Washington Post
May 23, 2013
From Washington Post:
“I eat on one side. I can’t chew, you know, because the teeth are very weak.”
I’ve researched various issues at the boundaries of public health and poverty policy. One basic issue seems to always lurk: bad teeth. I can’t count the times this health problem has come up when I’ve talked with a homeless person, someone with a mental health or substance use disorder, or someone who is simply quite poor. When I meet people who have gotten past a bad patch in their lives, their dental problems — including missing teeth or yellowed gums — still need treatment, stigmatizing reminders of what these people otherwise had left behind.
The populations most affected by dental health issues are sadly familiar. According to the Florida Dental Care Study, “African Americans and persons of lower [socioeconomic status] reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them.”
Let’s put it simply: Over a four year period, respondents with incomes below the poverty line lost three times as many teeth as those with higher incomes.
Access problems have worsened during the great recession, as states and localities curtail Medicaid and non-Medicaid oral health services. Here in Illinois, Medicaid for adults doesn’t cover regular cleanings, and no longer covers routine care such as dental X-rays, filling of cavities, or root canal surgery. You can get an emergency tooth extraction; that’s about it. California and many other states enacted similar policies. State cuts in the adult Medicaid program have put severe pressure on federally funded health centers and dental education institutions; they can no longer afford to provide previous level of care and cross-subsidized services to uninsured adults.
You might wonder what you would do if you were uninsured or on Medicaid and you woke up with a piercing toothache. I wondered that, too. So I called Dr. Mona Van Kanegan, a public health dentist who provides safety-net care at Chicago’s Heartland Alliance. Her answer wasn’t reassuring:
Most people with a dental emergency live with the pain for months or even years. Some self-medicate, and when they can’t bear it any longer, they go to the ER. Most ERs do not have the ability to provide definitive oral health treatments, and the best that they can do is provide pain medication and antibiotics. The person may also be given a phone number of a community clinic where they can receive further care. If the person cannot find affordable care in their community, they may repeat the ER cycle again and again.
Unfortunately, these glaring issues went virtually unaddressed in the health reform measure. Pediatric dental services are covered in Medicaid. They are also essential health benefits within the new health insurance exchanges. The Affordable Care Act also provided resources for Federally Qualified Health Centers. That was helpful. Yet adult dental care was otherwise barely mentioned in ACA.
