Science
Commentary: My toothache led to a painful discovery: The dental care system is full of cavities as you age
I had a nagging toothache recently, and it led to an even more painful revelation.
If you X-rayed the state of oral health care in the United States, particularly for people 65 and older, the picture would be full of cavities.
“It’s probably worse than you can even imagine,” said Elizabeth Mertz, a UC San Francisco professor and Healthforce Center researcher who studies barriers to dental care for seniors.
Mertz once referred to the snaggletoothed, gap-filled oral health care system — which isn’t really a system at all — as “a mess.”
But let me get back to my toothache, while I reach for some painkiller. It had been bothering me for a couple of weeks, so I went to see my dentist, hoping for the best and preparing for the worst, having had two extractions in less than two years.
Let’s make it a trifecta.
My dentist said a molar needed to be yanked because of a cellular breakdown called resorption, and a periodontist in his office recommended a bone graft and probably an implant. The whole process would take several months and cost roughly the price of a swell vacation.
I’m lucky to have a great dentist and dental coverage through my employer, but as anyone with a private plan knows, dental insurance can barely be called insurance. It’s fine for cleanings and basic preventive routines. But for more complicated and expensive procedures — which multiply as you age — you can be on the hook for half the cost, if you’re covered at all, with annual payout caps in the $1,500 range.
“The No. 1 reason for delayed dental care,” said Mertz, “is out-of-pocket costs.”
So I wondered if cost-wise, it would be better to dump my medical and dental coverage and switch to a Medicare plan that costs extra — Medicare Advantage — but includes dental care options. Almost in unison, my two dentists advised against that because Medicare supplemental plans can be so limited.
Sorting it all out can be confusing and time-consuming, and nobody warns you in advance that aging itself is a job, the benefits are lousy, and the specialty care you’ll need most — dental, vision, hearing and long-term care — are not covered in the basic package. It’s as if Medicare was designed by pranksters, and we’re paying the price now as the percentage of the 65-and-up population explodes.
So what are people supposed to do as they get older and their teeth get looser?
A retired friend told me that she and her husband don’t have dental insurance because it costs too much and covers too little, and it turns out they’re not alone. By some estimates, half of U.S. residents 65 and older have no dental insurance.
That’s actually not a bad option, said Mertz, given the cost of insurance premiums and co-pays, along with the caps. And even if you’ve got insurance, a lot of dentists don’t accept it because the reimbursements have stagnated as their costs have spiked.
But without insurance, a lot of people simply don’t go to the dentist until they have to, and that can be dangerous.
“Dental problems are very clearly associated with diabetes,” as well as heart problems and other health issues, said Paul Glassman, associate dean of the California Northstate University dentistry school.
There is one other option, and Mertz referred to it as dental tourism, saying that Mexico and Costa Rica are popular destinations for U.S. residents.
“You can get a week’s vacation and dental work and still come out ahead of what you’d be paying in the U.S.,” she said.
Tijuana dentist Dr. Oscar Ceballos told me that roughly 80% of his patients are from north of the border, and come from as far away as Florida, Wisconsin and Alaska. He has patients in their 80s and 90s who have been returning for years because in the U.S. their insurance was expensive, the coverage was limited and out-of-pocket expenses were unaffordable.
“For example, a dental implant in California is around $3,000-$5,000,” Ceballos said. At his office, depending on the specifics, the same service “is like $1,500 to $2,500.” The cost is lower because personnel, office rent and other overhead costs are cheaper than in the U.S., Ceballos said.
As we spoke by phone, Ceballos peeked into his waiting room and said three patients were from the U.S. He handed his cellphone to one of them, San Diegan John Lane, who said he’s been going south of the border for nine years.
“The primary reason is the quality of the care,” said Lane, who told me he refers to himself as 39, “with almost 40 years of additional” time on the clock.
Ceballos is “conscientious and he has facilities that are as clean and sterile and as medically up to date as anything you’d find in the U.S.,” said Lane, who had driven his wife down from San Diego for a new crown.
“The cost is 50% less than what it would be in the U.S.,” said Lane, and sometimes the savings is even greater than that.
Come this summer, Lane may be seeing even more Californians in Ceballos’ waiting room.
“Proposed funding cuts to the Medi-Cal Dental program would have devastating impacts on our state’s most vulnerable residents,” said dentist Robert Hanlon, president of the California Dental Assn.
Dental student Somkene Okwuego smiles after completing her work on patient Jimmy Stewart, 83, who receives affordable dental work at the Ostrow School of Dentistry of USC on the USC campus in Los Angeles on February 26, 2026.
(Genaro Molina / Los Angeles Times)
Under Proposition 56’s tobacco tax in 2016, supplemental reimbursements to dentists have been in place, but those increases could be wiped out under a budget-cutting proposal. Only about 40% of the state’s dentists accept Medi-Cal payments as it is, and Hanlon told me a CDA survey indicates that half would stop accepting Medi-Cal patients and many others will accept fewer patients.
