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When pain drove Tori Pence to a dentist, she found she had 15 cavities. Penn´s dental clinic has been filling them, at a reduced rate. (Clem Murray/Staff)
When pain drove Tori Pence to a dentist, she found she had 15 cavities. Penn's dental clinic has been filling them, at a reduced rate. (Clem Murray/Staff)
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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.

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Posted 07:11 AM, 07/26/2010
It is not the responsibility of the American taxpayer to provide health/dental insurance to anyone.
Posted 08:10 AM, 07/26/2010
How to the medical plans in Canada, Europe, Cuba, Japan and other industrialized countries and areas handle dental care? What is the dental health picture for citizens there? How are dentists paid there? A followup story is clearly due here.
Posted 08:28 AM, 07/26/2010
How do the medical plans in Canada, Europe, Cuba, Japan and other industrialized countries and areas handle dental care? What is the dental health picture for citizens there? How are dentists paid there? A followup story is clearly due here.
Posted 08:46 AM, 07/26/2010
Dental care is just as important as ordinary healthcare. Many diseases and infections originate in the mouth.
Posted 08:54 AM, 07/26/2010
Jen D
Poor dental health is strongly connected with poor birth outcomes, including low birth weight and premature labor. (Google it or look on By giving pregnant women dental care, many dollars spent on a preemie baby could be avoided.
Posted 08:57 AM, 07/26/2010
Jen D
One thing I have never understood: My health insurer won't cover dental work. But if I can't afford dental work, and end up with an abscess that becomes sepsis or a brain infection, they will pay for me to spend days or weeks in the hospital. Does that make sense? Not to me it doesn't. Teeth are as much a part of the body as kidneys, and yet health insurers have weaseled out of paying for dental care. How did that happen? And don't get me started on why health insurers think eye exams that might prevent me from falling should not be covered.
Posted 11:22 AM, 07/26/2010
How is it that this girl could afford a bunch of tatoos, but not a trip to the dentist? I do agree that dental care and health care are the same thing, but they could have found a better poster child than someone who pays to make herself look unemployable.
Posted 11:50 AM, 07/26/2010
If society can't come together and provide reasonable dental care to its citizens than what is society for?
Posted 12:59 PM, 07/26/2010
This article is a long one so I will have to read the rest of it later. BUT. Excellent for covering dental as an important part of the healthcare story. I could hardly believe the food fight over health reform ended without any discussion about dental. The only time I saw it mentioned on tv was when Wendell Potter publicized the fact that volunteer healthcare "expeditions", which we expect to see in developing nations, were happening right here in America because the need is so strong despite our status as most wealthy nation. The images depicted urgent dental services provided in the open air ( Dental care IS healthcare and that's an important message. So I hope this is just the beginning. We're not done with health reform and dental deserves its time in the spotlight.
Posted 01:01 PM, 07/26/2010
I have an idea...brush your teeth and floss! Whatever happened to personal responsibility?
Posted 01:10 PM, 07/26/2010
Maybe the young lady needs to stop paying for tattoos and green hair dye, and start saving for dental care.
Posted 01:56 PM, 07/26/2010
Dartvader, I agree, Tattoos are not cheap and hair dy is a once a month process. Money spent on vanity instead of health care!! I have not had dental insurance since 2005 but good oral hygine and regular cleanings are much cheaper than tatoos and filings.....
Posted 02:20 PM, 07/26/2010
So this writer belives that Obamacare wasn't comprehensive enough? At the rate Obama and the Dems are going its better for me to be unemployed. Why work for a living and earn benefits? Just leech off of society. Obama will provide.
Posted 03:10 PM, 07/26/2010
Tattoos she can afford, dental care she can't. Why do you expect responsible people to pay for this dope's out-of-whack priorities?
Posted 03:12 PM, 07/26/2010
Judging by this girls picture, if all she has is cavities, she's way ahead of the game. More free stuff, drill sergeant , more free stuff.
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