Something NEVER talked about in the 'Health Care' debates is dental care.
Yet an astounding number of people simply can't afford to go to the dentist. Dental insurance is even rarer than Health Insurance.
People put off treatment for cavities until teeth rot. Bad teeth - which could have been saved if treated earlier - get pulled. Often the person pulling that bad tooth is the sufferer themself - or some friend. Get out the pliers.......Echoes of frontier 'dentisty' of 150 years ago.
I recall an article some time back noting that the condition of one's teeth said more about one's social position and class than anything else. A smile could reveal an impeccably white set of straight cavity free teeth - or empty sockets and crooked teeth. The image presented by people with truly bad teeth effectively keeps them out of certain jobs more than any lack of skill.
Bad teeth are a brand as clear as that left by a hot iron on someone's cheek.... people are marked as 'poor' - and often with that 'uneducated' or 'ignorant' or worse. The stereotypical 'Appalachian poor' is always marked by a toothless smile, right?
I'm ignoring of course the all too real pain and infections usually suffered by those with bad teeth.
I have some sympathy - and experience - in this area.
My own teeth were horribly crooked as a child. Really bad. My parents could not afford treatment - even after my mother went back to work. Plenty of kids at school had braces but they weren't cheap. Only the 'rich' kids had them - or so it seemed to me. I wasn't all that aware of our 'socio-economic' status as a kid but knew we sure didn't have what a lot of other people had. Didn't bother me - except when I didn't get that $29 'Fort Apache' set for Christmas one year. Hand-me-downs were a regular thing. Other kids went through the same. You had a pretty wide range of incomes in town. We were the 'blue collar' town between two really affluent ones. Westchester wasn't uniformly wealthy then (still isn't actually though it's gotten a LOT more expensive).
We were lucky. NY state had a program that paid for orthodontic work for those that could not afford it. You had to be pretty bad to qualify. I was.
One problem though. The state didn't pay all that much, and the amount was fixed. Orthodontists voluntarily took on the work but had a great incentive to get the job done as cheaply as possible - with not all that much 'checking up' as I recall.
Well, anyone with old metal band braces knows what a pain they were. I had them on for 6 years. It turned out that you're SUPPOSED to have them all removed at least once a year so teeth can be inspected and cavities filled. Braces are NOT easy to clean - making regular check-ups important. However removing these bands every year was time consuming and expensive (take them off and put everything back).... My orthodontist didn't do this..... I suppose my parents naively assumed that the orthodontist was paying attention to the rest of my dental health - though he was not.
When the braces finally came off my teeth were much straighter but all those rear molars (which had bands on for 6 years - and were really hard to clean) were full of cavities. I suppose in retrospect there were grounds for taking action against the guy but you didn't think that way back then - not looking for any excuse to sue, with lawyers more than willing to do so. My parents were simply thrilled that my teeth were straighter.
When I started West Point in '72 I remember being surprised at how many plebes were getting braces and how many spent so much time at the dentist. A lot of my classmates were there (as was I to a certain extent) because it WAS a free education - a form of indentured servitude actually costing 5 years of your life. Vietnam was still hot, Nixon actually ESCALATED while we were there..... (I resigned but that's another story). The Army was really good in making sure that future officers LOOKED like officers even if they came from a pretty deprived background. And the way things were at that point in time, USMA wasn't competing with the Ivy League.... Wouldn't surprise me today if many recruits for the Army spend a good amount of time at the Dentist making up for past neglect. Too many recruits are there because it's the only work they CAN get.
Moving on in time....
I paid for those long term consequences for years..... when first married, we were lucky enough to have an understanding dentist I could pay off in installments. He regularly repaired teeth that were falling apart - teeth that really needed crowns I could not afford. Those molars rotted in the center and from the sides - leaving four corners of tooth that regularly broke off - one at a time. Getting Wisdom teeth removed was more painful financially in my twenties - an oral surgeon was expensive. My plain old dentist tried to save us some money but the first one he tried would NOT come out and he had to send me off to a surgeon with the extraction undone to be completed. But there were still some real 'crunches' - we owed him $400 for too long a time when we simply didn't have any money for payments.
I can't imagine what I paid out every year in getting all those cavities redone and patched further........
We never did have any dental insurance - though I had decent benefits at most of the jobs I held. Only in the past few years - when money has not been a routinely pressing issue - have I not worried regularly about going to the dentist.
Truth is that there's little left to do now. At about the same time I started having 'catastrophic and irrepairable' failures, I could finally afford to do what was needed.
All those molars now have crowns - at a total cost that exceeded what I paid for the first new car I ever bought (well into my late 30's at the time BTW). Such an expense would have bankrupted us early in our marriage and remains unaffordable for most of the US population. I don't know what I'd be doing - or have done - if I could not paid for that work. makes you wonder how all the others that had state financed dental work have fared over the years.
