The Silent Epidemic

By HEATH FOSTER
SEATTLE POST-INTELLIGENCER REPORTER

Angelito Haney was just over a year old when his teeth started to fall apart. Chips of the curly-haired toddler's baby teeth would come out if he bit down on a plastic toy.

The SeaTac boy's pediatrician gave his mother the card of a local dentist. But when Tammy Haney called to make an appointment, she was told the dentist wouldn't accept her son's Medicaid coverage.

These days, only one in three practicing dentists in the state accept the low-paying government insurance for poor families. But it's not just the poor who have trouble obtaining care.

More than three times as many Americans lack dental insurance as lack health insurance. About 3.1 million people in Washington -- half the state's population -- have no dental insurance or rely on Medicaid. For them, care has become a luxury afforded only after the rent has been paid and food put on the table -- and often only when tooth pain becomes unbearable.

The U.S. surgeon general has called this growing lack of dental access a national "silent epidemic."

Angelito's mother lost her family's insurance when she was laid off from her $15-an-hour job in the accounts-payable department of a large painting company. She had no savings to pay for a private dentist.

When she finally got her son to the non-profit Odessa Brown Dental Clinic in Seattle a year later, the damage was done. The painful toothaches keeping Angelito awake at night had come from dying nerves and an abscess in the bone threatening the development of his permanent teeth.

After a six-month wait, a surgical team at Children's Hospital and Regional Medical Center sealed, capped and filled as many of his teeth as they could. They had no choice but to send the talkative boy home earlier this month without any front teeth.

In recent years, surgery to repair badly decayed teeth has become one of the top 10 procedures to fill Children's operating suites. Pausing after pulling the last of six unsalvageable teeth, pediatric dentist Barbara Sheller remarked, "It's heartbreaking to face the same difficulties in family after family. This is a really complex way to manage dental disease. If kids were getting routine dental care, we could avoid this."

Disparities in Washington

About 40 percent of people under age 65 and 77 percent of seniors in the state are making do without dental insurance, according to estimates by the Washington Dental Service Foundation.

The only insurance that guarantees quick access to care is the increasingly expensive private kind. In 2002, just a third of the 1.1 million low-income people in Washington eligible for Medicaid-covered dental care actually saw a dentist, according to state data.

Meanwhile, those who do have the private insurance accepted by mainstream dentists are sometimes getting more treatment than they need, experts say. Tooth-whitening, a $600-million-a-year industry, has become the fastest growing segment of dentists' practice, according to a 2002 American Dental Association survey.

"We have one group of people that is way over-seen, and another that is not being seen at all," said Dr. Peter Milgrom, director of the University of Washington's Northwest and Alaska Center to Reduce Dental Disparities.

A common rule of thumb in the dental world is that 80 percent of cavities are found in 20 percent of the patients -- people who tend to be poor, elderly and members of immigrant and minority groups.

This isn't a joke. Dental work isn't on anybody's radar screen, yet it affects the poor in ways it affects no other class of people. A couple of months ago, just about the time I started FTT, I developed gum problems that required pulling a lot of teeth. I managed to pay for the surgery but the continuing treatment I need to stop the gum disease is beyond my means, as is paying for a dental plate. The pain in my jaw is constant, talking is difficult--between the loss of teeth and the shooting pains that come whenever I try to move my jaw to form words, I am almost unintelligible when I try to talk--and eating almost impossible; I've had to give up eating a lot of vegetables simply because I can't chew them. Except for hamburger, meat is out of the question. Nutritionally, my diet has gone to hell.

And I have health insurance--one of the main reasons I hang onto the job I have. In fact, until recently when my employer switched carriers, I had probably one of the best health insurance plans available in the state, and even it didn't cover dental work.

There's a perception that dental health is somehow a 'luxury'. Not for the poor, it isn't. We are judged more harshly by our appearance than most, and teeth are a big part of that. I grew up with a kid who'd had to have his teeth removed and replaced by a dental plate before he was 12. He was ostracized by other kids, seen as retarded by the school administration even though he was quite bright, and in general placed on a path that would ensure he never rose above his 'natural place'.

Bad teeth affect our diets, our acceptance by society, and our ability to get jobs. Annie LaMott once wrote that of all the fears her neurotic mother suffered from, the fear of 'people with rotten teeth--or worse, no teeth' was the worst. 'She felt there was something predatory about them. Mothers don't like it when people without teeth look at their children.'

It's something we suffer in silence and nobody else is talking about it, either. Dental insurance exists but it's prohibitively expensive even though most dental procedures are a lot cheaper than your standard medical procedure; health insurance will pay thousands of dollars for a tonsillectomy but refuse to pay a few hundred for a root canal. I don't, in all honesty, know why.

Maybe it's because only the poor need help paying for such things.