Dental Health and Access to Dental Care
Oral health is an integral part of general health and well-being. Good oral health and freedom from oral pain and infection substantially contribute to quality of life and self-esteem. Poor oral health, on the other hand, is an obstacle to good nutrition, can severely affect people’s ability to carry out the normal activities of daily life. It is also a risk factor for such major systemic diseases as coronary heart disease. The oral health of Americans has improved greatly over the past 50 years, but there are areas where severe oral health problems remain. Experts estimate that as many as 42 million Americans have no insurance coverage for dental care, and low-income families that have some type of health insurance still find it difficult to obtain quality health care (Summary…). Many people in America without insurance do not see dentist on a regular basis and have poor oral health which can lead to poor overall health (A Solution…).
Constant pain from decaying teeth can make a good night’s sleep impossible, causing adults and youths to be irritable and too tired to concentrate at work or school. Gum disease (It is also called periodontal disease and is defined as the inflammation of the structures that surround and support the teeth) can make it painful to chew or eat certain foods (Gum Disease). People with severe dental disease, such as untreated abscesses, can wind up with a deformed jaw or chronic halitosis (bad breath). These last two conditions can additionally cause embarrassment and low self-esteem, make a person less apt to socialize; and more apt to stay isolated – and, in general, just feel miserable.
Community health centers (CHCs) are one of the sources of health care for low-income consumers. CHCs provide health care to low-income families, particularly the uninsured. They are typically private, nonprofit, consumer-directed health care corporation that provides comprehensive primary and preventative care to medically underserved people (Program…). I work as a Dental Assistant for one of these Community Health Dental Clinics in Everett. Many people that are seen at our clinic tell about their experiences of how extremely difficult it is to find a dentist who’d ‘fit their pocketbook’ or take Medicaid. One mother of a Medicaid insured child recently told us: “I could not get a dentist who would take Medicaid. I got the phone book and went through about 20-30 dental offices, and no one wanted to take Medicaid. I just gave up. I didn’t know what to do. My child was in severe pain day and night, and I simply couldn’t help him.” Another single mom of three kids said: “This one dentist did take our insurance for low-income families but one day we received a bill for a huge amount that I wasn’t able to pay off with my little child-support money I was getting from the State. I called our dentist to find out what was going on, and they simply told me that procedures that my children received at their office were not covered by Medicaid, and the only thing they could help with is let me make payments for the next 12 months”. Hundreds of other people such as seniors, students, unemployed, homeless and other come to our clinics in severe pain, dangerously swollen in their face and neck seeking urgent emergency care. They live with infection and pain that could have been easily avoided with proper dental care. Many of them don’t have jobs, homes, or income. They look everywhere for help. They call number of places with the same question: “Do you take Medicaid?” or “Do you provide emergency dental care for no-income people?” And when we give a positive answer, there is a long silence and suddenly a burst of questions “Do you really?”, “Are you sure?” and a big relief in their voice like people which finally found what they were looking for.
To change this situation, US health departments (such as American Dental Association, the U.S. Public Health Service, the American Medical Association and the World Health Organization), instead of calling for more investment in Medicaid, all too frequently seek the cheap and easy “fix” – water fluoridation (Fluoridation Facts). In such campaigns, the challenge of finding the much-needed government funds for strengthening Medicaid is usually ignored. This is, of course, probably one of the attractions of water fluoridation – no difficult budget decisions – simply add an inexpensive chemical (inexpensive because it’s a hazardous industrial waste product) to the water, and presto – the poor can enjoy the dental care they wouldn’t otherwise receive. In a sense, water fluoridation has become a substitute for dental insurance. Perhaps this is one of the reasons why Western Europe hasn’t felt as compelled as the US to fluoridate their water – because most of these nations have universal health insurance (Improving…). As a result, poor children do not have the same kind of difficulty finding dentists who will treat them. Of course, just because fluoridation is cheaper and easier for government, doesn’t necessarily mean that it is an effective substitute for dental insurance. Indeed, there would be a good discussion to be had, were fluoridation a safe and effective means of reducing dental decay in the poor.
What can we draw from this? Well, for one thing, people in the United States without dental insurance don’t go to the dentist on a regular basis. Another way of putting it is that the people who regularly go to the dentist have dental insurance.
