Inequitable access to dental health results in more than just bad teeth: Eric Foster


ATLANTA — For most of my life, I have been blessed to have fairly decent teeth. That is almost entirely due to the efforts of my mother. I remember her taking my sister and me to our annual cleanings when we were younger. She taught us how to brush our teeth (and tongue). She tried to get us to floss (I wasn’t doing that). In sum, she tried to make sure that we did what we could to take care of our teeth.

We couldn’t do everything, though. When I was around 9 or 10, the dentist wanted me to get braces. I remember when we got back to the car, my mom told me that braces were not an option because we couldn’t afford it. Braces aside, I ended up with a fairly decent set of teeth. Thanks, Mom!

For me, those regular dental visits came to a screeching halt in college. Finding a dentist and scheduling an appointment was a part of adulting that I was not mature enough to indulge in. I don’t think I saw a dentist at all through college. If I’m being honest, I don’t think I saw one through my 20s. I brush my teeth every day. I’m all right.

As you can guess, my carefree attitude with my teeth eventually caught up to me. First, I had to have a root canal at 31. Do not recommend. Terrible experience. Since then, I have had several cavity fillings, a bridge implanted because my dental crown was pushed out due to yet another cavity, and more cavity fillings. Most recently, I have a cracked tooth which must be pulled out, and I need a “deep” dental cleaning.

It has been a crazy journey with my teeth since 31. A lot of dental visits. A lot of time spent lying in a chair with a beacon light in my face and someone pulling and pushing and yanking and scraping while intermittently apologizing for my obvious discomfort and pain.

But what has been the craziest thing to me through this journey is the cost. It is wildly expensive to care for your teeth. Four hundred dollars here, $1,200 there. Another $758 the next time. Every time I go to the dentist, it seems like the dentist is cleaning up, both literally and figuratively. Just in the past two years, I have spent roughly $3,500 on fixing my teeth. And that is with dental insurance. I can only imagine what the costs would have been without it. What I do know is that I probably would not have paid it.

What I fail to understand are two things: 1) Why health insurance doesn’t cover dental health; and 2) Why does dental insurance cover so much less than health insurance? Dental health is a part of overall health, right? Study after study has shown that people who have poor oral health (such as gum disease or tooth loss) have higher rates of cardiovascular problems such as heart attack or stroke than people with good oral health. Your dentist will tell you that good teeth are a sign of good health.

I know, some of you might be reading this and thinking that if I had only taken care of my teeth when I was younger, I wouldn’t have these problems. You’re probably right. If I brushed and flossed twice a day and got regular cleanings, my teeth would be in a better condition. Yes, and water is wet. If we were all responsible, we would all have fewer problems. That’s just not how people are, though.

The reality is that a lot of Americans don’t take the best care of their teeth. According to the federal Centers for Disease Control and Prevention (CDC):

* “More than 1 in 4 (26%) U.S. adults have untreated tooth decay.”

* “Nearly half (46%) of all adults aged 30 years or older show signs of gum disease.”

And according to the Cleveland Clinic, “More than 80% of Americans have at least one cavity by the time they enter their mid-30s.”

True, I didn’t help myself, but the fact is that, at some point, the dentist comes for us all. The dentist, like Father Time, is undefeated.

And for many Americans, they don’t take the best care of their teeth because they can’t afford to. An estimated 74 million Americans have no dental insurance. In comparison, 28 million Americans have no health insurance.

If you’re on Medicaid, your state may not offer dental benefits to adults (Ohio does, thankfully). If you’re on Medicare, you’re pretty much out of luck, since standard Medicare without supplements doesn’t cover most dental care, procedures, or supplies.

A 2015 survey found that, “Nearly two in five American adults (39%) say they have limited or will delay dental care due to their financial situation, a number that has increased by nearly 8% in the past two years.” The survey also found that 80% of those putting off care did so knowing that “postponing or delaying routine visits will cost them more money in the long run.” The lack of access to dental care is a huge problem.

Eric Foster

Eric Foster is a columnist for The Plain Dealer and

I’ve been talking about adults, but children also bear the burden of the high cost of dental care.

According to the CDC:

* “For children aged 2 to 5 years, 17% of children from low-income households have untreated cavities in their primary teeth, three times the percentage of children from higher-income households.”

* “By ages 12 to 19, 23% of low-income family children have untreated cavities in their permanent teeth; twice that from higher-income households.”

It is going to cost me another $2,500 for my cracked tooth to get pulled and my teeth to get “deep” cleaned. My dental insurance will only pay half of the cost to remove the tooth and none of the cost for the deep cleaning. They said a deep cleaning isn’t preventative.

I’ll be all right. I’ll get the procedures done … eventually. Once I can wrap my head around spending that kind of money on something that — while improving my oral health — doesn’t really make me feel any better. It’s the responsible thing to do. My elderly self will thank me.

But what I can’t seem to wrap my head around is how we’re OK with dental care being essentially a luxury. With the amount of financial investment that it takes to have healthy teeth, good teeth, like a 401(k) or a fancy car, it’s arguably a status symbol. Why is that the accepted reality?

I know there are a lot of things in this world to care about. The war in Ukraine. Inflation. Rising crime rates. COVID-19.

Access to dental care might not be anywhere on your list. However, what I do know is that things become more important to you when you are personally affected. And as I previously mentioned, the dentist will come for us all. So keep moving along. Nothing to really see here. Just a guy, ranting and raving.

Enjoy forgetting this column. Until your tooth aches.

Eric Foster, a community member of the editorial board, is a columnist for The Plain Dealer and Foster is a lawyer in private practice. The views expressed are his own.

To reach Eric Foster: [email protected]

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