Science
The L.A. wildfires left neighborhoods choking in ash and toxic air. Residents demand answers
Nearly two weeks after the Eaton fire forced Claire Robinson to flee her Altadena home, she returned, donning a white hazmat suit, a respirator and goggles.
The brick chimneys were among the few recognizable features of the quaint three-bedroom 1940 house neighboring Farnsworth Park. Nearly everything else was reduced to ashes.
The scorching heat melted the glass awards her daughter had received for her theater performances, leaving behind deformed globs of crystal. Where her washer and dryer once stood, Robinson found only a blackened metal frame. The flames even managed to consume her cast-iron bathtub.
“The screws were the only thing that didn’t vaporize,” Robinson said after she scoured through the debris. “Everything else is in the air.
“How do we live in this highly toxic environment and make sure that people aren’t being sent back to their homes prematurely?” she said. “Families are just being told, ‘You’re clear to go in.’ They’re calling us and saying, ‘Is it safe?’ I’m like, ‘I don’t know.’”
Claire Robinson wears a protective suit while inspecting the ruins of her home, which was destroyed in the Eaton fire in Altadena.
(Ryan Ihly)
Tens of thousands of wildfire survivors, including Robinson, have returned to ash-cloaked neighborhoods, even as serious questions about what could be lurking in the debris remain unanswered.
Environmental regulators and public health officials have warned survivors that fire-damaged neighborhoods are probably brimming with toxic chemicals and harmful substances, such as brain-damaging lead and lung-scarring asbestos fibers. Air monitors have measured elevated levels of heavy metals miles downwind of the wildfires.
However, despite the dire warnings from environmental and health officials, fire officials and law enforcement have decided to reopen large swaths of the evacuation zones before disaster personnel could sweep residential communities for some of the most dangerous materials — such as firearm ammunition, propane tanks, pesticides, paint thinner and car batteries.
The EPA’s hazardous waste cleanup was initially projected to last three months. Earlier this week, President Trump signed a federal directive to shorten the cleanup time to 30 days, prompting EPA officials to increase the number of personnel and teams assigned to the hazmat response, and accelerate the process.
Meanwhile, the Army Corps of Engineers’ debris removal was expected to take 18 months. After Trump’s recent visit to L.A., the Army Corps now says it can be done in a year.
“Once a crew shows up to a property, depending on the complexity of that site, it can take two to ten days to clear the debris from that site,” said Col. Eric Swenson of the Corps. “It just really depends on how fast we get those rights of entry.”
As the monumental work of cleaning up the burned zones begins, Robinson and others say they would like to have clearer guidance and support from government agencies to keep people safe from toxic materials.
I think it’s unbelievable that people are being told just to go ahead and go back in.
— Claire Robinson, Altadena resident
Robinson said she thinks it’s alarming that many people have been returning to their destroyed homes without wearing protective gear, and have not been adequately warned about the risks as they begin to clean up their contaminated properties.
“We know that it’s all combusted, and it’s all in the air — metals, plastics. I think it’s unbelievable that people are being told just to go ahead and go back in,” Robinson said. “There’s a lack of coordinated, comprehensive expert response.”
This week, officials from the federal Environmental Protection Agency supervised specialized crews as they began collecting these substances, the first step in what is expected to be a yearlong, multibillion-dollar cleanup and recovery.
As of Wednesday morning, the EPA-led personnel had conducted preliminary surveys of about 2,500 of an estimated 14,500 fire-damaged properties. These crews have been collecting and removing hazardous waste only since Monday. After two days, they had cleared a total of three homes — marking the properties with laminated placards fixed on wooden posts.
A sign indicates EPA contractors have cleared out hazardous materials at a property in Altadena.
(Christina House / Los Angeles Times)
“As places were being [reopened], we had to take a different strategy,” said Harry Allen, an on-scene coordinator for the EPA. “Most fires, we haven’t had [people returning] this early. Because we’re in L.A., it’s really important that people are able to return. … So in this case, as Cal Fire lifted evacuation zones, we said, ‘Let’s get in there, let’s do recon as quickly as we can in advance of repopulation.’”
