Health care reform: addressing America's growing dental problem Special

According to the U.S Census Bureau, for every American without health insurance, there are three without dental insurance, nearly half of the US population and causes 164 million missed working hours.

During the overall discussions on health care reform in the United States, very little attention has been given to one aspect of medicine that has changed dramatically over the last several years, slowing crawling towards the same problems that are faced in other areas being focus on with health care reform: dental health. Going forward with health care reform, it is wise to ask whether or not the dental community will face the same challenges as the medical community, or if it will be ignored as increased costs drive more Americans away from proper dental care, leading to have possible long-term health problems as a result. Gone from most practices are the days of billing and payment plans, replaced with same-day payments and more restrictive business practices. Mandy Stephans, Slidell, LA, is hoping that dental will be included somehow. She covers her mouth as she speaks to me, ashamed of her broken and rotten bottom teeth. Stephans has her Masters Degree in Marketing, obtained through an accredited university program on-line, and works from home as a marketing consultant. Having a history of bad teeth, a punch in the face she suffered from a former boyfriend started a cycle of rotting and broken bottom teeth. She has gone on a series of job interviews, trying to get permanently placed in a position that would offer her both health insurance and pay equally to approximately twice as much as what she makes independently now, but never receives call backs, knowing it is because of her appearance. "I do not get angry about it because I get it. Marketing is about the total package, from what you are selling to who is selling it and who they are selling it to. It is frustrating because I am good at what I do, but you can imagine where my self-esteem is at right now." she tells me, looking uncomfortable speaking about the subject. Stephans also has a special needs son, Evan, who requires a lot of medical attention. She makes too much to receive state assistance, too little to take care of herself. His monthly prescriptions and doctor visits are paid for by her wage, leaving enough to cover her monthly expenses and not much more. She has called area dentist to ask about payment plans, bartered treatment and to work off in their offices the amount it would cost to repair her teeth and has been met with hesitations and refusals. "It will take $5000 to fix my teeth and jaw. That is $5000 I do not have. When I have spoken to area dental professionals, I am told to apply for credit programs from third parties that work with their offices on financing. Don't you think if I had the credit to do that, I would have done that already instead of walking around like this and living on soft foods?" This problem is not unique to Stephans. An alarming amount of Americans are going without proper dental care, leading to much more serious health-related problems and potential death. In May of 2000, the Surgeon General released the first-ever public report on oral health in American. It found that many Americans were going without dental care, suffering from chronic issues. A study funded by the National Institute of Health found links between bad oral health and heart problems, respiratory conditions, stroke, and arthritis. Socio-economic issues tended to play a role in proper dental care, such as income, race, ethnicity and gender. However, that isn't always the case, as Stephans demonstrates. In 2007, 12 year old Deamonte Driver died of complications related to an untreated abscessed tooth. The infection spread into his brain and despite two brain surgeries, he couldn't be saved. "That is my biggest fear," says Stephans. Home remedies continue to pop up on the Internet, offering advice such as taking antibiotics from the pet store intended for dogs to chase away an abscess to using clove oil or sleeping with a tea bag in the mouth to draw out the infection. Taking a trip to the ER for pain medication is also suggested, this being the route taken by most. If one cannot be seen at the ER, the next step taken is usually removing the tooth themselves, a very dangerous practice that could lead to wide spread infections. "We have seen an increase of patients come in with teeth that need a lot of repair. Dental care is seen as that one thing you can put off until next month, then next year. Unfortunately, what comes with that is increased costs to get work done, because so much will have to be done at once. We have had a lot more people come in within the last two years who have attempted to pull their own teeth, which automatically leads to an oral surgery," says Vickie Turner, dental assistant in a private practice in Dallas, TX. "I get depressed. I won't look in mirrors. I have become a stereotype in people's minds. All I want is to be able to give my son a better life and to laugh and smile again without having to put my hand over my mouth to do it,' Stephan says. Several dental offices were contacted in Stephan's area but failed to return calls.