Dental Decay: The Hidden Health Crisis

Last Spring, following the death of twelve-year old Deamonte Driver of Maryland whose untreated tooth infection spread to his brain, I wrote about the national epidemic of dental disease and the lack of access to dental care faced by the poor and working class. Last month, an article in The New York Times painted a horrifying picture of the state of dental care, where bootleggers sell dentures that would otherwise be unaffordable to many people missing teeth; where low Medicaid reimbursement rates perpetuate a dearth of participating dentists; where untreated cavities are a leading cause of kids missing school, people use Krazy Glue to reattach broken teeth, or swish rubbing alcohol to treat an infection, "burning the gums and creating ulcers."

Currently, Medicaid only covers pulling teeth to treat infections -- not root canals or dentures -- which can certainly dim the job prospects for someone trying to earn a living in our economy.

"Try finding work when you're in your 30s or 40s and you're missing front teeth," Jane Stephenson, founder of the New Opportunity School in Berea, Kentucky told the Times.

According to Maryland Senator Ben Cardin's staff, dental decay is now the most common chronic childhood disease in the US, affecting twenty percent of children aged 2 to 4, fifty percent of those aged 6 to 8, and nearly sixty percent of fifteen year olds. It is five times more common than asthma among school age children, and nearly 40 percent of African-American children have untreated tooth decay in their adult teeth. Improper hygiene can increase a child's adult risk of having low birth-weight babies, developing heart disease, or suffering a stroke. Eighty percent of all dental problems are found in just 25 percent of children, primarily those from lower-income families.

In March, in response to Driver's death, Cardin cosponsored the Children's Dental Health Improvement Act of 2007 along with Senator Jeff Bingaman, who had pushed similar legislation for seven years. The bill called for $40 million annually for five years to help community health centers hire dentists to serve poor children. It also would have awarded $50 million in grants to help states improve dental services to children enrolled in Medicaid or the State Children's Health Insurance Program (SCHIP). At the time, Cardin said on the Senate floor: "It is outrageous today that in America, a young boy can die because his family can't find a dentist to remove an infected tooth. It is not enough simply to mourn Deamonte's death. We must learn from this failure of our health-care system and take action to make sure it never happens again."

The dental bill was folded into the CHIP bill. The final version of CHIP -- passed by Congress and vetoed by President Bush -- didn't contain the grants sought by Cardin and Bingaman but it did guarantee dental coverage to kids and also established minimum standards of care. Senator Cardin explained the dilemma he and his colleagues faced: "When things get tight in state budgets, one of the first things they cut is something that's not mandated, so when we had to choose between grants to cover dental benefits or a guarantee of dental care, the latter was a greater, immediate priority. We know now that dental care is vital to a child's overall health -- experts tell us that it impacts many other aspects of their health as well. Not to mention it's an indicator of one's ability to get ahead and thrive," he said.

Cardin, Bingaman, and their allies were successful in passing $5 million in grants in the Labor Health and Human Services bill to help states reach poor kids but clearly -- as indicated by the initial grant request -- the need is far greater than that. Even Cardin said of the CHIP bill, "There is more work to do ... . We still have to improve reimbursement for dental providers [so more dentists will participate in Medicaid], and get grants to the states to allow them to offer dental wraparound coverage for those who may have health coverage, but no dental insurance."