Healthcare debate: Dental care lacking for millions
Millions of Americans have no dental insurance and haven't seen a dentist in years. The new legislation will be no remedy.
It began with a toothache. Tori Pence, 23, could feel the hole that had suddenly developed on her tooth, and she couldn't stand either hot or cold food. The bespectacled girl with electric-blue hair had worked a string of odd jobs and hadn't seen a dentist for at least five years.
When she finally got in to see one, she needed a root canal. And fillings for 15 cavities.
"Dentally speaking, I am healthy now," says Pence, who lives in Lansdowne and has been making monthly visits to the University of Pennsylvania's dental clinic for almost a year. "But I still have seven more [cavities] to go."
Pence is one of the estimated 132 million people in the United States without any sort of dental insurance. It's an endemic problem among the unemployed, the poorly paid, and those without medical insurance.
While the national health-care act passed in spring will increase the number of people eligible for medical insurance, its effects on dental will be mixed.
The law increases coverage for children, and will eventually cover more adults under Medicaid, the joint state-federal health plan for the poor. But adult dental services are often hard to find: Less than one-third of dentists in Pennsylvania and New Jersey participate in Medicaid.
Many people don't see the value in preventive dental care - or they dread it - and postpone routine checkups. That is, until it becomes too painful to chew or a front tooth is chipped.
In Philadelphia, geriatric dentist Ann Slaughter says many elderly patients she has examined at inner-city senior centers haven't seen a dentist for up to 15 years.
But "oral health is intimately connected to overall health," she says.
Periodontal disease can cause or worsen heart conditions, strokes, and respiratory illness.
It can be perilous for diabetics. Germs from gum disease can make them more prone to complications, says Slaughter, an assistant professor at the University of Pennsylvania School of Dental Medicine and a member of the city Board of Health.
More than 200 diseases of the mouth can also cause problems elsewhere in the body. The plaque on teeth can travel into the blood and contribute to hardened arteries, a risk for heart attack.
In 2000, Surgeon General David Satcher called dental and oral diseases a "silent epidemic" facing the nation.
"We're in 2010, and we haven't made many advances," Slaughter notes. "That's the sad part."
One problem is the many gaps in dental insurance, which unlike medical insurance, was never intended to completely cover anything.
For those without insurance, the median price for a root canal in Philadelphia is $862, according to a survey that dentists use to price procedures. A crown can cost as much as $1,200.
And while 172 million Americans under 65 have private health insurance, just 45 million of them have any sort of dental plan, according to the National Center for Health Statistics.
In Pennsylvania, 40 percent of the entire population of adults and children lacks dental insurance, according to the Pennsylvania Dental Association.
Medicare has substantial holes as well. It covers health care for virtually all seniors and some younger people with permanent disabilities. But it doesn't pay for routine dental care.