Slusarewicz ’23: We need to start caring about dental care


When I was growing up, I had no idea that scheduling biannual dental appointments was commonplace. Due to the economic recessions of the 2000s, my family’s income was fragile for many years, and even after the Great Recession, we moved many times for work. Most of the time we didn’t have the stability to attend regular medical appointments due to our high health insurance deductible – under which there are usually large out-of-pocket payments – not to mention going to the dentist, which was not covered by our insurance. When I started attending regular dental appointments in college, I was blown away by the experience. But we still don’t have dental insurance and pay for appointments without help. So, if our financial situation were to turn grim again, we would once again give up on dating.

General medical opinion regards oral health as an essential element of public health. Poor oral health is correlated with poorer physical health and quality of life and disproportionately disadvantages marginalized communities. Yet the lackluster dental care covered by public and private health insurance policies perpetuates the perception that dental and non-dental care are inherently separable. Dental care is unaffordable for many Americans, and insurance plans often don’t cover major operations. Comprehensive dental care must be fully covered by public and private health insurance policies if we hope to promote the health of all Americans.

Poor oral health can contribute to many diseases and conditions, including cardiovascular disease, pneumonia, and complications in pregnancy and childbirth. And the relationship between oral and non-oral body health works both ways. For example, diabetes and gum disease aggravate each other in a positive feedback loop, and conditions such as HIV/AIDS, osteoporosis and Alzheimer’s disease lead to dental decline. Despite the potentially serious effects of neglecting oral health, the lack of access to primary dental care discourages people from using the medical system until an emergency occurs, with consequences both medical and financial.

Financial obstacles add to these disincentives. Dental expenses represent less than 4.5% of health care expenses, but constitute a large part of patient expenses: 44.2% of dental bills were paid out of pocket, compared to 10.3% of medical expenses, which are largely covered by insurance schemes. . Recent research indicates that the expensive nature of dental care prevents medically insured people from meeting their treatment needs.

Although the federal Medicaid program helps alleviate some of the economic burden of oral health care for low-income individuals and families, it remains insufficient. Although Medicaid is supposed to cover dental care for all children, less than half of eligible children actually receive dental care. Also, adult dental care depends on state Medicaid policy. In 2016, 15 states offered extended dental benefits to adults, but 13 only offered dental coverage for emergency care or pain relief, and four states provided no dental benefits at all. But even if a state offers substantial dental care, individuals are limited by the ability to find dental professionals in their communities. Less than half of US dentists participate in the Medicaid dental program due to low reimbursement. As a result, dentists tend to set up businesses in affluent areas where residents can afford better insurance or pay for procedures out of pocket. As a result, poorer areas of the United States offer little or no access to dental care – more than 50 million Americans live in communities with a federally designated shortage of dental professionals.

Medicare, which insures those 65 and older or disabled, also provides insufficient dental coverage. The program does not cover primary dental services — “the care, treatment, extraction or replacement of teeth or structures directly supporting the teeth” — necessary for the installation of prostheses and the extraction of diseased teeth. Also, while it covers necessary surgery for “non-dental” procedures, Medicare will not pay for dentures or any other type of device needed to care for the mouth after surgery. Medicare’s shortcomings in dental coverage are particularly glaring given the heavy burden of oral disease on older populations.

While the separation of dental and non-dental medical care in health care policy disproportionately harms marginalized communities covered by Medicaid and Medicare, a much larger group may feel the consequences. Of civilian workers who received occupational medical insurance in 2018, like my family, only 44% also received dental coverage, leaving the rest uninsured for dental care. The uninsured dental rate is four times higher than the uninsured medical rate, with some 74 million Americans having no dental coverage in 2016. Even those who can purchase separate dental insurance do not receive full the coverage they need. For example, many private dental insurance plans do not cover major dental procedures, which can be expensive. Although dental insurance companies cover preventative care, regular dental maintenance does not completely eliminate the risk of dental emergencies.

All of these factors add up to paint a clear picture of dental care in the United States: inaccessible and unacceptable. As medical journalist Mary Otto said, “Due to economic deprivation, geographic isolation, age, disability and lack of dental coverage, it is estimated that one third of the population faces significant difficulties in accessing the autonomous, insular and privatized system which provides most of the dental care in this country.

Tackling disparities in dental care could, in turn, improve dental coverage for everyone. The Medicare and Medicaid Dental, Vision and Hearing Benefit Act, introduced in the US Senate on August 5, would significantly expand the scope of dental care covered by the Medicare and Medicaid programs. This legislation could be the first step in changing attitudes about dental health, but right now the bill has a 3% chance of passing, according to forecasts by the dental prediction company. machine learning Skopos Labs. For real progress to be made, dental health must be seen as inseparable from non-dental health at all levels. It’s time to move beyond outdated insurance structures so we can focus on improving the health of all Americans, regardless of socioeconomic status.

Megan Slusarewicz ’23 can be reached at [email protected] Please send responses to this opinion to [email protected] and other editorials to [email protected]


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