A big gap in dental care as U.S. coverage is cut

A big gap in dental care as U.S. coverage is cut
By Reed Abelson
The New York Times
December 29, 2004

Among American reservists, a common reason for not being sent to Iraq has been poor teeth. The military offers dental insurance to reservists and members of the U.S. National Guard, but for those who opt for it, the benefit of $1,200 a year fails to cover many procedures and still requires reservists to pay as much as half the cost of the care.
The reservists are hardly alone. With dental costs rising and employers cutting dental coverage, an increasing number of working Americans cannot afford to see a dentist even for chronic problems. Roughly a quarter of reservists in seven early-deploying U.S. Army units had dental problems that could require emergency attention within the next year, according to an analysis done last year by the Government Accountability Office. Similar problems surfaced in the first Gulf war. During the current Iraq war, some reservists and national guard members chose to have their teeth pulled so that they could be deployed, Robert McIntosh, a retired major general who is executive director of the Reserve Officers Association of the United States, testified before Congress in February.
"Although promised restorative dental work, their reward for their loyalty and patriotism will be dentures," he said. Dental implants, a better alternative to dentures, are not covered because they are more expensive.
In the United States, where a smile is considered a sign of general well-being and an important factor in landing a job, dental care is becoming ever more unequal, policy experts say. In 2000, the surgeon general issued a report describing the silent epidemic of dental and oral diseases affecting mainly the poor, but some experts, including those working at community clinics, say the problem is becoming worse.
Each year, Americans spend about $70 billion on dental services, ranging from basic checkups to sophisticated dental implants and new cosmetic whitening treatments. But for all that spending, what has evolved is a double standard of care, with the haves getting movie star smiles and the have-nots more likely to be living with bad or missing teeth. Only about half of Americans have any form of dental insurance, by some estimates. Most employers do not offer it, and dental coverage is often one of the first things companies cut to reduce costs. Just 39 percent of employers offered dental benefits in 2003, according to a Kaiser Family Foundation study, compared with 66 percent that offered health insurance. Costs have risen by about 50 percent in the last decade, above inflation.
Among the 45 million Americans without any health insurance, dental services are a low priority. Despite significant strides in dentistry, more people are going without procedures like root canals and crowns needed to save their teeth.
"It's one of the most disparate areas of care that I've seen," said Gina Nolte, the executive director for the Red River Valley Dental Access Project in Fargo, North Dakota.
Dr. Richard Haught, president of the American Dental Association, which has 150,000 members, says the issue is a priority for his group.
"We're committed, as an association, as a dental group, as a profession, to changing this," he said.
Renee Iverson, a mental health care worker in Alexandria, Minnesota, for example, could not afford a root canal, which would have cost her at least $1,000, to save a painful abscessed tooth. When she got together enough cash, $120, to have her tooth pulled, the dentist she saw refused, telling her it would be unethical to extract a tooth that could be saved.
"You're kidding, right?" Iverson recalls saying to the dentist.
.
She eventually went to a hospital emergency room for antibiotics and pain medicine, and had the tooth pulled two years later by another dentist, who has since retired.
For people who receive health coverage through public programs, what limited dental coverage there is has been shrinking. Medicare, the federal insurance program for the elderly, does not provide dental benefits, so the elderly poor have had to depend on state-financed programs. But in the last few years many states, including Massachusetts, Michigan, and Washington, have reduced or eliminated adult dental benefits offered through Medicaid, the joint state-federal program for the poor.
Only eight states now have full dental benefits for adults, down from 14 a few years ago, according to the Children's Dental Health Project, a private group. Many states will only cover emergency services. Seven offer no coverage whatsoever. Children in poverty fare better, because coverage under Medicaid is mandatory.
Among American reservists, a common reason for not being sent to Iraq has been poor teeth. The military offers dental insurance to reservists and members of the U.S. National Guard, but for those who opt for it, the benefit of $1,200 a year fails to cover many procedures and still requires reservists to pay as much as half the cost of the care.