In California, where electric vehicles and plug-in hybrids make up more than one-quarter of car sales, the U.S. EPA has had to exercise extreme caution around an estimated 1,000 fire-damaged, lithium-ion car batteries — perhaps the most ever damaged by a wildfire. These batteries — also used in e-bikes, scooters and small electronics — have been known to ignite, explode or release toxic gases when exposed to extreme heat or fire.
It’s probably going to be the biggest lithium-ion battery removal activity that’s taken place in this country, if not the world.
— Steve Canalog, deputy incident commander for EPA Region 9
“It’s probably going to be the biggest lithium-ion battery removal activity that’s taken place in this country, if not the world,” said Steve Canalog, deputy incident commander for EPA Region 9, who has overseen cleanups of wildfires, floods, earthquakes and chemical spills.
“Just the high heat can damage the integrity of these battery systems, and they become very unstable and have the risk of spontaneously catching on fire and exploding,” Canalog said. “We have to treat them as unexploded ordnance.”
Because of the risk, EPA personnel transport each battery individually to processing areas. The batteries are often soaked in a saltwater bath to drain the remaining power, and are eventually shredded and taken to recycling facilities.
Hazmat crews typically hear popping and hissing sounds from damaged lithium-ion batteries. In neighborhoods where homes are only a few dozen feet apart, the EPA is telling residents that they should maintain a football-field-length distance from such batteries to avoid injury.
“At the end of the day, you can’t put out a lithium-ion battery fire. It burns so hot and energetically, and you can’t put it out with water or sand or fire blankets. The firefighting strategy is just to let it burn,” Canalog said.
On Wednesday morning, EPA-contracted crews fanned out across a fully razed block in Altadena.
Personnel wore white hazmat suits, blue latex gloves, black sunglasses and respirators as they navigated around a burned-out panel van and blackened metal bed frame. The workers sifted through the ash and debris left in the footprint of a house on Pine Street with shovels and hand tools until they discovered hazardous waste.
An EPA contractor looks for hazardous materials at a home in Altadena.
(Christina House / Los Angeles Times)
One worker carefully held the charred remnants of an iPhone between his index finger and thumb, gently placing it into a black trash bag held by a colleague. Soon after, another approached with his hands full.
“These are all batteries,” he said as he dropped about 20 scorched cylinders into a 5-gallon bucket one by one.
Earlier in the week, another crew extracted a lithium-ion battery from the husk of a Tesla sedan next door. They placed fire-damaged compressed-gas tanks in a row on the front lawn and marked each canister with a white “X,” an indication the fuel had already been burnt.
The EPA has been gathering EV batteries and other hazardous materials found on wrecked properties and moving them to two processing areas: a site near Topanga Beach, where the Santa Monica Mountains meet the Pacific Ocean, for Palisades fire debris; and a site in Lario Park near the foothills of the San Gabriel Mountains in unincorporated Irwindale for Altadena waste. There, EPA crews sort the materials before they’re transported to landfills — exactly where is still unknown.
The decision to stockpile hazardous waste in Lario Park sparked swift backlash from residents and public officials. Four nearby cities — Duarte, Azusa, Irwindale and Baldwin Park — have lodged official complaints arguing that transporting hazardous substances 15 miles outside the Eaton fire and into a popular recreation area poses a risk to thousands more.
“The wildfires that have ravaged Los Angeles County must be cleaned up, but I cannot understand how trucking hazardous waste through so many vulnerable communities, and placing near homes and schools, is the best possible option,” said Michael Cao, mayor of Arcadia, another city near the site.
The EPA has not responded to the complaints, but agency officials said its crews have installed liners to prevent toxic chemicals from leaching into soil. They will also conduct soil testing after their work has concluded.
The EPA’s hazardous waste removal alone is expected to take several months. Once that work is completed, the U.S. Army Corps of Engineers will step up for the second phase: the removal of ash and debris from properties whose owners have signed up for free cleanup, which is expected to take up to 18 months. Property owners can also opt to hire specialized private contractors if they choose to pay the cost themselves.
Although the smoke and ash from any wildfire are considered harmful, urban wildfires are especially dangerous. The smoke and ash from structures and cars can contain more than a hundred toxic chemicals and poisonous gases, according to state officials. Perhaps the most notable is lead, a heavy metal — which has no safe level of exposure for anyone, and which can permanently stunt the development of children when inhaled or ingested.
