Dental care: MIA in health reform discussion

By GREG KLINE

Published on November 27, 2009

Where are the dentists? Why and how did adequate dental care slip under the radar screen of the current health-care reform discussion? While an estimated 40 to 50 million Americans do not have health insurance, more than 100 million Americans are without dental insurance. Whether individuals are unemployed, or their employer doesn't provide dental insurance, this can make dental work more costly than many can afford.

According to the U.S. Department of Health and Human Services and the American Dietetic Association, a variety of medical conditions - such as diabetes, heart disease, HIV and adverse outcomes of pregnancy - have associations with oral health. The connections between nutritional and medical status, and oral health have highlighted an important association between dental and systemic health.

Limited and basic free health care is available at several area locations including the Amherst Survival Center. What is not available is dental care. Many of the patients seen at the Survival Center clinic come because of dental problems. These patients often show up at the clinic because they are unable to find a dentist who accepts MassHealth, unable to wait for months to get an appointment at one of the few free or low-cost dental clinics in the area, or unable to pay for their care out of pocket. If a patient were able to access dental care when a tooth is chipped or a cavity present, care would be simpler, less painful and less costly.

Adults insured by MassHealth report that it is a struggle to find a dentist who will care for them, according to Karen Rafeld, assistant executive director and senior policy advisor of the Massachusetts Dental Society. The reason, according to Rafeld, is that MassHealth will reimburse less then 50 percent of the dentist's fee for treating adults. She goes on to say: "Adults can make decisions about their own dental care." For many, these decisions mean choosing between dental care or food or rent.

According to the Centers for Disease Control, nearly 30 percent of American adults have untreated cavities. While some of these cases are undiagnosed or ignored, many are the result of patients who simply cannot afford dental work. In December 2008, a woman came to the Survival Center with multiple infected teeth and accompanying pain. Health workers administered temporary pain relief and treated the infection. This treatment was repeated on several occasions. Meanwhile, every Thursday morning at 7 a.m., she would travel to Fitchburg's Free Dental Clinic hoping her name would come to the top of the list of potential clients. Once it did, she would then become a clinic patient and was entitled to full care. Presently, she is scheduled for extractions at the free clinic this month, almost a year after her to visit to the Survival Center clinic.

Another case is that of a young man whose case was confounded by his allergy to the local anesthetic xylocaine needed for the extraction. MassHealth will not be of much help as most oral surgeons don't accept this insurance.

Efforts to address this crisis are under way in other parts of the country. The Tampa, Fla.-based nonprofit Dentistry From The Heart is the county's leading free dental-care program and has expanded its free-day-of-dentistry events to more than 50 locations across 29 states in the United States. For dentists, it's a great opportunity to help the community and earn some positive recognition at the same time.

There is no similar outreach in our region. We applaud the efforts of Dentistry From The Heart and encourage local dental practices to step up to the plate and give the Pioneer Valley something to smile about.

Greg Kline is a member of the Amherst Survival Center Free Health Clinic Committee.