ANN ARBOR, MI - The dental health of middle-aged Americans faces a lot of problems right now, and an uncertain future to come, according to new results from the University of Michigan National Poll on Healthy Aging.

One in three Americans between the ages of 50 and 64 say they're embarrassed by the condition of their teeth. A slightly larger percentage say dental problems have caused pain, difficulty with eating, missed work or other health problems in the past two years. Forty percent of those polled don't get regular cleanings or other preventive care that can help prevent dental problems.

Insurance coverage appears to have a lot to do with this lack of care. Overall, 28 percent of respondents said they don't have dental coverage. But that percentage was much higher -- 56 percent -- among those who say they only seek care for serious dental problems.

As for the future, 51 percent of those surveyed said they simply didn't know how they will get dental insurance coverage after they turn 65.

Another 13 percent of middle-aged adults expect to count on Medicare or Medicaid to cover their oral care needs after that age. Traditional Medicare does not cover routine dental care, and Medicaid dental coverage is often limited.

The poll, based on a nationally representative sample of older adults, was conducted by the U-M Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, U-M's academic medical center.

"Our findings highlight a stark divide among middle-aged Americans in terms of their oral health now, and a real uncertainty about how they will get and pay for care as they age," says associate poll director Erica Solway, Ph.D. "This is not out of disregard for the importance of preventive dental care - more than three-quarters of the people we polled agree that regular care is important to preventing problems later. But it does highlight opportunities to improve access to care and insurance options after age 65."

Solway and poll director Preeti Malani, M.D., a professor of internal medicine at the U-M Medical School, divided the poll respondents into three groups based on their responses about their use of dental care:

   • prevention-focused: about 60 percent of the sample, who got regular preventive care as well as getting attention for dental problems

   • inconsistent prevention: the 17 percent who sought preventive dental care occasionally

   • problem-only: the 23 percent who went to the dentist only for serious dental problems.

"We know that oral health is a critical factor in overall wellness, and this research helps us identify some key issues - such as affordability and coverage - that we can focus on to address those 40% who are not prevention-focused," stated Dr. Alison Bryant, Senior Vice President of Research for AARP.

A clear divide

Poll respondents who were female, white, had higher incomes or had insurance were much more likely than others to take a prevention-focused approach to dental care. Men, African Americans, Hispanics, those with lower income, or those without insurance were more likely to seek dental care for problems only.

The differences among the three groups was also apparent when the U-M team asked about how easy it was to get care, and why they might not have sought care.

Among those who were prevention-focused, only 13 percent said they had delayed or hadn't received dental care when they needed it in the last two years. But that jumped to 35 percent in the inconsistent-prevention group, and 56 percent in the problem-only group.

Why didn't poll respondents get needed dental care? Cost was the most commonly reported answer, given by 69 percent who said they did not get or delayed needed care. Respondents also reported they were afraid of the dentist, couldn't find time to go, or couldn't find a dentist. Of the people who didn't receive care they needed, one in five cited fear of the dentist as a major factor.

Uncertain future

Looking ahead to the years beyond their 65th birthday - an age when most Americans become eligible for Medicare- the poll respondents were uncertain about how they'd get dental insurance.

Some - 16 percent - said they counted on employer-based coverage or a retirement-based plan. Another 12 percent said they planned to buy supplemental dental insurance.

And in addition to the half of respondents who indicated that they didn't know whether they will have dental insurance at all after age 65, another eight percent said they'd just go without it.

But it's the remaining respondents - the 13 percent who expect Medicare or Medicaid to cover their dental care in their older years - that concern the poll leaders the most.

"Traditional Medicare does not cover dental care, and many states offer very limited or no dental coverage for adults with Medicaid," says Malani. "Even those who were diligent about seeing the dentist and had dental insurance throughout adulthood may find it harder to afford dental care as they get older and coverage options may be more limited."

The nationally representative sample included 1,066 people ages 50 to 64, who answered a wide range of questions online; laptops and Internet access were provided to those who did not already have it.