Structural Inequities in Dental Care Use Across Dementia Progression: The Roles of Race/Ethnicity and Education

Dental care utilization in later life may reflect changing health needs, access to healthcare, and social inequalities that persist across the aging process. We examined trajectories of dental care utilization before and after dementia diagnosis and evaluated whether these patterns differed by race/ethnicity and educational attainment. We linked Health and Retirement Study data with Medicare claims (1992-2020) among 2,838 dentate adults aged 65 years and older with incident dementia. Mixed-effects logistic regression models estimated changes in dental care utilization relative to the year of dementia diagnosis. Dental care utilization declined in the years preceding dementia diagnosis, increased immediately after diagnosis (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI]: 1.04-2.03), and subsequently plateaued. Non-Hispanic Black participants had lower dental care utilization compared with White participants (AOR = 0.21, 95% CI: 0.10-0.44), although trajectories of change surrounding dementia diagnosis did not differ by race/ethnicity. Racial and ethnic disparities persisted even among participants with higher educational attainment. Dementia diagnosis represents a potential transition point associated with temporary increases in dental care engagement, but it does not eliminate longstanding disparities in oral healthcare utilization. These findings highlight the importance of examining oral healthcare access as part of broader aging-related inequalities and ensuring equitable integration of dental care into the continuum of care for older adults with dementia.