Healthcare Without Teeth - OZY | A Modern Media Company
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Because a lack of dental health care can end in ER visits and high bills, just like any other medical problem.

By Anne Miller

The U.S. could use a Tooth Fairy. 

Just as a slight irritation can explode into a root-canal crisis, experts are increasingly sounding the alarm over Americans’ lack of access to basic dental care. It’s the hole in the new Affordable Care Act: The so-called Obamacare includes dental coverage for kids, but adults are on their own. 

And we’re not talking about fancy whitening procedures. Unchecked tooth decay can end in the emergency room and cost the nation billions of dollars in health care — all for lack of a reliable twice-a-year cleaning. Sen. Bernie Sanders (D-VT) said at a hearing in September that dental-care bills are second only to prescription medicine costs when it comes to out-of-pocket expenditures. 

How big is the problem? 

181   million Adults who did not visit the dentist in 2010, according to the American Dental Association

830,590   Americans who were treated in emergency rooms for preventable dental issues in 2009, according to the Pew Charitable Trusts

Dr. Frank Catalanotto is chairman of the Department of Community Dentistry and Behavioral Science at the University of Florida and an advocate of better national dental insurance coverage. Some states offer coverage through local Medicaid programs, he says, but not all. 

“The patient gets dental disease,” says Catalanotto, “and that disease progresses until it causes a body infection.” That eventually triggers an emergency room visit, with pain medication and an antibiotic script and instructions to visit a dentist. But many patients never see a dentist, and the ER visits become cyclical.

“They will take antibiotics and get better, and a couple weeks later it will occur again,” Catalanotto says. 

How yawning is the coverage gap?

In September, the U.S. Government Accountability Office released a report on dental care in America, noting that:

42 percent  Adults who had dental problems and did not see a dentist because they couldn’t afford to or didn’t have insurance, according to 2008 numbers.

26 percent  Average hike in out-of-pocket costs for dental care from 1996 to 2010 ($520 to $653). That percentage includes adjusting for inflation and includes Americans with and without dental insurance.

Many reports site state, not national numbers, when it comes to the cost of those ER visits. But those state costs offer an indication of the size of the problem. 

$88 million  Cost of dental-related ER visits in Florida in 2010 for 115,000 patients

$23 million  Cost of dental-related ER visits in Georgia in 2007 for some 60,000 patients

Do we need more dentists?

Government reports found that 45 million Americans live in an area with a shortage of dentists. Meanwhile less than 20 percent of Americans age 75 and older have dental care, despite the increased likelihood of advanced dental needs, according to the advocacy group Oral Health America

The ADA maintains that the answer isn’t more dentists but rather more dentists participating in Medicaid — and more outreach for education and prevention. ”We have 40 percent of our members who have excess capacity and they could treat more patients,” says Dr. Charles Norman, president of the American Dental Association. “We really need to find out what the barriers are.” 

Even people who have dental insurance don’t always use it, Norman says. And Medicaid has become so unwieldy, and pays doctors so little, that many dentists don’t accept the relatively few patients who have that coverage.

”We have a great system in place,” he says, ”but unfortunately they’re often not funded properly and because of that they don’t operate efficiently.”

Meanwhile Sanders and a fellow Democrat, Rep. Elijah Cummings of Maryland, have introduced bills to expand dental coverage throughout the United States. 

The bill includes starting a special training program for dental therapists, who would play a roll similar to physicians assistants in doctor’s offices. But the ADA is against that idea, saying what’s needed isn’t more staff but more outreach (a stance that some advocacy groups, and Dr. Catalanotto, disagree with). 

Of course, that could be a moot point. As the federal government struggles to implement the sweeping new health-care changes, there’s little sense that leaders are going to jump at the chance to expand that right now. Emergency rooms, brace yourselves.

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