Millions of Americans Face Life Without Dental Care

Uploaded by PBSNewsHour on 15.11.2011

bjbjLULU JEFFREY BROWN: Next, the first of two stories about dental care and the difficulty
that many Americans face getting it. NewsHour health correspondent Betty Ann Bowser reports.
BETTY ANN BOWSER: It was 5:00 on a Saturday morning in rural southwest Virginia. By the
hundreds, people stood patiently in line in the freezing rain to see a dentist. For the
most part, they were low wage earners with no insurance and a mouthful of problems like
Bobby Horn. BOBBY HORN, Virginia: The worst pain you can imagine. BETTY ANN BOWSER: Horn
couldn't remember the last time he saw a dentist. Now at just 32 years of age, that kind of
neglect has led him to judgment day. BOBBY HORN: They want to extract them all, oral
surgery. They're going to take them all out, get them all out. And then I'm going to have
dentures put back in their place. BETTY ANN BOWSER: Like roughly one out of every two
Americans, Horn doesn't have dental insurance. His case is extreme, but it illustrates a
growing problem. For lots of reasons, people just aren't going to the dentist like they
used to. And the new president of the American Dental Association says they're courting disaster.
DR. WILLIAM CALNON, American Dental Association: We know there are distinct correlations between
poor oral health and diabetes, poor oral health and many cardiovascular diseases. There's
also a distinct correlation with women between poor oral health and low-birth-weight babies.
BETTY ANN BOWSER: And sometimes, although it's very rare, the consequences can be catastrophic.
The death of 24-year-old Kyle Willis made national headlines in August after an infection
in one of his teeth spread to his brain. The Cincinnati resident had no insurance and no
ability to pay. DR. WILLIAM CALNON: What are the barriers that prevent people from going
to the dentist? Some are financial. We all agree with that. Some are geographic. Some
basically are -- people are not aware of the need to go to a dentist. Oral health literacy
in this country is amazingly low. I had an individual sitting in my chair right here
a couple of days ago. And he is now unemployed. And he was telling me that one thing he's
really focusing on is doing a lot of preventive maintenance on his car, so he can make that
car last longer. I look in his mouth and he's got five broken teeth. And I said, "Did you
ever think of applying that same concept for preventive maintenance to your mouth?" And
he looked at me dumbfounded and said, "I never thought of it that way." BETTY ANN BOWSER:
But ignorance of the need for good dental care is not the only reason Americans aren't
getting it. The federal government has identified more than 4,500 areas of this country, like
Grundy, Va., where there are not enough dentists. It says nearly 10,000 new providers are needed
to meet the need. And the Institute of Medicine, an independent policy group that gives advice
to the government, reported a few months ago that fewer than half of Americans see a dentist
each year because of access problems. The IOM said, "There are persistent systemic barriers
to make dental care hard to come by for seniors, minorities, children and the disabled." Beth
Mertz is an assistant professor at the School of Dentistry at the University of California,
San Francisco. ELIZABETH MERTZ, University of California, San Francisco: There's about
170,000 dentists in the country, which is about a little over two-and-a-half dentists
per 5,000 people. The problem is, is, they're not distributed evenly in relationship to
the population. BETTY ANN BOWSER: The ADA denies there is a shortage of dentists and
calls it a maldistribution problem. But Mertz says, whatever name you give it, the issue
is still the same. ELIZABETH MERTZ: What that means is some communities have a lot of dental
providers from which they can go and get care, and other communities really have none. BETTY
ANN BOWSER: The areas where there are enough dentists tend to be where residents have dental
insurance or money to pay for care out of pocket. In fact, that's the model on which
many dental practices are based. Dental schools like this one at the University of California,
San Francisco, say some students don't want to practice in shortage areas for financial
reasons, and are increasingly turning to specialties because they can make more money. It's expected
that the number of practicing dentists will start declining, just as five million children
will begin to get dental care under Medicaid. That's in 2014, when a provision of the new
federal health care reform law kicks in. MAN: Go ahead and open up for me. BETTY ANN BOWSER:
But finding a dentist who will see them is another issue, because Medicaid reimbursement
rates are notoriously low. ELIZABETH MERTZ: Individuals who are covered by Medicaid right
now already have a very difficult time getting dental services, not -- there's a pretty low
participation by dentists in the program. And so it is hard to find somebody who will
accept that insurance. BETTY ANN BOWSER: Dr. Calnon, who practices in Rochester, N.Y.,
accepts Medicaid patients, but he said he loses money. DR. WILLIAM CALNON: There are
parameters that will allow us to do certain things that they will pay for and certain
things they won't pay for. I would say in this state depending on the type of practice
you have and the type of either generalist or specialist, you're losing anywhere probably
between 20 percent and 70 percent. BETTY ANN BOWSER: Experts say, in the last 25 years,
the population has been growing faster than the number of graduating dentists to meet
the need. And the American Dental Education Association says the trend is continuing.
JEFFREY BROWN: In her next story, Betty Ann reports on one experiment to improve access
to dental care, bringing it to a remote Alaskan village. hFLP hFLP urn:schemas-microsoft-com:office:smarttags
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