As the bones in 69-year-old Barbara's jaw started to disintegrate, her teeth began to fall out.
The public servant from Parkes, New South Wales immediately went to a specialist dentist, where she was told a combination of factors — including osteoporosis — meant she would need a full set of oral implants.
The out-of-pocket costs totalled almost $70,000.
Barbara, who does not wish to be identified with her full name, said she was forced to withdraw money from her mortgage offset account to cover the costs.
"I just had to deal with it, end of story. There wasn't a lot of other options," she said.
"But I thought 'what do other people do?'. What really hit home was the fact that there's so many people in Australia, whether they have private health insurance or not, who can't afford to do that."
One of those people is Michael Powell, 62, who lives near Ipswich in Queensland.
Michael's teeth have been a major problem for the past decade, and he desperately needs teeth extractions and dentures.
"They have deteriorated over time with age and now I have less than eight teeth left to clean and have a basic meal at night," he said.
Despite having top-tier private health insurance when he was working full-time as a driver, he was unable to afford the $6,500 in out-of-pocket costs to fix his teeth.
"Considering I was making $120 net a day driving a cab or an uber — it was just outrageous," he said.
Now on the disability pension, Michael has been on the waiting list for public dental care since 2020, and has been told it could be up to eight years before he gets help.
"It's very frustrating. I mean, your quality of life, your self-esteem; it would be nice to be able to smile without having to worry about showing all your teeth decay," he said.
"Your self-esteem is at an all-time low and it doesn't help with your anxiety or even depression."
Dental divide deepens on back of pandemic
The COVID-19 pandemic has exacerbated the long-running dental divide between the rich and poor, and nowhere is that more apparent than among older Australians.
A quarter of Australians over 75 have teeth affected by decay, while 20 per cent have complete tooth loss.
Those who cannot afford out-of-pocket costs to care for their teeth have few options.
Many Australians like Michael spend years on lists for public dental clinics, which are run by the states with help from the Commonwealth.
Pressure has been steadily building on the major political parties to commit more money towards combating poor oral health among Australians, with Australian Dental Association vice-president Stephen Liew saying additional funding for the sector was long overdue.
"There's no doubt. It is drastically underfunded, drastically ignored."
Dr Liew said the first step to addressing that would be a targeted senior benefits program for aged care residents.
That would fund basic dental services in aged care facilities, train staff so they can help with dental care, and include oral assessments in the over-75s health check performed by GPs.
Dr Liew said while the policy would cost about $95 million a year, it was a small price to pay.
"We have stories of patients in aged care facilities with almost no teeth left, with abscesses, pus bleeding and discomfort to a level where they cannot be treated," he said.
"This is unacceptable in a country like ours."
The scheme was one of the recommendations of the royal commission into aged care, but has not been adopted by the Coalition.
Not funding it also comes at a cost, experts say
A $2.5 billion seniors dental pledge was one of the more ambitious policies Labor took to the last election, as part of a package of measures ultimately rejected by voters.
Grattan Institute Associate Anika Stobart said while expensive policies are rarely palatable for voters, not funding aged care dental would also come at a cost.
"This also puts pressure on the health system, people are more likely to go see GPs, and need pain relief, or end up even in emergency or get admitted to hospital for the most serious healthcare conditions.
"The waiting lists incredibly long for the state schemes — on average about a year — so you can imagine if you have a health issue with your teeth, you might put yourself on a waiting list, but then your issue gets exacerbated because you're waiting for so long, and it can degenerate and get even worse and may require further medical treatment.
"So it's really unacceptable, the current system that we have."
The Coalition argues dental and oral health are a key part of primary care, saying it is extending its agreement with the states to fund public dental for another year.
Labor said it is committed to its "long-term" goal of expanding Medicare to dental health services but has not specified a time frame.
Meanwhile, the Greens recently promised universal access to free dental care if it wins the election, with a $77.6 billion pledge over 10 years.
For Michael Powell, that policy alone could be enough to sway his vote this coming election.
"Everyone seems to scoff at those things because of the cost factor, but at the end of the day, I know the Greens won't be in power, but they can influence things in a hung parliament or at least through the Senate," he said.
"I might be leaning that way just to get my teeth fixed."
