A new study from Boston University School of Public Health, published in The Journals of Gerontology in April 2026, found that older adults who cannot afford necessary dental care face a measurably higher risk of heart failure, heart attacks, strokes, and dementia. As of May 2026, this research strengthens the case for publicly funded dental programs like Canada's CDCP — and raises urgent questions about whether financial barriers to oral care are quietly driving systemic disease across the country.
For dental professionals across Toronto and the Greater Toronto Area, this study is more than an academic curiosity. It connects directly to what many Canadian practices see every day: patients who delay treatment because they cannot pay, and the downstream health consequences that follow.
What the Boston University Study Found
Researchers led by Mabeline Velez, a PhD student in epidemiology at Boston University, analyzed data from more than 88,000 adults aged 55 and older enrolled in the National Institutes of Health's All of Us research program. The study tracked participants across four major health outcomes: heart attacks, heart failure, strokes, and dementia.
The findings were significant. Older adults who reported being unable to afford necessary dental care showed higher incidence rates across all four conditions. At the population level, eliminating financial barriers to dental care could prevent 2 to 4 percent of each outcome among older adults — a figure that translates to tens of thousands of preventable cases annually.
The research team, which included co-authors from Boston University's Department of Epidemiology, noted that fewer than 30 percent of adults aged 65 and older in the United States have dental insurance, and nearly 8 percent report being unable to afford the dental care they need.
The Oral-Systemic Health Connection Is Not New — But the Scale Is
The relationship between oral health and cardiovascular disease has been studied for decades. Chronic periodontal disease introduces inflammatory mediators and bacterial pathogens into the bloodstream, which can accelerate atherosclerosis, promote endothelial dysfunction, and contribute to plaque formation in coronary and cerebral arteries.
What makes this study notable is its focus on affordability as the mechanism. Previous research has examined how periodontal pathogens affect cardiac tissue or how inflammation markers correlate with cognitive decline. This study asks a simpler question: what happens when people simply cannot pay for dental care?
The answer, supported by a large cohort and rigorous methodology, is that cost barriers alone are associated with worse health outcomes — independent of other socioeconomic factors.
Why This Matters for Canadian Dental Practices
Canada's dental care landscape is undergoing a structural shift. The Canadian Dental Care Plan (CDCP), administered by Health Canada, now provides coverage for eligible Canadians who lack private dental insurance. As of May 2026, the program has approved millions of Canadians for coverage, though a significant utilization gap persists — more than two million approved individuals have not yet visited a dentist.
For Ontario dental practices, particularly those in the GTA serving diverse populations, this study reinforces why removing cost barriers is a clinical imperative, not just a political one. When patients skip preventive cleanings, delay restorative work, or avoid periodontal treatment because of cost, the consequences extend far beyond the oral cavity.
Pro Tip: If your practice accepts CDCP patients, consider proactive outreach to eligible patients in your recall system who have lapsed. A simple reminder that their dental visits are now covered could prevent years of compounding oral and systemic health issues.
Periodontal Disease, Inflammation, and Cognitive Decline
The dementia findings deserve particular attention. Research from multiple institutions has identified pathways through which oral bacteria — particularly Porphyromonas gingivalis, a keystone pathogen in periodontal disease — may cross the blood-brain barrier and contribute to neuroinflammation associated with Alzheimer's disease.
Chronic low-grade inflammation from untreated gum disease may also accelerate vascular dementia through its effects on cerebral blood flow. When cost prevents patients from receiving regular periodontal maintenance, the inflammatory burden accumulates over years and decades.
For dental hygienists and periodontists in Canadian practices, this research provides additional clinical rationale for emphasizing periodontal maintenance schedules with patients — and for documenting the systemic health implications of treatment refusal or deferral.
Canada's Regulatory Context: What Practitioners Should Know
The Royal College of Dental Surgeons of Ontario (RCDSO) requires dentists to provide patients with clear information about treatment options and their consequences. In light of this research, informed consent discussions may increasingly need to reference the systemic health risks of deferring dental treatment.
The Canadian Dental Association (CDA) has long advocated for the integration of oral health into primary care frameworks. The Ontario Dental Association (ODA) has similarly emphasized the importance of interprofessional collaboration between dentists and family physicians in managing patients with chronic disease.
Pro Tip: When discussing treatment plans with patients who express cost concerns, document the conversation and the potential systemic health implications of deferral. This protects the patient, supports informed consent, and strengthens your clinical record should complications arise later.
What This Means for Public Policy
The Boston University study adds to a growing body of evidence that dental care is not a luxury — it is a determinant of overall health outcomes. In Canada, where the CDCP is still maturing and provincial dental programs vary widely in scope, this research supports the case for expanding coverage, simplifying enrollment, and reducing administrative barriers that prevent eligible patients from accessing care.
For dental practices in Toronto, Mississauga, Brampton, Markham, Vaughan, and across the GTA, the practical implication is clear: every patient who walks through your door with untreated periodontal disease or delayed restorative needs represents not just a dental problem, but a potential cardiovascular and neurological risk factor.
Frequently Asked Questions
Q: Does skipping dental care really increase the risk of heart disease?
Yes. Research from Boston University found that older adults who cannot afford dental care show higher rates of heart failure, heart attacks, and strokes. Chronic oral infections and periodontal inflammation introduce pathogens and inflammatory markers into the bloodstream, which can accelerate cardiovascular disease over time.
Q: How does the CDCP help reduce these health risks for Canadian patients?
The Canadian Dental Care Plan (CDCP) provides dental coverage for eligible Canadians without private insurance, removing cost as a barrier to regular dental visits. By enabling preventive and restorative care, the program can help reduce the chronic inflammation and infection that contribute to systemic health conditions.
Q: What should dentists tell patients who want to delay treatment due to cost?
Dentists should clearly explain the potential systemic health consequences of deferring dental treatment, including increased risk of cardiovascular disease and cognitive decline. Document these discussions in the patient record, explore available coverage options like CDCP, and consider offering phased treatment plans that address the most urgent clinical needs first.
EBIKO Dental will continue monitoring research developments at the intersection of oral health, systemic disease, and dental care accessibility in Canada.