“It’s appalling that when the cost of providing healthcare is at an all-time high, the state is considering cutting program funding back to 1990s levels,” Hanlon said. “These cuts … will force patients to forgo or delay basic dental care, driving completely preventable emergencies into already overcrowded emergency departments.”
Somkene Okwuego, who as a child in South L.A. was occasionally a patient at USC’s Herman Ostrow School of Dentistry clinic, will graduate from the school in just a few months.
I first wrote about Okwuego three years ago, after she got an undergrad degree in gerontology, and she told me a few days ago that many of her dental patients are elderly and have Medi-Cal or no insurance at all. She has also worked at a Skid Row dental clinic, and plans after graduation to work at a clinic where dental care is free or discounted.
Okwuego said “fixing the smiles” of her patients is a privilege and boosts their self-image, which can help “when they’re trying to get jobs.” When I dropped by to see her Thursday, she was with 83-year-old patient Jimmy Stewart.
Stewart, an Army veteran, told me he had trouble getting dental care at the VA and had gone years without seeing a dentist before a friend recommended the Ostrow clinic. He said he’s had extractions and top-quality restorative care at USC, with the work covered by his Medi-Cal insurance.
I told Stewart there could be some Medi-Cal cuts in the works this summer.
“I’d be screwed,” he said.
Him and a lot of other people.
steve.lopez@latimes.com
Science
The Longevity Secrets Helping Athletes Blow Past the Limits of Age
The assessment covers seven simple movements — various lunges, jumps and timed balances — and produces a player score relative to the rest of the league and the player’s own history. The report also includes “jump” and “landing strategy” metrics that chart the distribution of force across a player’s hips, knees and ankles, and it translates arcana like “max ankle dorsification angle” into the lingua franca of basketball: “how small your ankle angle can get like when you get low on a quick first step.” The file, which a player can access throughout his career, regardless of team, is meant to give him information about how hard he can push his body — and, just as critically, when it’s time to ease off.
“When you’re younger, there’s days you can take as many — for us — baseball swings as you want,” New York Yankees first baseman Paul Goldschmidt, who is 38, told me. We were talking in mid-February at the team’s spring training facility in Tampa, Fla., as he was getting ready for eight straight months of baseball. “As you get older, there’s times when rest is more important than work.”
For some athletes, the right biometric data presented in the right context represents “permission to rest,” says Ana Montero, a co-founder of Atlas, a San Francisco-based company that makes brain-wave-scanning, behind-the-ear wearables about the size of Mentos candies. “It’s quantifiable evidence that is showing you: Dude, today — or right now — is not the day. Go to the gym, go for a walk, go for whatever it is. And then coming back and actually seeing that you’ve bounced back.”
The Atlas device gathers several types of data, including electroencephalography, or EEG, which measures electrical activity in the brain, and galvanic skin response, or G.S.R., which is what a polygraph test measures. That data is sorted into five categories (among them agility, vitality and stress) and then delivered with advice through a smartphone app.
“There’s always some noise in brain activity because neurons are not perfect chips or transistors,” André Marques-Smith, Atlas’s other co-founder, says. “So mistakes get made.” He adds that what causes neurons to lose their precision are things that we’re all familiar with: fatigue, stress, anxiety, hunger, aging. Tom Ryan, the N.B.A.’s senior vice president of basketball strategy, says Launchpad chose Atlas because it was eager to find a device that collected this sort of data in real time. If it works the way it’s supposed to, then a vet like Goldschmidt will know exactly when he’s good for some extra batting practice and when he should take a nap instead.
Science
Trees that survived L.A.’s wildfires are dying at alarming rate. Can they be saved?
The deadly fires that devastated homes in Pacific Palisades and Altadena also laid waste to a lush canopy of leaves and pine needles that had cooled and shaded residents here for generations.
Now, more than a year later, trees that had survived the flames are disappearing at a troubling rate.
Since the January 2025 fire siege, roughly 20% of surviving street trees have gone missing, according to preliminary results from a University of California research team.
Many of the hundreds of missing trees probably would have recovered from the damage they suffered in the fires, experts say.
Edith de Guzman cuts into the cambium layer of a carrotwood to see if it is green and healthy near Aiglon Plaza in Pacific Palisades.
The results from the survey of about 500 trees in the Palisades and 1,500 in Altadena — including conifers, palms, Chinese elms and carrotwoods — seem to confirm worrying patterns observed by arborists and local volunteers in the burn scars, who said losses will probably continue for years to come.
Several factors appear to be at work.
Even as the Palisades and Altadena rebuild, local governments only undertook limited efforts to water recovering trees. At the same time, building contractors have been quick to remove trees that stand in the way of construction, while debris removal crews have cut down living trees that they mistakenly identified as dead.