It seems as if the insurance industry is responsible for getting more people into our offices. They have really done a good job of convincing the working people that dental benefits are very important. The large employers of our country have been convinced by the insurance industry that dental benefits are important to a well balanced health care plan for their employees. They have been told that unless they have a dental plan in their health care package that they won’t be able to attract the better qualified employees. Whether or not you accept these opinions the facts seem to point out that the insurance industry has done more to get people into our offices than ALL of our “organized” efforts. In my opinion the insurance industry has become the most powerful force in the economics of our profession.
Another fact that we all must understand is that the vast majority of patients out there look for a dentist who will “work with” their insurance ( accept the assignment). The patients that can afford to pay the entire dental fee and wait to have their insurance company reimburse them are few and far between. Even patients that could afford to pay without insurance will go out of their way to find a dentist that will work with their insurance. Of course there will always be the offices that will not accept insurance but it is getting harder and harder to do it. Whether the results of insurance invasion into our industry is good or bad is a topic for discussion but in my opinion there are many more positive results than negative. More patients are coming into our offices because they have dental benefits. People that don’t have dental coverage (very often low-income), don’t come to the dentist on a regular basis. These people come in usually with an emergency condition and if the aspect of dental coverage is looming on their horizon they will put off even emergency care in many cases. And that is due to high dental fees. Many low-income families forgo health care or rely on expensive emergency room visits for health care. This means they receive limited preventive care, obtain care only when health problems are acute, and have little continuity of care. It seems very unfair. People suffer because they do not have dental insurance. And they don’t have dental insurance because they need to feed their families and pay off bills. There is no money left to get insurance, therefore, they end up not seeing dentist on regular basis or not seeing him at all. I heard a lot of patients when in pain tried to pull their own teeth with some kind of pliers or other home tools. Some of them actually extracted their teeth but still ended up in dental chair. This time it was for left-in roots or severe infection. Others fill their teeth with different materials starting with over-the-counter temporary fill-ing material ending with gum and home-made wax and plaster. I wish our teeth were that simple to treat but they are not. More and more people suffer from dental problems but do not have resources to solve them. That is why some parents look at kids’ teeth as something that they are going to lose anyway by the time they are 9 or 10, so it doesn’t really matter if they don’t take care of them. But the fact is, it does.
All this explains why 75 percent of American adults have some form of periodontal disease – although the majority of them do not know they have it (Periodontal…). That’s because many oral infections and diseases are painless and silent in the early stages. And while daily brushing and flossing at home is important, it’s not enough. Periodontal disease starts below the gumline where toothbrushes and floss cannot reach. Only regular, professional cleanings done by licensed dental hygienists, in a dentist’s office, can keep dental disease under control. The more often you go to the dentist for cleanings, the easier each trip will be. If you keep your gums and teeth healthy and catch problems early, those problems will be easier to treat. It’s also during regular checkups or treatments for dental problems that signs of serious health problems can be detected or suspected — although conclusive diagnoses are generally made by physicians or other specialists.
The most common illnesses linked to oral disease are:
Oral cancer. More common than leukemia, and many other forms of cancer, oral cancer is frequently associated with long-term use of tobacco products and alcohol — although many people who’ve never smoked or drank develop oral cancer, too. Symptoms include mouth sores (often painless) that don’t go away. If caught early, oral cancer can be treated successfully more than 90 percent of the time. Untreated, it can spread into other parts of the body and become difficult, if not impossible, to treat. One of the most important parts of a regular oral health exam is a thorough oral cancer screening.
Heart disease. Cardiovascular disease affects 58 million people in the U.S. and kills almost a million people each year. Some studies show that patients with periodontal (gum) disease are twice as likely to develop heart disease. Bacteria from periodontal disease can enter the bloodstream and spread throughout the body, inflaming coronary arteries and causing changes in blood pressure, heart rate, heart function, and promoting blood clots, which can lead to heart attacks and strokes.
Diabetes. Periodontal disease is a major complication of diabetes. In fact, approximately 95 percent of Americans who suffer from diabetes also have periodontal disease. Research shows that people with periodontal disease have more difficulty controlling their blood sugar level.
Respiratory ailments. Respiratory diseases like pneumonia, bronchitis, and emphysema affect millions of Americans annually. Bacteria associated with periodontal disease can travel from the mouth to the lungs and lower respiratory system where it can lead to or aggravate respiratory diseases, especially in patients who already suffer from other diseases or conditions.
Premature and low birth-weight babies. Studies have found that expectant mothers with periodontal disease are seven times more likely to deliver premature, low birth-weight babies than women who don’t have the disease. Bacterial infections accelerate the production of labor-inducing fluids and can result in pre-term births.
