I recently had a routine dental visit turn into something much bigger.

What began as a simple replacement of an old filling quickly escalated into a crown - $450 out of pocket - followed by pain when I drank cold beverages, and the unwelcome news that the same tooth now required a root canal. That procedure alone cost me another $725, paid directly to an endodontist. And I’m not finished yet. I still need to return to my regular dentist to permanently fill the opening in the crown - another out-of-pocket expense waiting just around the corner.

I’m fortunate. I have dental insurance and access to care, and I am working so I can pay these costs. And even so, I found myself wincing - not from the procedure (which was surprisingly painless), but from the bill.

That experience got me thinking about something we rarely talk about openly: what dental care really costs as we age - and how exposed many older adults are once they transition to Medicare.

What truly stunned me was a recent conversation with my mom about her sister and brother-in-law. I learned that when they went on Medicare some 25 years ago, they never obtained dental insurance. Not because they didn’t value oral health, but because - like many older adults - they assumed Medicare would cover it. It doesn’t.

In fact, nearly half of adults age 65 and older have no dental coverage whatsoever. Traditional Medicare does not include routine dental care—no cleanings, fillings, crowns, root canals, or dentures. For many seniors living on fixed incomes, that gap means hard choices: delay care, skip care, or absorb significant out-of-pocket costs that compete with housing, food, medications, and utilities.

For those who do seek care, the costs add up quickly. Among older adults who use dental services, average annual out-of-pocket spending often approaches or exceeds $1,000. And that’s an average—many spend far more, especially when more complex procedures are required.

This matters far beyond teeth.

Oral health is deeply connected to overall health - affecting nutrition, heart health, diabetes management, infection risk, and even cognitive well-being. Yet our system treats dental care as optional, even as we ask people to age with dignity, independence, and good health.

Some Medicare Advantage plans include limited dental benefits, and for many seniors, those plans are a lifeline. But coverage varies widely, annual caps are often low, and navigating the options can be confusing - particularly for those with language barriers, cognitive challenges, or limited access to trusted guidance.

So, when I think back on my own dental saga - one tooth, one problem, one cascade of bills - I can’t help but ask: what happens when you’re 78, living on Social Security, and the pain becomes unbearable? What happens when the cost is not inconvenient, but impossible?

For seniors and adults in the Conejo Valley who simply cannot afford routine dental care, there are local options—though many people don’t know they exist. The Conejo Free Clinic is the primary free dental resource in our area, offering exams, cleanings, X-rays, fillings, simple extractions, and referrals for more complex needs to uninsured and underinsured residents.

Additional low-cost services are available through Clinicas del Camino Real, which operates dental clinics throughout Ventura County, including the Free Clinic of Simi Valley. For those willing to travel a bit farther, the Oxnard College Dental Clinic provides care at reduced cost through a supervised dental training program. These clinics are lifelines - but they often have limited capacity, long wait times, and eligibility requirements, underscoring just how fragile the safety net can be for older adults who lose dental coverage after Medicare begins.

Dental care should not be a luxury reserved for those who can afford surprises. As our population ages, we must have more honest conversations about what it means to truly support healthy aging - and what gaps still quietly undermine it.

Sometimes, it starts with a tooth.