During the 2018 Camp fire in Paradise, elevated levels of airborne lead lingered for longer than a day. The metal-infused pollution traveled more than 150 miles and was measured as far away as San Jose and Modesto.
On Jan. 7, as the L.A. County wildfires broke out, air samples measured “highly elevated levels” of lead and arsenic over a dozen miles downwind of the Eaton fire, according to the South Coast Air Quality Management District. The highest concentration was recorded in Vernon, about 13 miles southwest.
Wearing protective gear, Eaton fire victim Ian Crick and his friend Matt Listiak search for keepsakes and valuables at his burned-out home in Altadena.
(Allen J. Schaben / Los Angeles Times)
Separately, a Los Angeles-based air quality monitor supported by federal funding showed that hourly measurements of airborne lead spiked on Jan. 8 and 9, when smoke from the Eaton fire cast a pall from Altadena to San Pedro.
As the Eaton fire approached the home of Felipe Carrillo, he urged his wife and two children to evacuate while he stayed behind to protect the home with a garden hose fitted with a high-pressure nozzle. For hours, Carrillo said, he tried to defend their home by preemptively spraying water onto the roof and later extinguishing small fires sparked by the onslaught of wind-driven embers.
By the next day, his was one of the few homes left standing on the block. It wasn’t until a week later that it dawned on Carrillo that he should also be worried about the smoke and toxic chemicals he was exposed to in the overnight firefight — which he waged without any protective gear.
“In that moment, it was fight or die,” Carrillo said.
After things calmed down, he went to see a doctor, who monitored his breathing for any signs of fluid buildup.
“They told me, you know, unfortunately, there’s no way of knowing any effects that may linger from the fact that you fought a fire without a mask or anything,” Carrillo said.
Ahead of the recent rainfall, Carrillo returned to the house to put sandbags around the perimeter of his property to keep ash from drifting onto the property. He’s also temporarily moved his family out of Altadena out of worry that his 14-year-old son and 10-year-old daughter could inhale the same toxic chemicals that he may have already been exposed to. In addition to the recent strong winds that have whipped up dust, Carrillo fears the ensuing cleanup will also kick up contaminants.
Army Corps of Engineers officials said they would spray water and mist on wildfire ash and debris to reduce the risk of airborne contaminants during their cleanup, but Carillo remains concerned.
“What about these dust storms that they’re gonna cause?” Carrillo said. “Let’s say my kids are in the backyard playing football and this big bulldozer kicks up a lot of dust and my kids inhale it?”
Some of the most concerning toxic contamination could be from older buildings. Lead-based paint and asbestos-containing construction materials were commonly used in homes until they were banned in the late 1970s. About 86% of the buildings near the Eaton fire, and 74% near the Palisades fire, were built before 1980, according to Cal Fire.
For Jane Williams, executive director of the nonprofit California Communities Against Toxics, the copious amounts of ash and rubble hearken back to the aftermath of the Sept. 11 attacks on the World Trade Center. In the months that followed, first responders and residents were exposed to a hazardous mix of asbestos, silica dust, heavy metals and other dangerous substances.
As the years passed, many of those affected by the devastation at Ground Zero were diagnosed with long-term health issues such as asthma, diminished lung function and other respiratory problems.
Over the course of January 2025, Williams watched in dread as social media videos and news coverage emerged showing Southern California residents whose homes had been destroyed sifting through the rubble unmasked.
This is the disaster after the disaster.
— Jane Williams, executive director of California Communities Against Toxics
“It’s exactly what happened with the Twin Towers,” Williams said. “This is the disaster after the disaster. Tens of thousands of people will go back to their properties, and most of them will not wear masks.”
At this point, little is known about the contaminants lingering in the wildfire ash in Altadena and Pacific Palisades. The August 2023 fire in Maui similarly incinerated residential communities composed largely of older housing. After that wildfire was quelled, experts found that ash contained a myriad of heavy metals, including lead, arsenic, copper and cobalt.
