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U.S. Dental Crisis: Sen. Sanders on the Fight for Coverage

Laura Austan hasn’t regularly seen a dentist in almost 14 years. She has gingivitis, a broken tooth, a cracked tooth and little chance of relief — few area dentists accept her disability and Medicare coverage.

Out of options, she dialed her senator. “I’m sure at some point I will be losing most of my teeth,” she told Sen. Bernie Sanders, I-Vt.

Sanders had heard that story before. In fact, a quarter of adults age 65 and older lose nearly every natural tooth in their mouth. That’s one reason why the senator asked his constituents to flood his phone lines with stories of their dental woes. He wanted them to build his case for more comprehensive dental care in the U.S.

On Feb. 29, Sanders, the chairman of the Senate Subcommittee on Primary Health and Aging, convened a hearing on the matter and released a report with some startling statistics: More than 47 million people live in places where it is difficult to access dental care. In 2009, nearly 17 million low-income children didn’t see a dental-care professional. Low-income adults were almost twice as likely to go without a check-up as higher-income adults. And nearly 9,500 new dental providers are needed to meet the country’s current oral health needs.

In the past several months, the NewsHour’s health unit profiled the depth of the crisis in a series of reports in Virginia, New York and California:

Health correspondent Betty Ann Bowser traveled to the remote villages of Alaska to examine a controversial solution some say could relieve America’s dental pain in the lower 48.

(Be sure to read an update on the dental therapist program here. It’s a concept that Sanders supports despite the American Dental Association’s strong opposition.)

For more perspective, we checked in with Sanders. Despite the debate over health care reform and deficit reduction, Sanders is still pushing for greater dental coverage and other federal reforms.

The conversation below has been lightly edited for length.

NewsHour: How did you become involved in this issue?

Sanders: Well, decades ago in the state of Vermont — especially in the rural areas — it was obvious to anyone who had eyes that many of our kids and many working people were not getting access to the dental care that they needed. There were children who had rotting teeth in their mouths and many seniors who had no teeth in their mouths. It was clearly an issue that needed to be addressed, and over the years I’ve worked very, very hard on this with some success. In Vermont, as a result of the expansion of community health centers, we have opened up dental care access to tens of thousands of Vermonters, and we’re making progress. But we have a long way to go.

NewsHour: In your opinion, what’s the biggest problem here?

Sanders: No. 1, we simply don’t have enough dentists in this country. The dentists that we have are getting older and retiring, and we are not replacing them to a significant number with younger dentists. No. 2, we have 130 million Americans who don’t have any dental insurance at all. Furthermore, we have millions of kids who are not getting to a dentist when they should. And many of the dentists that we do have, for whatever reason, are not choosing to provide dental care to lower-income people — Medicaid recipients. Those are some of the issues that we’re dealing with right now.

NewsHour: Why do you think this story flies so far under the radar?

Sanders: Well if you are upper middle class, while dental care is expensive, you can get the care that you need. Often you get excellent quality dental care. I think lack of access has a lot to do with the needs of lower-income people, and the needs of lower-income people don’t get a lot of public attention.

But the bottom line is that for low-income Americans, we are having a dental health care crisis in this country. It’s a crisis that goes beyond dental care to other health-related issues. As you know, if you have an infection in your mouth that’s not treated, that could lead to other problems. If you don’t have teeth in your mouth, you can’t digest well, and that could lead to problems.

And oddly enough, it also becomes an economic problem because if people don’t have teeth in their mouths, when they smile and there are huge gaps, that really becomes a badge of poverty. Those people will find it harder to get jobs than other people with a nice set of teeth.

Newshour: What can be done about it? And what role should Congress have?

Sanders: Well, a lot can be done about it and should be done about it.

For a start, we need to increase the number of dentists in this country. In recent years, there have been new dental schools, and hopefully we will be seeing more dentists. But just increasing the number of dentists in this country is not enough. We need to get more dentists into underserved areas to address people who right now have a very difficult time finding a dentist.

No. 2, we have to do something about the high cost of dental care. It is just very, very expensive. I’m not sure why that is so, but it is. We also have to continue to expand the number of community health centers in this country, which provide dental care to low-income people regardless of ability to pay. I think the answer is that we have to focus increasingly on making sure that people who graduate dental school can work in underserved areas because we forgive their loans or we provide scholarships to them.

But I think in one way or another, through the National Health Service Corps or other ways, we have got to make sure that we have an ample supply of dentists and other dental providers in areas of the country where low-income people can access those services.

NewsHour: Is there something the government could do increase the number of dentists who accept patients using Medicaid?

Sanders: Yes. We can increase and should increase Medicaid reimbursements rates for dentists, but I am not confident that that is going to go all that far in addressing the crisis. For whatever reason, many dentists feel they can make more money by serving non-Medicaid patients than Medicaid patients. And while raising reimbursement rates may help, I’m not confident it will result in a significant improvement in the situation.

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