Medicare covers your mouth before heart valve surgery, but routine cleanings are on you

Key takeaways

• About 1 in 5 U.S. adults ages 20 to 64 had at least one untreated cavity in national exams from 2017 to early 2020, and about 1 in 5 adults 75 and older had lost all their teeth¹.
• In people with diabetes, a deep cleaning below the gumline lowered A1c, a measure of average blood sugar, by about 0.4 percentage points over three to four months, a 2022 Cochrane review of 35 trials found⁹.
• Sealants prevent 80% of cavities in children’s back teeth over two years, yet fewer than half of children and teens have them⁴.
• For adults, a 2020 Cochrane review found little to no difference in cavities or gum bleeding between six-month, two-year and risk-based checkup schedules¹¹.
• Original Medicare doesn’t pay for routine cleanings, fillings or dentures, but dental schools, health centers and some Medicare Advantage plans offer cheaper routes¹³¹⁴.

Medicare will pay a dentist to examine your mouth before a heart valve replacement or an organ transplant¹³. It will pay to clear up a mouth infection before you start cancer treatment such as chemotherapy¹³.

It won’t pay for the routine cleanings, fillings or dentures that might keep trouble from starting¹³. A section of the Social Security Act shuts most care of the teeth out of Medicare¹³.

The gap shows. In 2015, 62% of older Americans had no dental insurance, the Centers for Disease Control and Prevention (CDC) reports². Among adults 75 and older, nearly 1 in 5 have lost every natural tooth¹.

Even the U.S. Preventive Services Task Force, an independent expert panel, notes that dental care and primary care run as largely separate systems⁷.

For readers who put prevention first, the mouth is a good place to start, because the proven steps are few. This guide covers dental care as part of prevention. Later articles in this series go deeper on brushing and flossing, fluoride, the oral microbiome, gum disease, dry mouth and oil pulling.

One in five working-age adults has a cavity nobody has treated

CDC’s 2024 Oral Health Surveillance Report draws on national dental exams from 2017 to March 2020¹. About 21% of adults 20 to 64 had at least one untreated cavity, as did about 13% of adults 65 and older¹. Among children 6 to 8, about 18% had untreated decay in their baby teeth¹.

Gum disease is even more common. The Task Force cites estimates that about 42% of adults over 30 have periodontal disease, the kind that damages the gums and bone holding teeth in place⁷. That share rises to nearly 60% at 65 and older, and untreated periodontitis is the leading cause of tooth loss in older adults⁷.

Tooth loss climbs with age. In the CDC report, 1.2% of adults 35 to 49 had no natural teeth, compared with 5.9% at 50 to 64, 11.4% at 65 to 74 and 19.7% at 75 and older¹.

The burden isn’t shared evenly. Untreated decay reached 41.4% among working-age adults who smoke and 39.6% among those in high poverty¹. In 2009 to 2014, 60% of lower-income adults 30 and older had periodontitis, double the 30% among higher-income adults². CDC notes these gaps have stayed the same since the Surgeon General’s 2000 report on oral health first described them¹.

Gum disease travels with diabetes and heart disease, but cause is harder to prove

With diabetes, the link runs both ways. The National Institute of Dental and Craniofacial Research (NIDCR) says poorly controlled blood sugar makes gum disease more likely and more severe, and gum disease in turn may make blood sugar harder to control⁸. Diabetes can also slow healing and dry the mouth⁸.

Treatment trials back part of that loop. In 2022, Cochrane, an independent network that reviews medical evidence, pooled 35 randomized trials with 3,249 people, nearly all with type 2 diabetes⁹. A deep cleaning below the gumline lowered A1c by 0.43 percentage points at three to four months and 0.30 points at six months, compared with no treatment or usual care⁹.

That’s a modest drop, and the reviewers rated the evidence moderate certainty⁹. Picture someone whose A1c is 8.0%: by the trial average, gum treatment might bring it near 7.6%. That example is ours, and individual results vary.

The heart story is less settled. The American Heart Association (AHA) weighed it in 2012 and again in February 2026, in a statement whose first author is Andrew Tran¹⁰. The new statement says research has grown substantially since 2012, including genetic studies, gum-treatment studies and work on inflammation markers¹⁰.