The L.A. fires have also led to concerns about water contamination. Water districts in Altadena and the Pacific Palisades/Malibu area have issued “do not drink” advisories for some areas. Suppliers that manage these water systems are assessing impacts of the fires, making repairs and testing for contamination.
According to the State Water Resources Control Board, these advisories “were issued as a precautionary measure until the condition of the system could be determined.” That said, the board’s website also notes that while building materials can contain chemicals that may contaminate water runoff from burned areas, this generally does not affect drinking water supplies, which are protected from exposure as long as infrastructure wasn’t directly damaged.
Completing the extensive cleanup efforts in the burned areas of L.A. will probably take years. In the meantime, residents — not just in the neighborhoods that burned but those nearby too — wonder how to protect themselves.
For example, Garo Manjikian evacuated from his Pasadena home with his wife and three children as the Eaton fire exploded. The family returned to find their house and garden covered in a layer of ash.
They spent days cleaning the house; washing their clothes, bedding and rugs; and throwing away pillows that had absorbed smoke. Manjikian said he hosed ash off the roof and out of the gutters, and power-washed the outside walls. Inside, he used the power washer and a shop vac to clean out ash that had collected in the windowsills.
I decided to just do everything I can myself to remove the ash.
— Garo Manjikian, Pasadena resident
“I decided to just do everything I can myself to remove the ash,” said Manjikian, who rented three industrial air purifiers and ran them in the house for about a week. “I still don’t for sure know how toxic it still might be in the house, but at this point, there is no more smell of smoke.”
But fine ash continued to float down, coating the house and the yard. Manjikian and his wife have been urging their three sons, the oldest aged 8 and the twins aged 5, not to play outside. And when they do have to leave the house, the boys are getting used to wearing masks again, like they did during the pandemic.
An EPA contractor looks for hazardous materials at a home in Altadena.
(Christina House / Los Angeles Times)
Manjikian has heard that some homeowners, schools and businesses have been paying for lab tests out of their own pockets to determine what types of contaminants need to be cleaned up. He said it would be helpful if the results of those tests could be made available for him and others who might have been exposed to hazardous waste.
“If they do the testing and find out there’s toxic material there, that would be good information for the neighboring houses to have, whether it came back positive on the toxic particles or negative,” Manjikian said.
For Robinson, the Altadena resident whose home was destroyed in the Eaton fire, the disaster has brought multiple layers of grief and unanswered questions.
Robinson is the founder of Amigos de los Rios, a nonprofit group, and already knew the importance of wearing protective gear to guard against hazardous materials during river cleanups and park construction projects.
When she returned to inspect the ruins of her home, as well as the group’s nearby office, which also was destroyed, she and her husband spent about $250 at a hardware store buying two disposable coverall suits, nitrile gloves and leather gloves to go over them, plus multiple packages of goggles, booties and N100 masks.
Robinson said she thinks L.A. County officials should be doing much more to help residents understand the risks and to protect themselves. Residents shouldn’t be left in the dark, she said, about how much danger they might encounter as they sift through the ashes.
“I would expect there to be a much more concerted, organized, comprehensive effort to share information,” she said, and also to provide protective gear for those who can’t afford to buy it.
Robinson is also concerned about the health effects. Recently, she has had difficulty breathing unlike anything she remembers. At times, she feels tightness in her chest, and experiences a fit of coughing and wheezing.
She said it’s crucial that as others return to inspect their devastated neighborhood, they take measures to protect themselves.
“I’m less concerned about looting,” Robinson said, “than I am about people being exposed to these things and facing short, medium and long-term health impacts.”
Times staff writer David Zahniser contributed to this report.
Science
Mobile clinic brings mammograms to women on Skid Row
Sharon Horton stepped through the door of a sky-blue mobile clinic and onto a Skid Row sidewalk. She wore a yellow knit beanie, gold hoop earrings and the relieved grin of a woman who has finally checked a mammogram off her to-do list.
It had been years since her last breast cancer screening procedure. This one, which took place in City of Hope’s Cancer Prevention and Screening mobile clinic, was faster and easier. The staff was kind. The machine that X-rayed her breast was more comfortable than the cold hard contraption she remembered.
Relatively speaking, of course — it was still a mammogram.
