Millions of Americans Face Life Without Dental Care

The lack of access to dental care is a problem that affects millions of Americans. Health correspondent Betty Ann Bowser reports.

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    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.


    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.


    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.


    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.


    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.


    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.


    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."


    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.


    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.


    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.


    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.


    But finding a dentist who will see them is another issue, because Medicaid reimbursement rates are notoriously low.


    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.


    Dr. Calnon, who practices in Rochester, N.Y., accepts Medicaid patients, but he said he loses money.


    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.


    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.


    In her next story, Betty Ann reports on one experiment to improve access to dental care, bringing it to a remote Alaskan village.