It describes two possible paths: mouth bacteria slipping into the bloodstream, and long-running inflammation¹⁰. Its summary doesn’t claim that gum disease causes heart disease, and it lists open research questions¹⁰. In plain terms, the two conditions travel together, and the statement doesn’t establish that treating gums protects the heart.

Pregnancy is another place the mouth matters. CDC says pregnant women are more likely to develop gingivitis, a mild gum inflammation, and that both checkups and urgent dental treatment are safe throughout pregnancy⁵. Children of mothers with many untreated cavities or missing teeth are more than three times as likely to have cavities⁵.

The best-proven protection starts in childhood

Some of the strongest evidence in prevention sits in a child’s mouth.

Fluoride varnish. In 2021, the Task Force gave a B grade to painting fluoride varnish on the baby teeth of all infants and children, starting when the first tooth appears⁶. The Task Force reviewed 15 varnish trials with 9,541 children. In the 12 that tracked new cavities, varnish cut the risk by about 20%, or about 7 fewer children with cavities per 100, with a likely range of 2 to 12⁶. CDC puts the drop in baby-tooth cavities at about a third³.

In four trials that checked, children given varnish didn’t develop more fluorosis, the white flecks that excess fluoride can leave on teeth, than those given a placebo or nothing⁶.

Fluoride supplements, where agencies differ. The Task Force also gave a B grade to fluoride supplements from 6 months of age for children whose water is low in fluoride⁶. On October 31, 2025, the Food and Drug Administration (FDA) said swallowed prescription fluoride should be limited to children 3 and older at high risk of decay, such as those with past cavities and no fluoridated water. It said it would act against unapproved products labeled for younger children or not limited to high-risk children¹⁵. Ask your child’s dentist or pediatrician which advice fits your family. Our article on health promotion covers the separate debate over fluoride in tap water.

Sealants. A sealant is a thin protective layer a dentist or hygienist paints onto the molars. CDC reports that sealants stop 80% of cavities in those teeth for two years, which matters because 9 in 10 cavities form in back teeth⁴. Yet only 42% of children 6 to 11 and 48% of teens have them⁴. Children without sealants have almost three times as many cavities in their first molars⁴. CDC estimates that school programs reaching about 7 million low-income children without sealants could save up to $300 million in dental bills⁴.

Sugar timing. Mouth bacteria feed every time you eat or drink and make acid that dissolves enamel, while saliva works to repair it³. CDC lists sugary or acidic foods and drinks, especially between meals, as a risk³. By that logic, a sweet drink sipped all afternoon is harder on teeth than the same drink with lunch. Whole-food, low-sugar eating already serves your teeth.

Fluoride toothpaste and no tobacco. Kids who use fluoride toothpaste every day get fewer cavities, CDC says³. Tobacco in any form raises oral cancer risk⁸, and 29.4% of adults 65 and older who smoke have lost all their teeth¹. Our article on quitting tobacco lays out what helps.

One fine-print point: in 2023, the Task Force issued “I” statements, meaning too little evidence, for screening and prevention delivered by primary care clinicians to people 5 and older⁷. That’s because most of the studies took place in dental offices or schools, not doctors’ offices⁷. It isn’t a verdict that sealants or fluoride fail.

Twice a year is a habit, not a finding

The six-month checkup feels like a rule of nature. When researchers tested it, the evidence was thin.

In 2020, a Cochrane review found just two trials: one in Norwegian children and one in British adults, called INTERVAL¹¹. INTERVAL enrolled 2,372 adults at 51 practices and followed them for four years¹². People assigned to checkups every six months, every two years or on a schedule set by their risk had about the same cavities, gum bleeding and quality of life¹¹¹².

For children and teens, the evidence was too weak to judge¹¹.

England’s National Institute for Health and Care Excellence (NICE) sets intervals by risk: as short as 3 months for anyone, and as long as 24 months for adults or 12 months for people under 18¹². The dentist reviews the interval at each visit, weighing factors such as smoking and heavy drinking¹².