In response to the continuing loss of trees, a group of arborists and volunteers are working to keep the recovering trees alive — and hopefully someday start planting the next generation of the burn scars’ urban forests.
While many homeowners view trees through the lens of maintenance costs — regular pruning can be expensive, and tree roots can wreak havoc on sidewalks and underground pipes — the benefits of trees are numerous and well-documented, experts say.
The shade they provide and the process of evapotranspiration — where water on the surface of leaves evaporates and carries away heat similar to how human sweat works — can cool neighborhoods by more than 10 degrees. This cooling reduces the risk of heat illnesses and can lower homeowner energy costs.
Trees also improve air quality, improve residents’ mental health, and reduce the risks of flooding and landslides. Meanwhile, fire experts say that reasonably spread-out and well-maintained trees do not pose a significant fire risk.
Edith de Guzman, a climate change, water and urban forestry researcher with UCLA, has been studying the burn area trees with her team. The researchers did their first assessment in the months following the fire, and donned orange vests to do it again this past month.
Edith de Guzman uses a hypsometer to calculate the height of a tree in Pacific Palisades.
Their discovery that roughly two out of every 10 trees the team went back to check on were missing was particularly concerning to De Guzman because her team was only looking at public street trees — which the city and county have authority over and work to protect — as opposed to trees on private property, which are maintained or felled largely at the discretion of the property owners.
“On private property it’s a different story — except for protected species,” she said. Public trees, however, “we are still seeing removals that are unnecessary, and the city is not sure who is responsible.”
L.A. City Bureau of Street Services did not respond to a request for comment.
The fires themselves killed and damaged a significant fraction of the areas’ urban tree cover — both private and public — although precise estimates are hard to come by.
Almost immediately, the surviving trees faced trouble.
David Card, board president of the Palisades Forestry Committee, said shortly after the fire, trees began to fall. In the chaos of the aftermath, it was unclear what organizations — or what agencies — were responsible.
Rebecca Latta, co-founder of Altadena Green, said that when the U.S. Army Corps of Engineers debris removal efforts began, leadership worked with them to save trees but that the Army Corps’ contractors often pressured homeowners to approve tree removals and incorrectly identified native oak trees — which did not have leaves at the time — as dead.
Chinese elm trees rise over Pacific Palisades.
Once private contractors arrived to begin rebuilding, they often removed trees on private properties they determined were in the way — and sometimes even removed public street trees they did not have authority over, the advocates said.
At the same time, neither the city of Los Angeles nor the county have routinely watered surviving public trees — which arborists say is essential to helping damaged trees recover. The county did one round of watering in Altadena, but found it to be too expensive, Latta said. The city conducted no watering in the Palisades due to a lack of resources, according to Card.
L.A. County Public Works said it remains “committed to preserving the community’s public trees.” It routinely waters newly planted trees and will continue to assess the needs of mature street trees, the department added.
So, local groups are stepping up to save the trees.
The Forestry Committee began sending two watering trucks around the Palisades: a 2,000-gallon tanker from a landscaping company and a 500-gallon tank on the back of a trailer. Altadena Green began conducting property tree surveys to help residents understand which damaged trees would probably survive and how to take care of them.
The Forestry Committee is also working on a long-term tree planting program for the Palisades that will utilize fire-resilient tree species — although the Los Angeles Department of Water and Power asked the Forestry Committee to hold off for a year as it starts working to move power lines underground, Card said. Excavation will probably occur on plots where street trees are typically placed.
Researchers Oliver Khachikian, Matthew Murphy, Mariana Vargas and Sophia Riemer prepare to survey trees near Aiglon Plaza in Pacific Palisades.
In the meantime, saving existing trees remains the tree doctors’ priority.
Laura Travnitz, an Altadena resident who lost her home in the fire, recalled an Army Corps contractor pressuring her to remove more than a dozen fire-impacted trees on her lot. Now, they’re just stumps. Some already have little green shoots reaching up toward the sky.
“I’m 65,” she said. “I’m not going to be around for those to grow again.”
Science
A Landslide in Alaska Set Off a Tsunami. There May Be More to Come.
Nearly 500 feet up a near-vertical rock face, scraped clean of soil and alder trees, Bretwood Higman, a geologist, looked down across the Tracy Arm fjord in southeast Alaska at a scene of devastation.
At 5:26 a.m. on Aug. 10 last year, a mass of rock with a volume 24 times larger than that of the great pyramid of Giza crashed down the mountainside, sending a wave of water 1,578 feet up the opposite wall and setting off a tsunami that roared down the fjord. It swept over the ridge that Dr. Higman was now standing on. The whole thing took about a minute.
