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NY Times article By Reed Abelson
Reposted by Certified Dentists Internationale’
With dental costs rising and employers cutting dental coverage, an increasing number of working Americans cannot afford to see a dentist even for chronic problems. If you need a full-mouth restoration, several root canals, 27 crowns or dental implants - most dental insurance won’t cover you.
During the Iraq war, some reservists and Guard members chose to have their teeth pulled so that they could be deployed, said Maj. Gen. Robert A. McIntosh,in testimony before Congress.
"Although promised restorative dental work, their reward for their loyalty and patriotism will be dentures," he said. Dental implants, a better alternative to dentures, are not covered because they are more expensive.
In a nation where a person's smile is considered a sign of general well-being and an important factor in landing a job, dental care is becoming ever more unequal, policy specialists say. In 2000, the Surgeon General issued a report describing the silent epidemic of dental and oral diseases.
Each year, Americans spend about $70 billion on dental services, ranging from basic checkups to sophisticated dental implants and new cosmetic whitening treatments. But for all that spending, what has evolved is a double standard of care, with the haves getting movie star smiles and the have-nots more likely to be living with mouths full of bad or missing teeth.
Only about half of the country has any form of dental insurance. Most employers do not offer the benefit, and dental coverage is often one of the first things companies cut to reduce costs.
Among the 45 million people without any health insurance, dental services -- costs have risen by about 50 percent in the last decade, above inflation -- is a low priority.
Despite significant strides in dentistry, more people are going without procedures like root canals and crowns needed to save their teeth.
Renée Iverson, a mental health care worker in Alexandria, Minn., for example, could not afford a root canal, which would have cost her at least $1,000, to save a painful abscessed tooth. When she got together enough cash, $120, to have her tooth pulled, the dentist she saw refused, telling her it would be unethical to extract a tooth that could be saved.
"You're kidding, right?" Ms. Iverson recalls saying to the dentist. She eventually went to a hospital emergency room for antibiotics and pain medicine, and had the tooth pulled two years later by another dentist, who has since retired.
"The safety net is uniquely weak in dentistry," said Dr. Burton L. Edelstein, professor at Columbia University Medical Center. The realities of dental care also reflect shifts in the health system overall as more uninsured people turn to emergency care to manage illnesses that were allowed to worsen over time.
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| Patient without funds or insurance pulled 13 of his own teeth |
One factor contributing to low public funding is the perception among some policy makers that oral health is separate from overall health, but doctors and dentists say that diseased teeth and gums contribute significantly to many other medical problems, like heart disease.
Pregnant women with periodontal disease, for example, appear to be significantly more likely to give birth to low-weight babies because the resulting inflammation may contribute to premature labor. "If we could just get good oral health in this country, we can save a ton on the Medicaid system," Dr. Haught said.
As a result, many people without access to dentists eventually end up in hospital emergency rooms, said Ms. Nolte of Fargo. She noted that local hospitals said they received about 1,400 visits for dental services. But hospitals are often poorly equipped to handle these patients because they have no dentists on staff and can only offer temporary solutions like antibiotics and painkillers. "It seems barbaric," she said. "We're pulling teeth and calling it a service."
As for reservists returning to civilian life, they may well find themselves with missing teeth or problems that worsened during their service overseas. Many may end up on waiting lists at community clinics, with the problem of paying for dental services just as severe as before they left.
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Editor's comments:
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