“It’s like, OK, let me go already!” Horton, 68, said with a laugh.
The clinic was parked on South San Pedro Street in front of Union Rescue Mission, the nonprofit shelter where Horton resides. Within a week, City of Hope, a cancer research hospital, would share the results with Horton and Dr. Mary Marfisee, the mission’s family medical services director. If the mammogram detected anything of concern, they’d map out a treatment plan from there.
Naureen Sayani, 47, a resident of Union Rescue Mission, left, discusses her medical history with Adriana Galindo, a medical assistant, before getting a mammogram on last week.
(Kayla Bartkowski / Los Angeles Times)
“It’s very important to take care of your health, and you need to get involved in everything that you can to make your life a better life,” said Horton, who is looking forward to a forthcoming move into Section 8 housing.
Horton was one of the first patients of a new women’s health initiative from UCLA’s Homeless Healthcare Collaborative at Union Rescue Mission. Staffed by third-year UCLA Medical School students and led by Marfisee, a UCLA assistant clinical professor of family medicine, the clinic treats mission residents as well as unhoused people living in the surrounding neighborhood.
The new cancer screening project arrives at a time of dire financial pressures on county public health services.
Citing rising costs and a $50-million reduction in federal, state and local grant and contract income, the Los Angeles County Department of Public Health on Feb. 27 ended services at seven of 13 public clinics that provide vaccines, tests and treatment for sexually transmitted diseases and other services to housed and unhoused county residents.
Although Union Rescue Mission’s own funding comes mainly from private sources and is less imperiled by public cuts, the 135-year-old shelter expects the need for its services to rise, Chief Executive Mark Hood said.
Even as unsheltered homelessness declined for the last two years across Los Angeles County, the unsheltered population on Skid Row — long seen as the epicenter of the region’s homelessness crisis — grew 9% in 2024, the most recent year for which census data are available.
For many local women navigating daily concerns over housing, food and personal safety, “their own health is not a priority,” Marfisee said.
Those whose problems have become too serious to ignore face daunting obstacles to care. Marfisee recalled one patient who came to her with a lump in her breast and no identification.
In order to get a mammogram, Marfisee explained, the woman first needed to obtain a birth certificate, and then a state-issued identification card. Then she needed to enroll in Medi-Cal. After that, clinic staff helped her find a primary care physician who could order the imaging test.
Given the barriers to preventative care, homeless women die from breast cancer at nearly twice the rate of securely housed women, a 2019 study found. Marfisee’s own survey of the mission’s female residents found that nearly 90% were not up to date on recommended cancer screenings like mammograms and pap smears, which detect early cervical cancer.
To address this gap, Marfisee — a dogged patient advocate — reached out to City of Hope. The Duarte-based research and treatment center unveiled in March 2024 its first mobile cancer screening clinic, a moving van-sized clinic on wheels that it deploys to food banks and health centers, as well as to companies offering free mammograms as an employee benefit.
“In true Dr. Mary fashion, she saw the vision,” said Jessica Thies, the mobile screening program’s regional nursing director. After working through some logistical hurdles, the mission and City of Hope secured a date for the van’s first visit.
The next challenge was getting the word out to patients. Marfisee and her students walked through the surrounding neighborhood, went cot to cot in the women’s dorm and held two informational sessions in December and January to answer patients’ questions.
At the sessions, the team walked through the basics of who should get a mammogram (women age 40 or older, those with a family history of breast cancer) and the procedure itself. (“Like a tortilla maker?” one woman asked skeptically after hearing a description of the mammography unit.)
The medical students were able to dispel rumors some women had heard: The test doesn’t damage breast tissue, nor do the X-rays increase cancer risk. Others questioned a mammogram’s value: What good was it knowing they had cancer if they couldn’t get follow-up care?
On this latter point, Marfisee is determined not to let patients fall through the cracks.
Thirteen patients received mammograms at the van’s first visit on Wednesday. Within a week, City of Hope will contact patients with their results and send them to Marfisee and her team. She is already mentally mapping the next steps should any patient have a situation that requires a biopsy or further imaging: working with their case manager at the mission, calling in favors, wrangling with any insurance the patient might have.
