Clin-STAR Journey Story

Bridging the Divide: Lisa Simon’s Journey to Integrate Dental and Medical Care for Older Adults

Lisa Simon, MD, DMD, is an internal medicine physician and a general dentist. Her research is focused on the intersection of dental and medical care in the older adult population. While Medicare covers the medical needs of our aging population, it specifically ignores dental needs. Dr. Simon recognized this gap early in her training and has been an advocate for policy change and increasing dental access. “Making dentures was one of the most transformative things I could do for my patients. It is a key component of equitable dentistry.” Older adults often need dentures and other dental assistance as they age, but many lack insurance or other means to afford it. Seeing the large gap between medical and dental care, Dr. Simon decided to pursue her medical degree and became an internist—a specialty that treats many older adults. The gap between dental and medical insurance coverage negatively impacts older patients. To change policy, Dr. Simon’s research studies the impacts of this gap.

In 1965, when Medicare was implemented, dentistry was explicitly excluded. Dr. Simon explained the challenges that exist because of this decision. “The tracks of medicine and dental care are seen as separate, but they often depend on each other,” she said. The largest gap exists because most older adults do not have dental insurance and often experience fragmentation of care. The other gap she notes is the structure of dental care. While Medicare acts to protect or “insure” older adults from catastrophic events—medical bills that exceed the ability to pay - dental insurance is typically more of a coupon book, providing discounts but not helpful if the procedures are expensive or invasive. Dr. Simon expanded, “Many older adults have chronic conditions and co-morbidities in addition to a fixed income, so there are a lot of competing priorities. Dental appointments and procedures may not be prioritized when patients are faced with limited resources.” Another major challenge is that integrated dental and medical care is rare. Hospitals rarely offer dental services beyond oral surgery. Medicare may cover the hospital stay and the medications necessary to help fight a severe tooth infection, but there is no coverage to replace those teeth or the dental care to prevent those complications in the first place.

As a clinician-scientist working across traditionally separate disciplines, Dr. Simon is determined to make policy change. Her NIH/NIA Beeson award is focused on studying a recent shift in Medicare policy that provides dental benefits to a subset of Medicare beneficiaries. Since 2023, almost 1.3 million older adults now have dental care access and coverage they did not have before this change. It is the perfect “natural experiment” to be able to study the impact of a Medicare dental benefit. Dr. Simon’s goal is to collect and present the strong evidence needed to expand both coverage and access to dental care in the older population. “[The policy expansion] was progress and that really excites me and gives me hope. I am genuinely thrilled to determine how effective this policy change was, and my hope is that someday, everyone has equitable access to dental care.”

Dr. Simon is encouraged by how technologies in dental medicine are making a real impact. Silver diamine fluoride is a liquid that stops the growth of cavities and can decrease pain. This dental aid is easily applied and buys the patient and the doctor time to figure out more definitive care. It overcomes many traditional barriers to care. “It’s a transformative tool, and it is being embraced by the dental community and the insurers.” As Dr. Simon was seeking ways to fund her research, a fellow colleague introduced her to Clin-STAR, and she applied for a travel grant to attend the Clin-STAR annual meeting in 2024. “Since my work is so interdisciplinary, I had yet to find a space that felt like it met my needs and goals. Attending the Clin-STAR meeting was like finding ‘my people.’” She spoke about how helpful the community has been. After the recent Clin-STAR/Beeson meeting, Beeson awardees have started a text chain that provides support and resources. She emphasized that the career development focus of the Clin-STAR is unique. “Career development is often a hidden curriculum. Clin-STAR mentors guide you through it and unlock the secrets.”

For trainees or early-career clinicians who are interested in aging research but feel constrained by nontraditional career paths, Dr. Simon encourages them to “come on in”. Clin-STAR is a community for researchers across disciplines and specialties, and it has been an excellent way to find others with diverse interests.” She underscored the vast experience of those who participate in the Clin-STAR events, and how finding mentors and colleagues allows junior researchers to jump start their initiatives and find ideal funding opportunities.

As Dr. Simon looks ahead, she dreams of the collection of more data and the move towards comprehensive dental care. Her goal is to continue to study this research niche and contribute to both policy change and advancing technologies that provide more accessibility. This will also require clear and consistent communication to the aging research community and recruiting more experts to the cause. As dental, medical and other researchers gather and discuss oral health, they need to work together to make sure they are creating age-friendly places and age-friendly procedures. “In gathering together and working together, we won’t repeat the mistakes of the past.”