Of course the irony in all this is that regular treatment costing a TENTH or TWENTIETH of what I've spent over the years would have made all this work unnecessary.
My own children have coatings and regular treatment which makes cavities a rarity - and it has nothing to do with the things they eat or how well they brush...... It's not cheap but worth the cost. So far it looks like we'll escape braces. Funny how that is almost the norm now for middle class - or upper middle class - kids.
Of course, coatings and regular check ups could prevent real problems in ALL kids - cutting long term costs dramatically - but that's simply not happening for a large proportion of our population.
makes you wonder how hard it could possibly be to train technicians to do basic work like coating teeth - and what the cost of such a program would be? Far cheaper in the long term than its absence but......not happening, is it...
We don't think much about dental health being important - until we need a root canal or have a major infection..... people get used to bad teeth and can put off treatment for eons - you can always get one pulled if it gets too bad, right? Not THAT hard to do..... Remember Tom Hanks in Castaway? Alot easier with a good pair of pliers or vise-grips. I know people that have pulled their own teeth - it's not that unusual (sadly).
So.... bad teeth aren't likely to kill you - though they can and do on rare occasions. However they can be an ever-present source of pain. They can affect your basic nutrition - making it hard for you to eat. They can embarass you immensely - marking you as someone too poor to afford dental care.
How utterly absurd...... and unfortunately not so unusual.
People today - in an industrialized nation - regularly getting teeth pulled because they couldn't afford the care necessary to take care of their teeth.
We have an astounding dihotomy in this country where those that can afford dental care may have titanium implants installed to anchor 'new' teeth when a tooth cannot be salvaged or high tech crowns used to repair severely damaged teeth - in contrast to those who simply live without teeth and have them pulled when they can't be repaired.
Hell, even the Russians had state provided dental care for basic things like cavities.....
I found some intersting stats
from:
http://www.statemaster.com/...
Health Statistics > Oral health > Loss of natural teeth (most recent) by state
VIEW DATA: Totals
Definition Source Printable version
Bar Graph Map Correlations
Showing latest available data. Rank States Amount (top to bottom)
#1 West Virginia: 42.8%
#2 Kentucky: 38.1%
#3 Tennessee: 32.2%
#4 Alabama: 31.9%
#5 Louisiana: 31.3%
#6 Oklahoma: 31.1%
#7 Mississippi: 29.5%
#8 North Carolina: 28.3%
#9 Georgia: 28.2%
#10 Kansas: 27.8%
#11 Indiana: 27.3%
#12 South Dakota: 26.1%
#13 Missouri: 25.2%
#14 North Dakota: 24.9%
#15 Arkansas: 24.6%
#16 Puerto Rico: 24.5%
#17 Maine: 24.2%
#18 Pennsylvania: 23.7%
#19 Iowa: 23.2%
#20 Nebraska: 23.1%
#21 Alaska: 23%
#22 Idaho: 22.4%
#23 New Mexico: 21.8%
#24 South Carolina: 21.8%
#25 Wyoming: 21.8%
#26 Vermont: 21.2%
#27 Delaware: 21.1%
#28 New Hampshire: 21%
#29 Ohio: 20.4%
#30 Montana: 19.6%
#31 Wisconsin: 19.6%
#32 Virginia: 19.3%
#33 District of Columbia: 19.3%
#34 Florida: 18.7%
#35 Illinois: 18.7%
#36 Rhode Island: 18.4%
#37 Colorado: 18%
#38 Oregon: 17.7%
#39 Michigan: 17.1%
#40 New Jersey: 16.9%
#41 Texas: 16.8%
#42 New York: 16.8%
#43 Maryland: 16.6%
#44 Nevada: 16.5%
#45 Massachusetts: 16.4%
#46 Washington: 16.1%
#47 Arizona: 14.9%
#48 US Virgin Islands: 14.6%
#49 Minnesota: 14.3%
#50 California: 13.7%
#51 Utah: 13.5%
#52 Connecticut: 12.4%
Weighted average: 22.1%
DEFINITION: Adults aged 65+ who have had all their natural teeth extracted. NOTE: Data for Hawaii is not available.
SOURCE: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004.
Hmmm.. there may be something to those 'stereotypes' linking poverty and toothless grins..... I expect there's a pretty strong correlation to median income there - from lowest to highest. Let's look - reverse the order of THIS listing and compare
http://www.census.gov/...