There are caveats. INTERVAL didn’t measure whether longer gaps delay finding oral cancer, and people in the two-year group were slightly less satisfied¹². CDC’s public advice is still to see a dentist every year³.

Try this script at your next visit: “Based on my teeth, gums and health history, what’s my risk, and what checkup interval do you recommend? What would make you shorten it?”

Oral cancer: a few-minute check, and signs that shouldn’t wait

About 54,000 Americans were diagnosed with oral cancer in 2022, roughly 3% of new cancers, NIDCR reports⁸. It strikes more than twice as many men as women, and most cases occur after 40⁸.

The main risks are tobacco in any form, heavy drinking, especially combined with tobacco, infection with HPV type 16 and, for lip cancer, sun⁸. Our companion article on alcohol covers that risk in more detail.

A dentist or hygienist can check for oral cancer during a regular visit⁸. The check doesn’t hurt, lasts a few minutes and looks over your face, neck and lips, the whole mouth and the back of your throat⁸. The Task Force left oral cancer out of its 2023 oral health reviews and lists it as a separate topic⁷.

Medicare’s dental gap, and the routes around it

Original Medicare doesn’t cover routine cleanings, fillings, extractions, dentures or implants¹³. It does cover some dental care tied to covered medical treatment: exams and treatment before a heart valve replacement or a transplant, treating a mouth infection before chemotherapy, care for complications of head and neck cancer treatment, and exams before and during dialysis for kidney failure¹³. For covered dental care under Part B, you generally pay 20% after the deductible¹³.

If you’re scheduled for one of those treatments, ask whether your dental exam qualifies. Medicare Advantage plans may add dental benefits that Original Medicare lacks, so check what your plan covers¹³.

Medicaid covers dental care for children¹⁴. For adults, dental coverage isn’t required and varies by state; CDC counted 28 states plus Washington, D.C., with comprehensive adult benefits in 2023².

NIDCR lists other routes¹⁴:

• Dental schools and dental hygiene schools, where supervised students treat patients at reduced cost.
• Community health centers, which charge based on income; find one through the Health Resources and Services Administration’s Find a Health Center tool. A later article on preventive care on a budget covers them.
• State and local health departments, 2-1-1 and United Way, which can point you to free or reduced-cost programs.
• Clinical trials, which may offer limited free or low-cost treatment for the condition being studied.

One warning from NIDCR: the institute doesn’t hand out dental implants, implant trials or money for dental care, so ads, emails or texts claiming it does are likely scams¹⁴.

The dental prevention checklist

This checklist is ours, built from the sources in this article. Match your life stage, then work down the row.

Life stage	Proven steps	How to get them affordably
Babies and preschoolers	Fluoride varnish from the first tooth6; ask whether a fluoride supplement fits, given the FDA’s 2025 limits615; fluoride toothpaste3	Medicaid and CHIP cover children’s dental care; Insure Kids Now, 1-877-543-766914
School-age children and teens	Sealants on permanent back teeth4; fewer sugary drinks between meals3; checkups at least every 12 months, per NICE12	School sealant programs4; Medicaid or CHIP14
Pregnancy	Routine dental care, which is safe at any stage; treat cavities5	Health centers with income-based fees; dental schools14
Adults	Checkups at a risk-based interval1112; no tobacco18; with diabetes, tell your dentist and treat gum disease89	Dental schools; health centers; state Medicaid if eligible214
Adults 65 and older	Oral cancer check at visits8; ask about dental care before heart valve surgery, transplant, chemotherapy or dialysis13	Medicare Advantage dental benefits; dental schools; 2-1-11314

How strong is the evidence?

