Do We Have A Dental Health Care Crisis

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Millions of American adults are missing out on needed dental care, losing teeth and jeopardizing their health because they have no private insurance and can't afford to pay.

America has enough dentists, but there are a shortage of options for uninsured low-wage workers and poor people with government health coverage.

Without regular checkups, cleanings and other preventive care, patients with painful tooth or gum decay and often severe infections are showing up in increasing numbers at local hospital emergency rooms.

"Many of the patients that arrive at the emergency department aren't dental emergencies, not something that needs to be done today, but they are people with tremendous pain and have called every possible resource, and have nowhere else to go," said Bill Morris, medical director of Harrison's Emergency Department in Kitsap County, Washington, which saw 1,296 dental cases last year.

The local problem reflects a national gap in access to dental care.

According to the U.S. Centers for Disease Control and Prevention, for every American without medical insurance, three lack dental insurance. Nearly one-third of all adults have untreated cavities; one out of 20 middle-aged adults is missing all of his or her teeth.

This comes at a time when medical practitioners are becoming more aware of the connections between a healthy mouth and healthy body. Poor oral health — gum disease in particular — is linked to cardiovascular disease and diabetes, among other ills. In Kitsap County Washington, the United Way recently identified access to affordable dental care as the region's No. 1 need.

But solutions are elusive, and there's ample blame to go around.

Society's poorest are covered by government insurance, Medicaid, but reimbursement rates for adult dental care are low — typically less than half the going rate. Most dentists, consequently, don't accept patients on Medicaid. Dentists say that Medicaid patients also tend to miss appointments more often than private-pay patients, putting further strain on dental office budgets.

For their part, dentists as a group tend to focus more on building up their practices than sharing the burden of serving public health.

Like so many of health care's ills, that leaves hospital emergency rooms carrying the load. Yet the ER offers no cure. "Basically, all I can do is prescribe pain medications and antibiotics, if necessary, and try to provide some phone numbers to try to call," Bill Morris said, adding glumly, "The vast majority of the time, the patients already have tried all the same numbers."

Dental