The reservists are hardly alone. With dental costs rising and employers cutting dental coverage, an increasing number of working Americans cannot afford to see a dentist even for chronic problems.
Roughly a quarter of reservists in seven early-deploying U.S. Army units had dental problems that could require emergency attention within the next year, according to an analysis done last year by the Government Accountability Office. Similar problems surfaced in the first Gulf war.
During the current Iraq war, some reservists and national guard members chose to have their teeth pulled so that they could be deployed, Robert McIntosh, a retired major general who is executive director of the Reserve Officers Association of the United States, testified before Congress in February.
"Although promised restorative dental work, their reward for their loyalty and patriotism will be dentures," he said. Dental implants, a better alternative to dentures, are not covered because they are more expensive.
In the United States, where a smile is considered a sign of general well-being and an important factor in landing a job, dental care is becoming ever more unequal, policy experts say. In 2000, the surgeon general issued a report describing the silent epidemic of dental and oral diseases affecting mainly the poor, but some experts, including those working at community clinics, say the problem is becoming worse.
Each year, Americans spend about $70 billion on dental services, ranging from basic checkups to sophisticated dental implants and new cosmetic whitening treatments. But for all that spending, what has evolved is a double standard of care, with the haves getting movie star smiles and the have-nots more likely to be living with bad or missing teeth.
Only about half of Americans have any form of dental insurance, by some estimates. Most employers do not offer it, and dental coverage is often one of the first things companies cut to reduce costs. Just 39 percent of employers offered dental benefits in 2003, according to a Kaiser Family Foundation study, compared with 66 percent that offered health insurance. Costs have risen by about 50 percent in the last decade, above inflation. Among the 45 million Americans without any health insurance, dental services are a low priority.
Despite significant strides in dentistry, more people are going without procedures like root canals and crowns needed to save their teeth.
"It's one of the most disparate areas of care that I've seen," said Gina Nolte, the executive director for the Red River Valley Dental Access Project in Fargo, North Dakota.
Dr. Richard Haught, president of the American Dental Association, which has 150,000 members, says the issue is a priority for his group.
"We're committed, as an association, as a dental group, as a profession, to changing this," he said.
Renee Iverson, a mental health care worker in Alexandria, Minnesota, for example, could not afford a root canal, which would have cost her at least $1,000, to save a painful abscessed tooth. When she got together enough cash, $120, to have her tooth pulled, the dentist she saw refused, telling her it would be unethical to extract a tooth that could be saved.
"You're kidding, right?" Iverson recalls saying to the dentist.
She eventually went to a hospital emergency room for antibiotics and pain medicine, and had the tooth pulled two years later by another dentist, who has since retired.
For people who receive health coverage through public programs, what limited dental coverage there is has been shrinking. Medicare, the federal insurance program for the elderly, does not provide dental benefits, so the elderly poor have had to depend on state-financed programs. But in the last few years many states, including Massachusetts, Michigan, and Washington, have reduced or eliminated adult dental benefits offered through Medicaid, the joint state-federal program for the poor.
Only eight states now have full dental benefits for adults, down from 14 a few years ago, according to the Children's Dental Health Project, a private group. Many states will only cover emergency services. Seven offer no coverage whatsoever. Children in poverty fare better, because coverage under Medicaid is mandatory.
Among American reservists, a common reason for not being sent to Iraq has been poor teeth. The military offers dental insurance to reservists and members of the U.S. National Guard, but for those who opt for it, the benefit of $1,200 a year fails to cover many procedures and still requires reservists to pay as much as half the cost of the care.
The reservists are hardly alone. With dental costs rising and employers cutting dental coverage, an increasing number of working Americans cannot afford to see a dentist even for chronic problems.
Roughly a quarter of reservists in seven early-deploying U.S. Army units had dental problems that