SPECIAL REPORT: Focus on Healthcare
If the strident opposition to Obamacare has convinced you that medical professionals see no value in government involvement in healthcare, think again. TRUE talked to two representatives from the American Dental Association (ADA), both dentists, about what their organization would like to see the U.S. federal government and state governments do to help Americans get the dental care they need — and like Obamacare it involves ensuring better access, especially for low income people.
TRUE: Your organization helped write new legislation, the Action for Dental Health Act. What would you hope such a law could accomplish?
Charles Norman, DDS, ADA president: We’re trying to avert an impending dental care crisis in the country, based on some of these trends we’ve been seeing. Drops in utilization, drops in insurance coverage, an increase in disease risks among certain populations — we just felt like it was time for us to get the message out there that we’re looking at some problems ahead.
It’s not that much different from what we have been facing in medical care. For instance, in 2010, 2.1 million Americans, mostly adults, showed up in emergency rooms with dental pain — the vast majority suffering from preventable abscesses and cavities. They went home in most cases with some painkillers and still in need of a dentist because there wasn’t a dentist at the ER. The emergency room isn’t the place to treat dental problems but when people don’t go to the dentist, that’s where they too often end up.
We’re trying to accomplish three different things with Action for Dental Health. First, we want to make sure we can finance ways to get care to the people who need it most through programs like the ones we do through nursing homes and our mobile program Give Kids a Smile that goes out into the community to find underserved kids and provides free care. We’d also like to see more referral programs for emergency rooms so dentists can be on call, or we can create public or private clinics to work alongside ERs to treat the underserved.
Second, we’ve got to address the hole that has developed in our safety net that’s allowing the poorest to fall through and not get adequate dental care. You know Medicaid currently only spends about 2 percent of its funding on dental care. That’s not very much, especially when you consider it used to be 5 percent and when on average about 5 percent of the nation’s total health bill is spent on dental. Of all of the federally qualified health centers in the country that serve the Medicaid population, only a very small percentage even has a dental component. Most of them are medical. And the ones that do, well, many find themselves underfunded.
We’d like to see states correct that problem, and we’ve been working with some — Missouri, for instance, recently changed its Medicaid to include adults. And there are other barriers — administrative ones that make it unnecessarily complicated for dentists to participate in Medicaid and the Children’s Health Insurance Program.
Finally, Action for Dental Health wants to start a new push for prevention. We want to re-emphasize prevention, early intervention, and education in communities so that we can avoid disease. Literally, 90 percent of dental disease is preventable. And if we prevent it we can keep costs down and most importantly keep people healthy. This component calls for a push to fluoridate water systems, more public education and the creation of more community dental health coordinators to help connect people with dental resources.
Sally Cram, DDS, ADA spokesperson: Many dentists would like to care for Medicaid patients. The statistics show they have unused capacity in many offices. But in most states, Medicaid doesn’t cover adult dental services, and where it does, reimbursement rates don’t even cover a dentist’s overhead costs. That’s the kind of policy that leads to more people in emergency rooms with dental problems that are totally preventable in the first place with regular dental care.
Not too long ago, Connecticut increased its Medicaid reimbursement rates so they were closer to private, and the number of participating dentists went from 200 to 1,800. The result — children on Medicaid began to see dentists once a year, and at a rate that was even higher than kids on private insurance.
TRUE: Does the public understand the importance of dental care?
Norman: While the majority of the population understands the importance of oral health from a cosmetic standpoint, I’m not sure they understand it from a disease standpoint. A significant percentage of the population doesn’t understand that bacteria that build up in your mouth from tooth decay and infections in your gums are part of the disease process and can affect other parts of your body and chronic conditions like diabetes. For instance, there have been some studies connecting low birth-weight babies and periodontal disease in their mothers. I think that’s the part that’s hard for folks to grasp or it’s the part that’s not discussed enough. The mouth is the gateway to the body, and what gets in through there can make it to other parts of the body and can affect your ability to eat healthy foods and even get jobs because the way you look affects your confidence.
Cram: In the past, teeth have been kind of expendable. You lose a tooth it’s not that big of a deal. It’s not life threatening. But as we all live longer, being able to consume the right diet, enough fiber becomes increasingly important. If you’re missing teeth, you obviously are limited in the kind of food that you can eat. There may be limited research that directly connects dental health and longevity, but given the importance of nutrition for older people, it’s clear teeth play a role.
Norman: Over the past 10 years we’ve seen a disturbing decline in the percentage of young adults, for instance, going to the dentist for annual checkups. We’ve seen a decline in general. So while dental health has been helped by more people getting their children to brush twice a day, floss and the fluoridation of the water, you still need to see the dentist regularly and get teeth cleaned professionally to really keep both teeth and gums healthy. Our studies estimate that maybe only half of the adult population gets to the dentist once a year, and that number needs to be higher.
TRUE: What do you think has reduced the number of Americans getting to the dentist annually?
Cram: People’s spendable dollars, after their rent, their food and those kinds of things, have been falling so the money they have available to go see the dentist is also less — especially if they’ve been out of work for a long time. It’s really kind of astounding. In 2010, we estimated that as many as 181 million people hadn’t gone to a dentist for at least a year. To me, as a periodontist, it’s particularly frightening because the statistics say 50 percent of adults over 30 years old have some sort of periodontal disease, but anecdotally I can tell you it’s probably even higher than that.
Norman: During that same 10-year period when we saw millions not going to the dentist, we have also seen a drop in the number of people with traditional dental insurance. We haven’t done research but there is a likely correlation between that reduction in the number of covered lives during that same period of time and visits to the dentist.
TRUE: Only about three-fourths of the country on public water systems has access to fluoridated water. Given how long we’ve been fluoridating, why isn’t it 100 percent?
Norman: The reasons are different for different communities. Sometimes it has to do with cost. I know places where they are defluoridating because their equipment is old and they don’t want to replace it. Sometimes a water system is under the control of two jurisdictions. As part of the Action for Dental Health, we’d like to see fluoridation increased from 75 percent of the U.S. population on public water systems to 80 percent by 2020.
Cram: The Centers for Disease Control and the World Health Organization have called fluoridation one of the greatest advances for public health of the 20th century. The science is there; it’s a proven health benefit. But there are many complicated reasons why everyone in the country doesn’t have access to fluoridated water — some relate to cost, others to politics and jurisdiction and some is just pure ignorance.