Older adults are living longer and retaining their teeth, resulting in a concomitant increase in the need for oral care services. Despite improvements in oral health among the elderly, there continue to be profound disparities by race/ethnicity, socioeconomic and dentate status. Furthermore, challenges, such as limitations in activities of daily living, poor wheel-chair accessibility of dental clinics, poor geographic distribution of providers, difficulty navigating the oral health system and fiscal limitations make access to, and utilization of, dental services difficult among older adults. While dialogue around national policy, especially incorporation of dental benefits for adults in Medicare and Medicaid, is imperative, local efforts in New York and Northern Manhattan show promise in addressing the oral health and health care of older New Yorkers.