Thinking about Teeth

New Orleans   Maybe it’s personal. Several weeks ago, I had a root canal. It’s shocking how much those bad boys cost, and talking to a friend in the northeast, he had to pop for another $500, so I guess it’s time to stop my whining.

On the doors last week though it wasn’t personal. One of my comrades cracked wise, as we were debriefing, that we needed to keep some kind of teeth-to-tattoo count in order to figure the ratios. I laughed then, but the next day in Akron the first three doors my team hit, the count was zero teeth on the first two (with some tattoos!) and ten or so in the front on the third door with three or four tats.

Why don’t we do better in making sure low and moderate income families have dental care?

Reading a newly published book by Mary Otto called Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, provided chapter and verse while detailing one horror story after another of death and debilitation in lower income communities. Here are some startling facts from Otto’s book:

· For reasons including poverty, isolation, and the lack of private insurance and providers available to treat the poor, roughly one-third of the people living in America face significant barriers to obtaining dental care
· More than 35 million poor children are entitled by federal law to dental benefits under Medicaid, but more than half go without care. Fewer than half the nation’s roughly one hundred fifty thousand working dentists participate in the program.
· Approximately 49 million Americans live in communities that are federally designated as dental professional shortage areas.
· Private and even public dental benefits can help defray the cost of services. But more than 114 million Americans lack them entirely
· Among U.S adults who struggled with unpaid medical bills, 12 percent reported dental bills made up the largest share of the bills they had problems paying, a 2015 survey found.
· Medicare, the nation’s health care program covering roughly 55 million elderly and disabled Americans, does not cover routine dental services.
· Nationwide, a total of 61,439 hospitalizations were primarily attributed to periapical abscesses during the nine years between 2000 and 2009.
· In 2013, only 35 percent of private practice dentists reported treating any patients on public assistance, down from 44 percent in 1990, a separate ADA survey of dental practices found
· one-third (31 percent) of white toddlers and primary school–aged children (aged two to eight) have decayed teeth, the disease afflicts closer to half of black and Hispanic children (44 percent of black children and 46 percent of Hispanic children). And minority children are twice as likely as white children to go without treatment for the decay.

You get the message. Otto’s book makes it clear that the dentists bear a huge share of the responsibility here. They make more per hour than doctors. They have fought allowing dental hygienists doing more, including in public schools. They recommend costly procedures, rather than sealants. They opposed expansion of dental benefits in the original Medicare legislation. They drug their feet until the 1970s to integrate their state associations and, as you can see, they still do not provide service equitably to non-whites or those on public assistance.

How are they allowed to get away with this?

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