Why you may not find a dentist in an emergency
While still relatively new to Vermont, a simple tooth abscess turned into a major complication for a pregnant Kiah Morris, now 38-years-old.
Three years ago, her obstetrician told her it was imperative to treat the abscess for the sake of her unborn child, yet Morris had Medicaid coverage, and not all dentists accepted the insurance.
Desperately searching for help
She searched around the New England area to find a provide, including calling advocacy groups, ultimately finding a dentist over an hour away who would take her. But, even then, Medicaid only covered certain treatments.
“There were no other mechanisms other than to just pull [my] teeth,” Morris says.
By the time she found a dentist to care for the infection, it had already spread to her lymph nodes and part of her skull. It also required more expensive testing such as Cat scans, antibiotics as well as the increased risk to her unborn child.
Morris was frustrated because she’d actually been diligent about getting Medicaid coverage. She had already found out how frustrating finding good dental care was without coverage earlier that year.
Just after she moved from Chicago to Vermont to work for two non-profits, she needed a dentist immediately. Only one of her two part-time jobs offered dental insurance, but the high premiums kept her from purchasing it.
“I had a dental emergency and needed a root canal, and couldn’t find anyone who could do it,” she says. “There was nothing available, and I didn’t have any options. I checked all over town.”
She found a dentist 45 minutes away in a neighboring state who would perform the procedure at a discounted price — but still, hundreds of dollars that she couldn’t afford. An advocacy group, Modest Needs, helped her with a grant to afford the cost of the root canal.
“There really are no [avenues] for people, even those who are working in the social services field,” she says.
Dental care: Just as important
Morris’ issue is reflective of a larger one in Vermont as a whole. There are 385 dentists in Vermont for 626,000 people, but as Morris says, “Most have one foot into retirement,” and aren’t taking new patients.
Vermont is not unique. Urban neighborhoods and areas such as New Mexico and Alaska are also feeling the shortages.
“Dental access has to happen. It isn’t a luxury,” Morris says. “It’s an aspect of health, and you can’t get jobs when you’re missing teeth.”
With health care discussions on the table in the ramp up to the Affordable Care Act, many patients, dentists and dental organizations want to ensure that access to dental care is front and center — especially with stories such as Morris’.
“The reality is that we don’t have a health care system that adequately addresses this,” says Dr. Louis Sullivan, chairman of The Sullivan Alliance to Transform the Health Professions, which focuses on increasing healthcare manpower and increasing diversity among health professionals.
“We don’t have a sufficient number of dentists,” he adds. “The Affordable Care Act will be adding five million more children with health insurance into the system. That will exceed the capacity of the system to care for them, and half of the nation’s dentists do not accept Medicaid.”
Teeth and health are connected, even for kids
Dental care for children is a real concern. Tooth decay is currently the most common chronic illness among children ages six to 19. In teenagers, it’s actually four times more common than asthma.
“It impinges on the health of children and their ability to perform well in school. There’s also a higher absenteeism rate,” says Sullivan.
Not only that, but poor dentition is linked to diabetes, premature labor, pneumonia and inflammation in blood vessels that lead to heart disease. More than 90 percent of patients with heart disease have serious gum infections from poor oral hygiene. And, tooth infections can spread to the skull, as in Morris’ case, or even the brain.
Calling in reinforcements
Some communities are now looking for help. The University of Washington, for example, has a Dental Health Aide Therapist program where providers are trained — over two years — to perform basic dental care, particularly to underserved Alaska Native populations. The training teaches them to remove teeth, apply sealants and perform fluoride washes.
They function similarly to how physician assistants and nurse practitioners practice in the medical arena.
“We could provide services at lower costs,” says Sullivan. “It’s working well in Alaska, in remote Alaskan villages. But there is strong resistance.”
Sullivan stands by his opinion that the quality of the care that they provide is equal to that of dentists. But, the American Dental Association has its reservations.
“We’re trying to implement programs to get people the treatment they desperately need right now,” says Dr. Robert Faiella, periodentist and president of the American Dental Association who practices on Cape Cod, Mass.
“We don’t see having [dental health aide therapists] as a solution. Resources are best put toward programs that we know work, like national campaigns that increase access to dental care,” Faiella continues.
Some of those efforts include referring dental patients who end up in emergency rooms for pain or treatment into free dental clinics, and utilizing community resources to guide patients.
One dentist takes matters into his creative hands
When asked about Morris being turned away from dentists, even while pregnant, Faiella was surprised: “We have a code on ethics and professional conduct. All of the dentists that I know want to do what’s right. We want to help people more than anything else.”
Other dentists share Faiella’s sentiments.
“The problem is not this one patient and the one dentist who told her ‘no.’ The problem is the broken American health care system,” says Dr. Lee Gause, dentist and owner of the Smile Design Manhattan dental practice.
He explains that there’s an incredible cost for dentists to provide dental care and procedures — often thousands or tens of thousands — which ultimately impacts the prices charged.
“Any dental office would be bankrupt if they treated [free] patients for a month,” Gause says.
“We want to offer people the highest level of care,” he explains. “So, how do we provide the highest level of care in the most cost effective way?”
Since 2005, Gause’s office has become creative, literally, selling art from major artists and using the profits to fund their charitable work.
“We can then provide the highest level of care for people who don’t have access to insurance or the capacity to write a big check,” he explains. “I never wanted to be that guy that charges so much that the only people who could afford it is the uber-rich.”
The big picture
Morris advocated for a year in Vermont until she saw change. Since summer 2012, any pregnant woman on Vermont’s Dr. Dynasaur insurance plan — a plan based on income eligibility — now receives full dental care. She continues to advocate in hopes of even wider spread coverage.
The American Dental Association is pushing for access to dental care and building upon examples of what’s worked in certain states.
Dr. Tyeese Gaines is a physician-journalist with more than 10 years of print and broadcast experience, now serving as health editor for NBC’s theGrio.com. Dr. Ty is also a practicing emergency medicine physician in New Jersey and a clinical instructor of emergency medicine at Yale School of Medicine. Follow her on twitter at @doctorty.