Nothing to Smile About: The Inequality Gap in Dental Care

By MIKE KUHLENBECK

The sad state of dental care in the United States is nothing to smile about.

The American Dental Association, celebrating its 160th anniversary this year, paints an optimistic picture: “Many Americans today enjoy excellent oral health and on keeping their natural teeth throughout their lives.”

There is another picture, one most people cannot bear to look at. The “Medicare for All” debate rages on, meanwhile oral health and access to affordable dental care are important aspects that have been neglected or left out of the discussion completely.

As with other forms of healthcare, dental care is costly and inaccessible to millions of people. In 2016, over 74 million Americans did not have dental insurance, according to the National Association of Dental Plans.

Employers are not legally required to provide dental benefits to employees. They tend to hire people as cheaply as possible, offering a few benefits to appear “competitive” while exploiting the knowledge that potential applicants will concede certain benefits in order to be hired, including dental coverage.

The American Dental Association conducted a survey in 2015 which found the top reason for adults not visiting the dentist was due to cost, with 59 percent of respondents showing unwillingness or inability to pay regardless of coverage. Dental work is regarded as a secondary concern compared to paying for food, shelter and other immediate necessities.

The second reason was because respondents were “afraid of the dentist.” It is unclear if this refers to “Dental fear” (the fear of seeing dentists), or fear rooted in financial anxiety. Fear of escalated costs, fear of being unable to pay, fear of accruing or compounding debts, etc. When money is tight, dental bills can be terrifying.

The price range for six of the most common dental procedures (based on the 2018 “ADA Health Policy Institute Survey of Dental Fees”) are as follows: Cleaning, $70-$170; Cavity filling, $105-$718; Root canal, $613-$1895; Crown, $394-$1650; Extraction, $116-$900; and Sealant application, $39-$95. Some of these can be costly even with dental insurance.

Most dental plans resemble capped discount programs rather than healthcare services, especially when it comes to anything outside of routine cleanings, covering only a fraction of the cost. If patients require further treatment or referrals to specialists they are expected to grit their teeth and empty their savings.

The third reason respondents gave was not being able to find a convenient location or appointment time. It is often difficult to schedule appointments which do not clash with working hours. People worry about their wages being docked or even being fired, so they do not take the chance by taking the time off work.

In the eyes of many employers, dental work is perceived as merely “cosmetic” or done for reasons of vanity. This perception ignores that a wide range of diseases can result from lack of treatment including increased risks of cardiovascular disease, osteoporosis, diabetes and other illnesses.

Oral health is important to overall health, but those without means go without care. Between 2011 and 2014, over 31% of adults aged 20-44 and children aged 5-19 had untreated “caries” or cavities, according to the Centers for Disease Control.

Left untreated, decay and gum disease can cause teeth to break, fall out or warrant extraction. Some issues build up to such a devastating point where other teeth are compromised and topple like dominos. Replacements such as dentures and implants are luxuries beyond the realm of the average person’s budget.

As noted by the ADA’s Health Policy Institute, “Low income adults are more likely to report having problems due to the condition of their mouth and teeth.”

These problems can take a serious toll on mental health and quality of life for the afflicted. 39% of low income adults surveyed by ADA said “life in general is less satisfying due to the condition of their mouth and teeth” and 38% of low income young adults shared this view.

Medicare, created to aid senior citizens and those with disabilities, excludes dental coverage, “leaving beneficiaries at risk for tooth decay and periodontal disease and exposed to high out-of-pocket spending,” a report from 2012 concluded.

This report found, “The average total cost for dental services were $427 per year, three-quarters of which is paid for out-of-pocket.”

Due to the high cost of coverage, scores of young adults visit hospitals desperately seeking relief from toothaches, as reported in a 2015 study by The Journal of the American Dental Association.

“In 2009-2010, 42% of the people who went to emergency rooms with toothaches were aged 20-29” because most ERs “have a legal mandate or mission to offer treatment regardless of someone’s ability to pay.”

There are few places to turn when searching for other ways to obtain treatment without being ruined financially, and the options currently available are dead ends.

One alternative frequently touted is Medical Tourism, where people travel to other countries for procedures that would cost a fortune if performed in the US. However, this is not a practical solution for those living paycheck to paycheck, comprising roughly 78% of the workforce.

Those who can barely afford everyday expenses cannot afford airline tickets, rental cars, lodging and accompanying costs if they can’t afford basic procedures or take time off work in the first place. Those who cannot travel long distances due to health reasons are also excluded.

Occasionally towns are visited by mobile dentists who provide low-income communities with free check-ups and services, particularly rural areas where providers are scarce. These opportunities are rare, patient outreach is limited and do not help when surgery or prolonged treatment is needed.

For-profit dental care is an abscess on the oral health of the US. It has failed workers, the unemployed, the impoverished and millions of other human beings. This form of passive callousness in an era where tremendous wealth is being amassed from suffering is a symptom of a society in decay.

Without guaranteeing the right to affordable care, expanding public access and education to bridge the widening inequality gap, millions more will suffer in silence.

Mike Kuhlenbeck is a journalist based in Des Moines, Iowa. Email writermikekuhlenbeck@ gmail.com

From The Progressive Populist, May 15, 2019

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