Addressing Inequality in Dental Care
By Albert B. Kelly
When we think about issues like inequality and how it shows
itself in our nation, I don’t know anyone who thinks of it in the context of
dental health. After all, unless they hurt, who thinks about teeth? Yet dental
and oral health, or lack of it in some quarters, is a very serious thing.
If you doubt that, consider that there are still children in
this country die each year from abscessed teeth that lead to broader infections
all because their families are uninsured, can’t afford treatment, don’t have
access to dental care, or some combination of all of these.
To be truthful, I did not think about the issue at all until
a professional acquaintance shared a book he had just finished entitled “Teeth”
by Mary Otto. This particular book
touches on a number of topics, but what stuck out was just how separate the
area of dentistry and oral health is from the rest of medicine.
This “separateness” is a large part of the reason that the
poor, children, the elderly, and lower middle class routinely walk around in
pain with toothaches, abscesses, rotting gums, and damaged teeth.
This “separateness” is why most employer-sponsored dental
plans are often afterthoughts with high co-pays and deductibles. It is why most
dentists, upwards of 65% according to some studies, won’t take Medicaid
patients because of low reimbursement rates.
The real money is in cosmetic treatments: porcelain veneers,
shortening, reshaping, bleaching, crowns, and gum contouring. If you have
decent credit, you can get a medical credit card that lets you do long-term
financing of whatever cosmetic procedure you’re after.
But cosmetic procedures and dental credit cards aside, think
about the last time you had a toothache. If you’re like me, you were able to
focus on nothing but the pain. As much as we might try to ignore it, there was
little no eating, no sleeping or much of anything else.
Yet this silent epidemic of bad oral health is what the poor,
lower middle-class, many children, and many elderly live with every day. The
sad part of all of this is that many of the problems could be avoided with
regular preventative care.
The book highlights the tip of this iceberg. In 2007, a 12
year-old Baltimore child, Demonte Driver, died from problems that came about
from an untreated abscessed tooth. In
2011, a 24 year-old Ohio man named Kyle Willis died of the same thing.
While the problem impacts minorities at a high rate, this is
not about race or ethnicity, this inability to pay and lack of access can be
found in inner cities, in Appalachia, in the nation’s nursing homes and
everywhere in between.
It can get costly in other ways as well. Otto’s research
shows that ER visits for dental issues doubled in the decade from 2000 to 2010
with upwards of 4 million visits to the ER that cost the health care system
$2.7 billion- something for pain and an antibiotic, no actual dental care. It
also cost 100 lives.
In NJ, the statewide “go to” for those in need is NJ
FamilyCare which is state-funded, but only a small number of the state’s
8,000-plus dentists accept the plan which includes Medicaid- it doesn’t help
that NJ reimbursements rates are among the lowest in the country.
Locally, Gateway teams with Complete Care, as we have for
some time, to provide services- currently with the help of the Inspira Health
Network Foundation, we’ll be putting a new fully equipped tooth mobile on the
road to serve children and youth in the community. This is in addition to
Complete Care’s clinic helping adults.
While the tooth mobile is one way to help, another approach
might include allowing dental hygienists to set up independent practices and
bill Medicaid directly- even if confined to basic care in places like schools
and nursing homes, it will help vulnerable populations get preventative care.
Another possibility might be to grant dentists a fair amount
of student loan forgiveness for taking on a set number of Medicaid patients. Dentists
carry around $200k or more in student loan debt just to earn the credential- this
could help.
Over time, various pieces of legislation have been put
forward to address the problem in NJ. One bill called for having a State Dental
Director and an Oral Health Commission. While that bill was vetoed, it may well
be time to revisit this under the next governor.