“It’ll be a good fight,” Marfisee said, as residents in the adjacent cafeteria carried trays of sloppy joes and burgers to their lunch tables. “But we’ll just keep asking for help and get it done.”
Science
Can fire-resistant homes be sexy? ‘You be the judge,’ says this Palisades architect
At first glance, it looks like nothing more than a charming Spanish-revival, quintessentially Californian home — but this Pacific Palisades rebuild is constructed like a tank.
Every exterior wall of the steel-framed home is a foot-thick, fire-resistant barricade. The home is connected to a satellite fire monitoring service. Should a fire start in town, sturdy metal shutters descend to cover every window. An exterior sprinkler system can pump 40,000 gallons of water from giant tanks hidden behind the shrubs in the property’s yard. If the cameras and heat sensors around the house detect danger, the system can envelop the home in over 1,000 gallons of fire retardant and hundreds of gallons of fire-suppressing foam.
Palisades resident and architect Ardie Tavangarian is so confident in his design that he even asked the fire department if they could start a controlled fire on the property to test it all out. (They said no.)
Tavangarian built a career designing multimillion-dollar luxury homes in Los Angeles, but after the Palisades fire destroyed 13 of his works — including his family’s home — he found another calling: how to design a house that can handle what the Santa Monica Mountains throw at it. And how to do it quickly and affordably.
Water tanks form part of a backup water supply in a newly built fire-resistant home in Pacific Palisades.
“Nature is so powerful,” he said, sitting on a couch in the new house, which he built for his adult twin daughters. “We are guests living in that environment and expecting, ‘Oh, nature is going to be really kind to me.’ No, it’s not. It does what it’s supposed to do.”
Tavangarian watched the Jan. 1 Lachman fire from his property not far from here; a week later that fire rekindled, grew into the Palisades fire, and burned through his house. But the painful details of the fire — the missteps of the fire department, the empty reservoir — didn’t matter when it came to deciding how to rebuild, he said. The reality is, many fires have burned in these mountains. Many more will.
A sprinkler on the roof is part of a house-wide sprinkler system.
For the architect, who has spent much of his 45-year career designing for luxury, hardening a home against wildfire has brought a new kind of luxury to his homes: peace of mind.
It’s a sentiment that resonates with fire survivors: Tavangarian says he’s received considerable interest from other property owners in the Palisades looking to rebuild their houses.
The metal shutters and advanced outdoor sprinkler system are the flashiest parts of Tavangarian’s home hardening project, and the efficacy of these adaptations is still up for debate. Because the measures have not yet been widely adopted, there are few studies exploring how much or little they protect homes in real-world fires.
Architect Ardie Tavangarian inside the house he designed.
Anecdotal evidence has indicated the effectiveness of sprinklers can vary significantly based on the setup and the conditions during the fire. Extreme wind, for example, can make them less effective. Lab studies have generally found shutters can reduce the risk of windows shattering.
These measures aren’t cheap, either. Sprinkler systems can cost north of $100,000, for example. However, Tavangarian said when all was said and done, the home he built for his daughters cost around $700 per square foot — less than what Palisades residents said they expected to pay, but more than what Altadena residents expected for their rebuilds.
Tavangarian also hopes to see insurers increasingly consider the home-hardening measures property owners take when writing policies, which he said could potentially offset the extra cost in a decade or less. As he explored getting insurance for the new home, one insurer quoted him $80,000 a year. After he convinced the company to visit the property, it lowered the quote to just $13,000, he said.
The house includes metal heat shields that can drop down if a fire approaches.
The home also has essentially all of the other less flashy — but much cheaper and well-proven — home hardening measures recommended by fire professionals: The underside of the roof’s overhang is closed off — a common place embers enter a home. The roof, where burning embers can accumulate, is made of fire-resistant material. The windows, vulnerable to shattering in extreme heat, are made of a toughened glass. There is virtually no vegetation within the first five feet of the home.
When asked if he felt he had compromised on design, comfort or aesthetics for the extra protection — one of the many concerns Californians have with the state’s draft “Zone Zero” requirements that may significantly limit vegetation within five feet of a home — Tavangarian simply said, “You be the judge.”
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
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