Nothing to Smile About
By: Carole Fleck; Source: AARP Bulletin Date Posted: 2006-09-15 14:52:00-04:00
Marie Burton craves chilled watermelon and other cool fresh fruit, but she can't eat them. Carrot sticks are a favorite, and she adores a thick cut of steak, but she can't eat those, either.
Cold, chewy or crunchy cuisine is off-limits for Burton because her teeth hurt too much—at least the ones she has left. They're wiggly, broken and infected.
"I have teeth missing, and the teeth I do have ache," says Burton, 59, of Pawtucket, R.I. "I get this bad taste in my mouth all the time, and my stomach gets upset. I can't eat sometimes because I feel nauseous."
Burton has consulted with local dentists, but the dental plan provided by her $22,000-a-year job as a quality assurance inspector is extremely limited. She says she can't afford the thousands it would cost "up front" to fix her decaying teeth. So she stays home and avoids socializing because, she says, she is embarrassed by her appearance.
"I don't like looking in the mirror or talking to people unless I have to," says Burton, a soft-spoken mother of three. She doesn't like to smile or open her mouth. "It's awful," she says.
Like Marie Burton, millions of Americans have little or no dental care. An estimated 108 million have no dental insurance, more than twice the 46 million without health insurance. About three-quarters of people 65 and older are not in a dental plan.
The lack of access to affordable oral health care has long been ignored in the United States. But the problem is likely to get more attention as boomers retire in droves and lose their employer-provided dental benefits—and as evidence mounts that poor oral health may cause or worsen serious medical problems such as diabetes and cardiovascular disease.
A growing number of studies indicate that bacteria from chronic gum infections can travel through the bloodstream to the heart and other organs. Researchers are also exploring the connection between gum disease and inflammation elsewhere in the body: If the lining of the arteries becomes inflamed, blood clots can form and cause a heart attack.
In one study, researchers from Columbia University's College of Dental Medicine and the Aetna insurance company tracked 145,000 Aetna subscribers with diabetes, coronary artery disease or stroke. They found that medical costs for those conditions were lower among subscribers who had sought early treatment for periodontal disease.
"The way the health care system functions, one might think the mouth isn't connected to the whole body," says William Maas, director of the division of oral health at the U.S. Centers for Disease Control and Prevention.
"Dental care is just as important as medical care, hospital care and prescription drugs," Maas says. "It is inconsistent for society to recognize that oral health is important yet treat dental care as if it were discretionary."
A National Toothache
In May 2000, U.S. Surgeon General David Satcher, in the first-ever report on oral health by the nation's top doctor, called dental disease "a silent epidemic" among older people and children. The report cited a lack of insurance or the inability to pay as barriers to care.
Since then, not much has changed in the private or public sector to improve access to affordable dental care. Older Americans are still disproportionately affected because retirees no longer have dental insurance provided by employers and often live on fixed incomes.
Medicare, which primarily benefits people age 65 and up, does not provide dental coverage except in rare circumstances—such as surgery to treat oral injuries sustained in a car wreck. Medicaid, the federal-state health program for low-income people, provides a dental benefit for children. But only about two dozen states offer Medicaid dental benefits for adults, and in most cases the coverage is severely limited.
Gradually more insurance companies are beginning to sell individual dental policies to consumers, although such policies account for only 2 percent of all dental plans, according to the National Association of Dental Plans.
On the bright side, more of today's older adults are retaining most of their teeth compared with previous generations, thanks to fluoridated toothpaste and water and other modern improvements in prevention and treatment. But "those teeth have been through 60, 70, 80 years of use," says Ira Lamster, dean of the Columbia University College of Dental Medicine in New York, "so they'll need a lot of care to maintain."
Little Help for the Needy
At Oral Health America, a nonprofit group based in Chicago, not a week goes by without pleas for help from people around the country who desperately need dental care. The messages are heart-wrenching, says spokeswoman Elizabeth Rogers, and in many areas there are few, if any, low-cost options to suggest.
On Capitol Hill, a House bill (HR 4624), introduced last December but stalled in a subcommittee, would guarantee access to dental coverage under Medicaid for the most vulnerable citizens, defined as children or elderly, blind or disabled individuals. Advocates say the measure, sponsored by Reps. Charles Boustany Jr., R-La., and Robert Andrews, D-N.J., is a step in the right direction but doesn't go far enough.
Conan Davis, chief dental officer for the federal Centers for Medicare & Medicaid Services, acknowledges that government could do more to provide widespread access to dental care and treatment. But it will take greater demand from the public to persuade Congress to consider a Medicare dental benefit.
And, Davis says, there are "the costs involved for care...in a season where we're looking to reduce costs."
Don't expect states to help much either. "With the recession of 2001, states had to cut services," says Bernie Horn, senior director for the nonpartisan Center for Policy Alternatives, a state policy organization in Washington. "It was a matter of which services can we save and who are we going to cut off from health care."
The Uninsured on Their Own
Richard Manski, director of health services research at the University of Maryland Dental School, hopes to learn if people will be able to maintain good oral health when they retire and lose their dental benefits. "We really don't know exactly what people are doing as they transition, if they're forgoing treatment," says Manski, who has applied to the National Institutes of Health for research grants.
John Thomas, a dentist at the VA Medical Center in Gainesville, Fla., has a good idea of what Manski will find. "I see patients over 65 in all areas of the community who have untreated oral problems because they can't afford treatment," he says.
Some of his patients take matters into their own hands, like the man who fixed a broken denture by gluing it together with epoxy and a white T-shirt. "The T-shirt was still bonded on the denture by the time he came to me," says Thomas, who points out that only a small percentage of veterans get free dentistry. Patients who can't afford treatment come to the center as a last resort, he says, when they have pain, infection or swelling.
The question is whether public pressure will force Congress to add a comprehensive dental benefit to Medicare now that the lawmakers have dealt with the program's prescription drug benefit.
Marie Burton isn't optimistic. She's just about given up on finding a dentist who will fix her teeth and restore her smile—and her self-esteem—at a price she can afford.
"I've hit a very big brick wall," says Burton, who takes medication for diabetes, high blood pressure and cholesterol.
"I guess I'll never know what it would be like to have fresh breath again," she says, "and to not feel ugly."
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