Anyone who’s asking himself, ‘Should I go to the dentist?’ should remember this: With any health condition, the best medicine is preventive medicine. And when dental problems are found in the early stages, treatment is always easier.
Health care providers, program administrators, local, state, and government administrators, educators, scientists, and leaders, among others, have proposed ways of promoting health and preventing disease that respond to the principal health determinants presented in the chapter. Thus, efforts can be directed toward changing the environment to make it more life-enhancing; establishing new public health policies; enhancing health literacy to encourage healthy behaviors and lifestyles; working at the microlevel of neighborhoods and communities on health-related measures; and orienting health care to meet the needs of a changing society.
Building on programs and structures already in place that have contributed to the improvements in oral health is essential. Further advances in the oral health of all Americans cannot be made unless the health needs of the underserved and vulnerable populations are addressed. The inability of federal and state programs that are the primary source of funding for services to these populations, specifically, Medicaid, SCHIP, and Medicare, to cover and adequately reimburse for dental services has been duly noted. The current review of access to dental care by the Government Accounting Office should add to an earlier review of EPSDT and further address barriers to access and other issues that warrant attention. The Institute of Medicine (IOM) study on the extension of Medicare services to include medically necessary dental services is an additional source of recommendations to better address the health needs of vulnerable populations and enhance health overall (Field, et al.).
Ideally, organizations and agencies working together can resolve the issue of barriers to care. Concentrated efforts such as those focused on improving the access of children to Medicaid oral health services by the Health Care Financing Administration, Health Resources and Services Administration, American Dental Association, and National Center for Education in Maternal and Child Health are an example of how national organizations can unite to make a difference. Still, activities are needed at the local community level. In implementing these efforts, however, the capacity of current national, state, and local programs as well as legislative mandates to meet the oral health needs of all Americans must be reviewed and strengthened, as necessary.
States recognize that without access to ongoing health care, health problems may result in poor job performance and low job retention. In a 1997 survey, 48 percent of welfare recipients reported poor mental health or poor general health. By amending Section 1931 of the Social Security Act, the welfare law “delinked” Medicaid and welfare eligibility (Welfare Reforms…). Those receiving cash assistance are no longer automatically eligible for or enrolled in Medicaid. Moreover, a sizable number of welfare recipients find work in low-wage, entry-level jobs that rarely offer health insurance to employees, offer the benefit at premium rates the workers cannot afford, or offer coverage to the working parent but not other dependent family members. A 1996 demonstration found that less than half of all welfare recipients had jobs that offered health insurance (Welfare Reforms…).
States are taking steps to ensure that Medicaid-eligible families leaving welfare retain coverage and to make coverage available to other qualified, low-income families never in contact with the welfare system. They are changing administrative strategies and processes to better inform these families about Medicaid, help them enroll, and help them stay enrolled for as long as they qualify.
In conclusion, good dental care is important for your health and appearance throughout your whole life. Accidents can cause you to have to pay large dental bills, but even checkups may result in the discovery of poor dental health that needs immediate attention. Dental insurance takes that weight off your mind, knowing that you will not have to pay large dental expenses out of the blue, and knowing that your dental health care is in safe hands. Basic dental care should not be considered a luxury. Unfortunately, it has become a luxury many middle and low-income families cannot afford. Lack of work, low-income, and other factors can stop many people from enrolling into dental programs. There is a high percentage of unemployed people in our country who obviously can not afford dental insurance nor for their children nor for themselves. There is no simple, quick fix to this problem. States making comprehensive reforms to their health delivery systems show big improvements in the number of children receiving care. Increasing the number of school and community health clinics and mobile vans is another approach. Expansion of Medicaid coverage and improvement of access to dental care would be helpful, too, and could be accomplished by introducing more funding (to allow higher reimbursements so that more private dentists take more Medicaid patients), hiring new dentists and encouraging private dentists to treat more patients with Medicaid. Programs that would allow seniors and low-income families to purchase prescription drugs at the lower prices would be very beneficial, as well. There are a lot of unemployed people who should be considered, too. We probably could come up with some kind of a limited financial assistance to help pay for health coverage, which could provide them with short-term insurance at a minimal cost. These are just some of the effective ways to deliver services to the Medicaid and low-income patients but it will take a lot of time, thinking, and money to make them work. However, we see there are solutions for better oral health in our country. Dental disease is preventable, too. After the initial investment of treating the disease, it is relatively inexpensive to maintain healthy teeth through education and regular hygiene.
