It’s the day after Halloween. Do you know where your toothbrush is?
Hopefully, after all that candy, a brush is all you need. For many, however, the situation will be worse. Last year, emergency dentist visits on Halloween were 80% higher relative to an average October day, according to a survey by Sikka Software, a software company used by more than 13,000 dentist offices across the country.
But for many, even an emergency visit is out of the question. A third of the US population, by some calculations, doesn’t visit a dentist simply because they can’t afford to pay, and untreated tooth decay remains the most common chronic illness affecting schoolchildren. It’s hard to overestimate the value of that toothbrush. Especially in light of this weekend’s candy influx.
The Affordable Care Act, AKA Obamacare, opened up discussion over access to healthcare in the United States, but dental care was largely left out of the debate, even though untreated dental problems not only cause pain and, ultimately, tooth loss, but have broader medical consequences. Untreated periodontal disease can send bacteria into the bloodstream with scary results: studies show individuals with periodontal disease are 2.7 times more likely to suffer a heart attack and three times more likely to have a stroke.
In one particularly horrifying case, a 12-year old boy, Deamonte Driver, died when bacteria from an abscessed tooth spread to his brain. The boy’s mother – all of whose children were plagued by dental woes, and who relied on Medicaid – couldn’t afford the cost of an $80 extraction.
Obamacare has managed to cut the rate at which Americans are without health insurance to less than 10% – and increased access to basic healthcare in the process. True, expanding Medicaid’s “benchmark benefits” for new recipients means that millions of children will at least be eligible for dental care for the first time, if they can find a provider willing to accept the low reimbursement rates that Medicaid allows.
Even if you do have insurance, some of the most generous plans around cap annual benefits at around $2,500 a year. Someone with even mild to moderate dental problems – a few root canals, one crown, and a handful of fillings – could chew through their benefits midway through the year, and already be several thousand dollars out of pocket, thanks to co-pays. That’s why it’s entirely possible to find people with jobs – and even with dental insurance – who still can’t afford healthy teeth, if they’re playing catch-up.But about 40% of Americans don’t have any dental insurance at all, and about 40% of all dental spending comes from patients’ pockets. If you do have dental insurance, the National Association of Dental Plans says there’s a 99% chance it is provided by your employer. And its benefits are going to be skewed heavily in favor of those with good dental health already: a typical plan tends to fully reimburse individuals for routine cleanings, and cover 80% of the cost of fillings. More complicated procedures, such as root canals or crowns, which can cost thousands of dollars apiece and which are more common among people suffering from dental problems, are only covered at a rate of 50%.
Adding to this mess is the fact that, like healthcare, the world of dental care is plagued by a lack of transparency when it comes to pricing. One 2013 survey of dental care affordability and accessibility found that in the Los Angeles area, prices for some common procedures varied by an average of 384%, and that 25% of dentists wouldn’t disclose prices to prospective patients over the phone before the latter scheduled an appointment. Nor did the survey find any link between the price that a patient pays and the treatment’s outcome.
The icing on this unpalatable cake? It’s a kind of toxic spiral. The more dental problems someone has, the worse their teeth look. That, in turn, affects their ability to earn a living. With a bright smile – featuring white, even teeth – viewed as a key trait for all job applicants, anyone with broken or missing teeth or visibly in need of dental care is at a disadvantage, and shunted off into less well-paying non-customer service jobs, in the same way that overweight women find themselves relegated to behind-the-scenes and less well-paid positions.
As it turned out, the president was only able to push through a partial version of healthcare reform, one that excluded dental care for all American adults, even those on Medicaid. Gladwell’s article, however, reminds us that successful preventive programs, in dental health just as much as in healthcare, end up saving the system money in the long run. Had there been some way to finance an $80 extraction, it wouldn’t just have saved Deamonte Driver’s life, but also the $250,000 cost of the last-minute attempts to save him, including two operations and six weeks in the hospital.Bad teeth, wrote Malcolm Gladwell inan article for The New Yorker, have become “an outward marker of caste”. In a piece written before the passage of Obamacare, Gladwell cites a passage from a book by two Harvard University researchers, Uninsured in America. What, its authors questioned interviewees, would be the first thing they did if President Obama succeeded in establishing universal healthcare coverage? Their priority, the answers came, was their teeth.
It’s long past time for someone to attempt for dental care what Obamacare has done for medical care, given the scope of the problem – thousands of people routinely show up at open clinics organized by dental charities, and that’s just the tip of the iceberg. The fact that private equity firms now view dental care as a big and profitable business, and are hunting for dentists who want to sell their practices, serves as another red flag: with dentistry being less regulated than medicine, they see opportunities to drive profit margins even higher. That could spell more bad news down the road for those in need of dental treatment, if it ends up reducing the already too-few number of dentists, especially those working in high-demand areas or willing to take on Medicaid patients or those with intractable problems.
Democratic presidential candidate Bernie Sanders has discussed some of these issues, but even his report on what he calls a “dental crisis” doesn’t mention many problems. For instance, while someone without access to a physician can reasonably expect – as a last-ditch solution – to get help at a hospital emergency room, in the vast majority of cases, all most ERs are able to do for dental patients is hand out antibiotics and painkillers. They don’t have dentists on call or dental facilities to treat patients who need, say, an emergency root canal.
Volunteer efforts to address the crisis are great – free clinics, discounted care provided by dental schools, individual dentists who are willing to treat individual patients pro bono or by greatly discounting their rates. But as one critic has pointed out, these efforts don’t always match where the need is greatest, andcan’t be counted on to provide ongoing care.
Hence, the toothbrush. Which, of course, stands for preventive care in general. According to one survey, 17% of those with dental insurance say they haven’t made a single visit to a dentist in the last year; 19% of those with dental insurance have never used it to obtain preventive care. If the first time you visit a dentist is when you’re already experiencing pain, then there’s a problem. And yet even those with insurance reported having one major unmet dental need.
We can push for well-trained mid-level dental providers – akin to physicians’ assistants – to perform more routine procedures, like the kind of extraction that would have saved Deamonte Driver’s life. The American Dental Association opposes this, despite what is widely acknowledged to be a problem with access to this kind of basic dental service nationwide – and the fact that preventive care of this kind is precisely what is most needed.
And we can all realize that dental care and healthcare are inextricably linked. Gobbling up all that Halloween candy isn’t just going to add some unwanted pounds to your frame – making your doctor scowl at your next checkup – but it’s going to boost the risk that you’ll end up on the road to dental problems. That will make it more likely that next Halloween’s chills won’t come from that scary late-night horror flick on Netflix, but from learning the dentist’s estimated cost of providing the services you need to hang on to your teeth.
Source: http://www.theguardian.com/us-news/us-money-blog/2015/nov/01/dental-care-insurance-halloween
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