New Hampshire 57,352 938 4 0 45
New Jersey 56,772 920 5 0 44
Maryland 56,763 1,067 5 0 44
Connecticut 55,970 1,089 5 0 44
Minnesota 55,914 842 5 0 44
Alaska 54,627 992 6 1 42
Virginia 53,275 969 4 5 40
Hawaii 53,123 1,049 4 5 40
Massachusetts 52,354 959 5 6 38
Colorado 51,022 994 6 6 37
Utah 50,614 707 4 8 37
Delaware 50,152 1,071 5 8 36
California 49,894 543 4 9 36
Washington 48,688 840 4 11 34
Wisconsin 47,220 782 5 13 31
Nevada 46,984 991 5 13 31
Rhode Island 46,199 997 7 14 28
Illinois 45,787 669 6 14 29
Vermont 45,692 747 10 14 25
Nebraska 44,623 888 14 16 19
Michigan 44,476 704 13 16 20
Pennsylvania 44,286 619 13 17 19
New York 44,228 545 12 18 19
Ohio 44,160 642 14 18 17
Missouri 43,988 710 13 19 17
Kansas 43,725 981 14 18 17
Wyoming 43,641 743 13 19 17
District of Columbia 43,003 813 0
Georgia 43,217 667 13 19 17
Iowa 43,042 846 13 19 17
Indiana 43,003 686 13 19 17
Oregon 42,617 688 10 23 16
Arizona 42,590 873 13 20 16
Idaho 42,519 824 10 23 16
Texas 41,275 458 5 30 14
South Dakota 40,518 706 6 33 10
Florida 40,171 536 6 33 10
North Dakota 39,594 695 8 34 7
Maine 39,395 721 9 34 6
South Carolina 39,326 807 9 34 6
North Carolina 39,000 598 9 34 6
Tennessee 38,550 807 8 36 5
Oklahoma 38,281 603 8 36 5
Alabama 38,111 962 8 36 5
New Mexico 37,587 902 7 37 5
Kentucky 37,396 700 4 40 5
Louisiana 35,523 859 2 45 2
Montana 35,201 734 3 45 1
Arkansas 33,948 606 4 45 0
Mississippi 33,659 719 3 46 0
West Virginia 32,589 687 2 47 0
1/ The 3-year-average median is the sum of 3 inflation-adjusted single-year medians divided by 3.
2/ Excludes the District of Columbia.
Source: U.S. Census Bureau, Current Population Survey, 2003, 2004, and 2005 Annual Social and Economic Supplements.
Something of a correlation - though perhaps we should be looking back further - 40 or 50 year or so to incomes when those in the first chart were younger....
speaking of which......
This link addresses children's unmet needs:
http://www.childtrendsdatabank.org/...
from:
http://www.childtrendsdatabank.org/...
In 2004, more than 50 percent of children without health insurance had not seen a dentist in the past year, and more than one in five needed dental care but did not receive it for financial reasons. In contrast to children with insurance, 21 percent of uninsured children had unmet dental needs, compared with 4 percent of children covered by private insurance and 8 percent of those covered by public insurance (mostly Medicaid)...........
Differences by Race/Ethnicity6
In 2004, non-Hispanic black children were less likely than Hispanic children to have unmet dental needs (6 percent versus 10 percent, respectively).
Twenty-three percent of non-Hispanic white children, 27 percent of non-Hispanic black children, and 34 percent of Hispanic children had not been to the dentist within the past year in 2004. (See Figure 1) Among Hispanic children, 36 percent of Mexican or Mexican American children had not been to the dentist with the past year.
Note: Estimates for 1999-2004 reflect the new Office of Management and Budget race definitions, and include only those who are identified with a single race. Hispanics may be of any race.
> Back to Top
Differences by Health Insurance Coverage
In 2004, uninsured children were much more likely than children with Medicaid/public insurance and children with private insurance to have unmet dental needs (21 percent, versus 8 percent and 4 percent, respectively). (See Figure 2)
Fifty percent of uninsured children had not been to the dentist within the past year in 2004. Twenty-nine percent of children with Medicaid or other public health insurance and 18 percent of children with private health insurance had not been to the dentist in the past year. (See Table 1)
Differences by Poverty Status
In 2004, 10 percent of children in poor families and 11 percent of children in near poor families had unmet dental needs, compared with 4 percent of children in not poor families.
Thirty-five percent of children from poor families, 31 percent of children from near-poor families, and 18 percent of children from non-poor families had not been to the dentist within the past year in 2004. (See Table 1)
Note: Children from poor families are defined as those living in families below the poverty threshold, based on family income and family size using the U.S. Census Bureau's poverty thresholds for the previous calendar year. Children from near-poor families are in families with incomes between 100 and 200 percent of the poverty threshold. Children from not-poor families are in families with incomes 200 percent or greater.
.................
An interesting report on Britain's dental performance is here:
http://www.statistics.gov.uk/...
A cursory review seems to indicate that there's merit to a national health care system as far as dental needs go though there does seem to be a supply and demand problem..... Ironic if the British are doing a better job with kids teeth than we are.....
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