"As a nation, we don't talk about it much but there is a dental crisis in America," Sen. Bernie Sanders (I., Vermont) said Wednesday at a meeting of the Senate Subcommittee on Primary Health and Aging. The occasion was the release of a report-- Dental Crisis in America – that calls attention to the millions of Americans "unable to get even the basic dental care they need."
Among the report's more alarming findings are that "more than 47 million people live in places where it is difficult to access dental care," "17 million low-income children received no dental care in 2009," 25 percent of adults 65 and older in the U.S. have lost all of their teeth, and lower income adults in the U.S. "are almost twice as likely as higher-income adults to have gone without a dental checkup in the previous year."
The report also found that Americans are increasingly visiting emergency rooms for preventable dental conditions and that this problem is being driven, in part, by a significant shortage of dentists. It is estimated that 9,500 new dentists are needed to meet American's oral health needs – a problem that is compounded every year when more dentists retire than new dentists join the fold.
Nancy Epstein, a professor at the Drexel University School of Public Health whose work has focused on oral health-related disparities, reminds us that dental caries, or tooth decay, is caused by bacteria and "is the most common infectious disease of childhood." Epstein also worries that we still mistakenly reduce the issue of oral health to "a bunch of teeth that doesn't truly affect the health of the whole person."
Poor oral health is a serious, yet often underestimated, health matter. Untreated oral diseases, including oral infection and periodontal disease, can cause pain, infection, and tooth loss. But did you know that poor dental health also can lead to more serious and systemic medical conditions, like respiratory diseases, diabetes, heart disease, and poor birth outcomes, including pre-term birth and low birth-weight?
In 2000, the groundbreaking report Oral Health in America: A Report of the Surgeon General called "the profound and consequential disparities in the oral health of our citizens" a "silent epidemic." Yet here we are 12 years later and Senator Sanders' report is saying much the same thing; the epidemic still largely silent.
The new report believes there are concrete policy steps that could ameliorate worsening disparities in oral health. The United States needs "more oral health professionals who treat low-income individuals and other populations that face barriers to care," it says, which means increasing the numbers of dentists, including dentists from diverse backgrounds, and providing dental students opportunities to gain experiences in community-based programs.
Because more than 90 percent of dentists work in private practice, the report also calls for the expansion of Federally Qualified Health Centers (FQHCs) and School-Based Health Centers (SBHCs) to help increase access to dental care. To expand access to dental care, the report also calls on policymakers to "expand dental coverage to adults on Medicaid." Such a practice would "ensure coverage for those who now cannot afford to pay out of pocket for care." Medicaid does cover children's dental care, but finding providers to accept Medicaid patients can be challenging, as it was with the infamous case of Deamonte Driver, who died tragically at age 12 from an untreated infected tooth.
Finally, the report calls attention to the importance of prevention and education. The fluoridation of drinking water supplies is considered by the Centers for Disease Control and Prevention to be one of the 10 biggest public health successes of the 20th century. Adding small amounts of fluoride to water helps prevent cavities. Yet, while most Americans – and most Pennsylvanians -- drink fluoridated water, just 14% of New Jersey's water is fluoridated, one of the lowest rates in the country. A bill in the New Jersey state legislature would correct this problem by requiring all water systems to fluoridate; it is generating significant controversy by those who argue, against all the evidence, that fluoridation can harm human health.
Meanwhile, as a dismayed Professor Epstein again reminds us, "the inequalities of access to oral health care remain extreme and we must do more to prevent the pain, suffering and compromised overall health that result from poor oral health."