awareness about the need to enhance and preserve the oral health of older Americans.
"People have ideas that teeth are not supposed to last a lifetime," Price said. "Heck, teeth outlive us. After we're gone, our teeth and bones remain behind. Losing teeth is not a normal part of being alive. It's common, but it's not normal."
Greater awareness and more services for seniors might have prevented Lemon from being in the predicament in which she now finds herself. She can admit now that she didn't take great care of her teeth when she was younger.
"I only went to the dentist when I had a toothache," she said.
But Lemon has finally learned how important it is to have good dental care.
"I make my grands and great-grands go and get their check-ups," she said. "Yes, I do."