Dr. Higman was part of an international team investigating the aftermath of the geologic event, the second largest landslide-generated tsunami on record. Using computer models, the researchers were able to recreate the landslide and tsunami, as well as a standing wave called a seiche that sloshed back and forth for 36 hours after the landslide.
Among other things, the new study, published on Wednesday in the journal Science, revealed how tricky it is to predict such catastrophic landslides before they take place.
The Tracy Arm landslide was preceded by an unusually rapid retreat of the South Sawyer Glacier, leaving the rock slope that ultimately collapsed bare and unsupported. That same rearrangement of land elements is increasingly occurring throughout Alaskan fjords and around the world. As glaciers retreat and thawing permafrost lubricates slopes, these giant landslides may become more frequent.
Scientists have been sounding the alarm about the emerging hazards of climate-linked giant landslides in Alaska for years. In 2020, Dr. Higman discovered a slow-moving landslide in the Barry Arm fjord that he worried could collapse catastrophically and inundate the nearby town of Whittier with a tsunami.
“We’re rapidly approaching a totally new landscape that has way fewer glaciers in the Alps and really everywhere, and a lot of new lakes,” said Mylène Jacquemart, a glaciologist at ETH Zurich who was not involved in the study. She studied the Blatten landslide that buried a Swiss village in rock, ice and water last year.
Jackie Caplan-Auerbach, a seismologist at Western Washington University and an author on the new study, was among the first to hear about the tsunami: Her neighbors, whose boat was anchored at sea some 50 miles from the landslide, texted her about a strange surge of water that had hit their vessel. Other firsthand accounts trickled in from Harbor Island, where camping kayakers said their gear had been carried away by the wave, and from a 150-passenger cruise ship, the National Geographic Venture, that was sitting just outside the fjord.
The stakes are high for detecting these events ahead of time. Although no vessels were in Tracy Arm fjord proper when the landslide hit, that mostly came down to luck: It was early morning and not many boats were about.
But three large cruise ships carrying thousands of passengers and numerous small tour boats visit the fjord daily, ferrying tourists right up to the glacier’s calving face. Had the Venture been up the fjord, instead of at its mouth, the wave would have been “unsurvivable,” Dr. Higman said.
Increased cruise-ship tourism to glacial fjords, and more oil and gas exploration in the Arctic, mean “we, as a global society, are putting more infrastructure and people in harm’s way,” said Dan Shugar, a University of Calgary geomorphologist and the study’s lead author.
Scientists at the U.S. Geological Survey and its state counterpart in Alaska look for slopes along the vast coastline that are moving toward collapse, using satellite radar and optical imagery. Because resources are limited, only Barry Arm is monitored in real time, with on-the-ground scientific instruments. Detailed assessments of a handful more moving slopes are underway in Glacier Bay National Park, which is also frequented by cruise ships.
Dr. Shugar said Tracy Arm “throws a wrench in” the strategy of looking for slope deformation “because it happened, as far as we can tell, without much warning.” Scientists were unable to detect any deformation in the slope before the collapse.
But when Dr. Caplan-Auerbach dug deeper into the seismic data from the landslide, she noticed patterns of land movement similar to those that she had studied for decades, which sometimes preceded landslides on volcanic slopes.
These tremors were “probably tiny bits of slip on the base of the landslide, and it can do that only so much before it’s got to break apart and fall,” she said. Tiny coalescing fractures within the mountain eventually reach a crescendo, a threshold at which point the rock can no longer hold itself together, and the slope gives way.
It is not yet clear how many landslides display these seismic signals as precursors, but since there were no other cautionary signs, they provide a hope of early warning. If the signals are subtle — the slopes “whispering to us, not yelling,” as Dr. Caplan-Auerbach put it — it is possible the seismometer network in Alaska is spread too thin to typically pick them up.
“The bar is, can we do better than missing most of these,” said Noah Finnegan, a geomorphologist at the University of California, Santa Cruz, who was not involved in the study. “So getting a handle on why these precursors happen and what their relationship is to catastrophic collapse is an area many people are interested in.”
Last month, three cruise lines notified customers that their ships would not visit Tracy Arm this year, opting instead for nearby Endicott Arm and Dawes Glacier. “That’s probably a wise move, but there’s no reason why Endicott is any safer than Tracy,” Dr. Shugar said.
Stephen Hicks, a seismologist at the University College London and an author on the study, said the planet is entering a new era when warming has penetrated geology.
“When we think about climate change, we think about impacts in the atmosphere and rising sea levels,” he said. “We sort of look up and across, but we don’t often look down,” he added, but now “the ground has moved beneath all our feet.”
Many open questions remain. But among the biggest, Dr. Higman said, is whether we can expect a significant increase in such events as a result of climate change, as some studies suggest.
“If it’s a dice you roll every 50 years, well, maybe that’s all right,” he said. “But if it’s one you’re rolling once or twice a year, then this is really, really urgent.”
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