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Health & Medicine

The Decay of our Dental Care System

— September 16, 2016

In 2007, 12-year-old Deamonte Driver died from a preventable brain infection. The Maryland youth suffered from a tooth infection that spread to his brain after his family, who had difficulty finding a dentist who would take Medicaid before their coverage lapsed, was unable to afford dental care. After Deamonte’s death, then-Maryland governor Martin O’Malley introduced reforms that improved access to dental care for children in his state. Despite Maryland’s success story, there is a cavity in the dental care system for many Americans, especially the poor, rural, and minority populations. Solutions to this problem have been less than effective.

The separation of dental from regular medical care goes back a long time. Until the 1800s, dentistry was part of the barber’s profession. Because medicine was a high prestige profession, and barbers were thought of as hacks who performed amateur bloodletting and minor surgery along with their shaves and haircuts, the attitude that these were two separate concerns persisted. Dental students weren’t generally admitted to medical schools for ages, and dental care was left out when the public health system was created in the 1960s. It’s still very rare to find dental care as part of a medical insurance plan, and even though there are some dental insurance plans available via the exchanges created by the Affordable Care Act, they are not mandatory for adults. While the ACA made children’s dental health an “essential benefit” that insurers must cover, once you’re 18 you’re on your own, like a punch in the teeth.

Since most of the jobs created during the “recovery” from the 2007 recession are low-paying service jobs, often part-time in order to avoid having to offer benefits, dental insurance is often one of the first benefit expenses foregone when trying to keep a family or household afloat. Uninsured adults who need dental care have few decent options. Free weekend dental clinics held in school auditoriums attract not only needy locals, but people from several states away who are willing to drive for hours and wait in line with hundreds of others for basic services like fillings and extractions that they could not otherwise afford. Another option is to travel out of the country and pay a fraction of the cost for dental services in places like Mexico or Costa Rica – if you can afford the time off work, transportation, and other expenses. Dental schools with students who need to practice on patients is another option, if you don’t mind being a guinea pig, with the work sometimes being worth exactly as little as it cost. There are also dentists willing to put in some hours towards pro bono work for the poor in their communities, but charity waxes and wanes and should never be considered a real, permanent solution to systemic problems.

Dentists, for their part, have usually gone deeply into student debt in order to obtain their degrees, and they have expensive office equipment and overhead, which is why dental care is so expensive to begin with. (This is one more argument for socializing the expense of college.) There are also lesser-trained “dental therapists” who can perform very simple dental procedures in places where dentists are unavailable or too expensive, but they are likelier to be found in urban and suburban areas (just like regular dentists) while the people most in need of their services are usually rural, and have bigger problems than dental therapists can handle. While patients may turn to Medicaid, especially for their children, it’s hard to find a dentist who accepts it because Medicaid reimbursements are too low to cover the cost of the procedures. For-profit storefront dental mills have also sprung up to court families whose Medicaid won’t buy them a dentist or who make too much money to qualify for Medicaid but not enough to afford dental care on their own. Unfortunately, some of these outfits are also accused of “drilling for dollars,” performing unnecessary or even harmful procedures in order to pad the bill.

Are Dentists Drilling for Dollars? Inside Edition November 13, 2013. Courtesy of DTM

While salary-class people in wealthier areas who have decent dental insurance, perhaps provided or subsidized by their employers, might not perceive any problem at all with the American dental care system, it looks very different from the other side. Recommendations to “set aside a special dental care savings account so you’re not tempted to spend it on other things” sound a lot like privilege to people who have to pick and choose what bills to pay or whether they should buy food or gasoline to get to work. Based on 2011/2012 Federal data, for children living below the poverty line, 40% of 3-5 year olds, 69% of 6-9 year olds, and 74% of 13-15 year olds have measurable tooth decay, more than the children of more affluent families. According to the CDC, 25% of Americans 65 and older have lost their teeth, and one-third have untreated tooth decay. Poor dental health is linked to other problems, such as heart disease and diabetes, and in cases like Deamonte Driver’s, it can be fatal. Adults who are unable to access dental care can end up making expensive emergency room visits, taking on far more expense in the long run, and since these visits are usually preventable with proper care, arguably take needed resources away from people with traditional emergencies. Even missing a tooth carries a social and economic cost; a study by the National Bureau of Economic Research found that missing just one tooth can result in “an annual earnings loss of $720/year for a typical urban woman working full-time for a wage of $11/hour.” Unavailable, unaffordable, and sub-par dental care appear to be a driver of economic inequality as well as a way to make life more expensive and painful for poor, minority, and rural populations. Yes, the United States has the best health care in the world – for those who can afford to pay for it.

On other health-related fronts, those who suffer from alcohol addiction may benefit from the following resource, provided by a reader. It’s a UK-based site, but the information is universal.

Rehab 4 Alcoholism logo; image courtesy of
Rehab 4 Alcoholism logo; image courtesy of

Rehab 4 Alcoholism offers free support and help to people who suffer with alcohol and drug addiction. Rehab 4 Addiction offers free telephone assistance and also maintains useful resources and guides on its website.”


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