Claim	Evidence level	What it rests on
Sealants prevent cavities in children’s back teeth	Strong evidence	CDC: 80% fewer back-tooth cavities over two years4
Fluoride varnish prevents cavities in young children	Strong evidence	15 trials, Task Force grade B6
Fluoride supplements help where water is low in fluoride	Promising but early	One randomized trial and four other trials; FDA now limits use615
Treating gum disease modestly lowers blood sugar in diabetes	Strong evidence	35 trials, moderate certainty9
Treating gum disease prevents heart attacks or strokes	Not enough evidence	AHA’s 2026 statement calls for more research10
Six-month checkups beat longer, risk-based intervals for adults	Evidence says no, or unsafe	Little to no difference in a four-year trial1112

Questions readers ask

The bottom line

Your mouth is one of the few places where prevention is simple, visible and well tested. Sealants and fluoride varnish protect children’s teeth, avoiding tobacco protects everyone’s, and the timing of sugar matters, not just the amount.

Gum disease is worth treating for its own sake and for blood sugar, even though the heart benefit is unproven. Ask your dentist for a checkup schedule built on your risk, learn the warning signs that shouldn’t wait, and if Medicare leaves you short, try a dental school or health center.

Related reading

• Health promotion’s biggest wins changed the rules, not just the habits
• “Additive-free” cigarettes are still cigarettes, and these are the methods that help you quit
• Cut your medical bills without cutting the care
• The preventive care that costs you nothing, and the exceptions
• Your preventive care checklist survived the Supreme Court, but its authors are changing

Sources

1. Centers for Disease Control and Prevention. “2024 Oral Health Surveillance Report: Selected Findings” and “Editorial Comment.” CDC, October 9, 2024. cdc.gov and cdc.gov
2. Centers for Disease Control and Prevention. “Health Disparities in Oral Health.” CDC, updated October 17, 2024. cdc.gov
3. Centers for Disease Control and Prevention. “About Cavities (Tooth Decay).” CDC, May 15, 2024. cdc.gov
4. Centers for Disease Control and Prevention. “Dental Sealant Facts.” CDC, May 15, 2024. cdc.gov
5. Centers for Disease Control and Prevention. “Pregnancy and Oral Health Facts.” CDC, May 15, 2024. cdc.gov
6. U.S. Preventive Services Task Force. “Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions.” Final recommendation, December 7, 2021. uspreventiveservicestaskforce.org
7. U.S. Preventive Services Task Force. “Oral Health in Adults: Screening and Preventive Interventions” and “Oral Health in Children and Adolescents Aged 5 to 17 Years: Screening and Preventive Interventions.” Final recommendations, November 7, 2023. uspreventiveservicestaskforce.org and uspreventiveservicestaskforce.org
8. National Institute of Dental and Craniofacial Research. “Oral Cancer” (reviewed November 2024) and “Diabetes and Oral Health” (reviewed October 2024). NIH. nidcr.nih.gov and nidcr.nih.gov
9. Simpson TC, Clarkson JE, Worthington HV, et al. “Treatment of periodontitis for glycaemic control in people with diabetes mellitus.” Cochrane Database of Systematic Reviews, April 14, 2022 (plain-language summary). cochrane.org
10. Tran AH, Zaidi AH, Bolger AF, et al., on behalf of the American Heart Association. “Periodontal Disease and Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association.” Circulation, 2026;153(6):e73–e88, published February 10, 2026 (abstract via Universidad de Especialidades Espíritu Santo research portal). research.uees.edu.ec
11. Fee PA, Riley P, Worthington HV, Clarkson JE, Boyers D, Beirne PV. “Recall intervals for oral health in primary care patients.” Cochrane Database of Systematic Reviews, October 14, 2020 (plain-language summary). cochrane.org
12. National Institute for Health and Care Excellence. “Dental checks: intervals between oral health reviews” (CG19), 2020 exceptional surveillance decision. NICE. nice.org.uk
13. Centers for Medicare & Medicaid Services. “Dental service coverage” and “What’s not covered?” (Medicare.gov, accessed October 2026) and “Medicare Dental Coverage” (CMS.gov, modified March 10, 2026). medicare.gov and medicare.gov and cms.gov
14. National Institute of Dental and Craniofacial Research. “Finding Dental Care.” NIH, reviewed December 2024. nidcr.nih.gov
15. U.S. Food and Drug Administration. “FDA Recommendations on Ingestible Fluoride Prescription Drug Products.” FDA, updated October 31, 2025. fda.gov