WASHINGTON — As the waters from Hurricane Matthew recede, coastal residents from Florida to the Carolinas may have something else to worry about: Zika. The high winds broke through screen doors and windows, knocked out power and left behind small and large bodies of standing water that could be new breeding grounds for mosquitoes. Scientists raised… Continue Reading →
For as long as women have had breasts, women have been wearing bras, although the bra that we recognize today was first introduced in 1914. Most women have a love/hate relationship with their bra, refusing to leave the house without one, but counting down the moments until they can take it off again. Are there truly… Continue Reading →
When we talk about the successes and shortcomings of the Affordable Care Act (ACA) – and health care in the U.S. in general – little attention is given to dental care.
While the ACA defines dental coverage as an essential benefit for those under 18, insurers aren’t required to offer dental coverage for adults. Medicare, the nation’s largest insurer, doesn’t cover routine dental work. And coverage for adults through Medicaid varies from state to state.
Oral health isn’t just about nice teeth. As the surgeon general noted in a 2000 report, oral health is intimately connected to general health and can be implicated in or exacerbate diabetes, heart disease and stroke, and complications during pregnancy.
The absence of comprehensive dental care exacts a toll on millions of Americans in terms of poor health, pain and the social stigma associated with bad teeth.
People desperately need dental care
In 2003 and 2004 (pre-Obamacare), I conducted a national study of uninsured Americans in southcentral Illinois, northern Idaho, the Mississippi delta, the Rio Grande Valley of Texas and in eastern Massachusetts.
I asked nearly 150 interviewees: “If President Bush were to declare universal health care for everyone starting tomorrow, what is the first problem you would take care of?” The most common answer by a landslide echoed this respondent’s: “I’ll be waiting outside the dentist’s office at 5:00 in the morning waiting for it to open.”
Many of the people I interviewed lived with untreated diabetes, asthma or even cancer, yet their oral health problems presented the greatest challenges to their quality of life.
Recently I returned to these communities to reinterview the people I’d met over a decade earlier. Very little has changed. While the majority of the people I interviewed now had health care coverage of some sort (for nearly 20 percent of them, it was as a consequence of becoming sufficiently disabled to be eligible for Social Security), very few had managed to secure dental coverage.
Then and now, people told me about visiting emergency rooms in hopes of alleviating pain or using addictive pain medications to make it through the day. People even told me that they had resorted to pulling out their own teeth.
Take Misty, for instance. When I met her 12 years ago in Mississippi, she was a “dirt poor” (her words) married mother of five, and she was living with diabetes, domestic violence and excruciating headaches. Despite all of these quite serious problems, she told me that she was more troubled by her bad teeth than by anything else. In fact, Misty told me that she’d had such bad toothaches that she pulled her own teeth. When I asked her how she can face the pain of pulling out her own teeth, she said:
[the infected tooth] hurts so bad… it’s a relief just to get it out of there.… I’ve gone two weeks with just being able to eat soup, because they are just so bad.
By 2016 Misty had left her abusive husband, moved to Arkansas and was accepted onto disability (SSI), which allowed her to get health care coverage through Medicaid. Still, however, she suffered because of her teeth.
It can be very hard to find dentists who accept Medicaid, and when Misty finally did, she had the rest of her teeth – 25 in all – pulled in one day.
Misty’s situation isn’t uncommon. I have met women and men of various ages who, like Misty, have pulled their own teeth. I’ve also met people who were able to get part of their dental needs taken care of during brief periods of Medicaid coverage but then were left with unfinished treatment when the coverage ended.
Insurance stops at the teeth
Even though the link between dental health and overall health is clear, insurance plans tend to ignore teeth.
As health insurance began to appear to appear in the U.S. – initially in the 1920s and then more widely during World War II and in the postwar era – dentistry wasn’t part of the standard package of covered services.
As the nation’s largest insurer, Medicare plays an important role in shaping health care coverage norms. Medicare does not cover dental care. Today, according to government estimates, 70 percent of seniors lack dental coverage.
Since Medicare doesn’t cover dental, Dr. David Kroll, senior program officer at the Robert Wood Johnson Foundation, argues that this “inertia spilled over into the ACA.”
Americans who purchase dental plans typically find that the plans aren’t cheap, and often don’t cover much beyond routine preventative care. Plans often require hefty copays for procedures beyond preventative care and no or very limited coverage for dentures, bridges or periodontic work.
The ACA provided for an expansion of Medicaid eligibility, though not all states accepted the offer of federal funding to expand Medicaid coverage. Even in the states that expanded Medicaid under the ACA, strict limits on oral health care remain for most low- and moderate-income Americans.
There is one bright spot: children’s dental coverage is a required benefit included on all ACA compliant plans, and Medicaid as well. According to national calculations of the Health Policy Institute and the American Dental Association, dental care utilization among Medicaid-enrolled children increased from 35.3 percent in 2005 to 48.3 percent in 2013.
Oral health isn’t just about nice teeth
In the absence of coherent oral health services, too many Americans end up like Gina, a young Idaho woman who holds her hand in front of her mouth while she talks so that no one will see her rotted teeth. She can’t even get a job as a telemarketer because she cannot speak distinctly enough to be hired.
Many Americans incorrectly assume that rotten teeth are the product of bad decision-making; if someone had just brushed and flossed then they’d have nice teeth. But routine dental care – think of the twice-yearly checkups that are routine for people with dental insurance – keeps teeth healthy and can catch problems when they are easy to treat.
The reality is that tooth decay signifies poverty in pernicious ways. Without expanding insurance to cover oral health, millions of Americans will continue to live with pain, stigma and the risks of systemic diseases that could be averted through an accessible and integrated system of dental care.
Yeah, turns out it really was food poisoning. Just found out yesterday everyone I went out to dinner with Sunday night was sick all week — except one person. I should have ordered the same thing, right?
And I think it had a lot more to do with being a woman than with her being a doctor. I heard stories like this all the time — and remember, many moons ago, my HMO primary doctor disregarded EVERY SINGLE SYMPTOM I had for Lyme disease, and put me on Prozac instead.
So it kind of irks me when I get these weird neurological and cardiac symptoms that may or may not be related to 20+ years of untreated Lyme. No point to asking doctors anymore — they don’t know, and can’t really test. Because once the spirochete digs into your organs, it doesn’t show up on tests and they can only tell with an autopsy. Whee!
A GP who died from a rare form of kidney cancer has warned of the difficulties doctors face in getting treatment for themselves, in an emotional blog published posthumously.
Dr Lisa Steen described her anger at colleagues for failing to go the extra mile to help identify the disease and for dismissing her as a hypochondriac, in the essay published on BMJ.com.
The 43-year-old mother-of-two from Cambridge wrote of spending “two years wandering in the wilderness of the medically unexplained” before finally being diagnosed in July 2014, by which time the cancer had spread to her bones. She died in February.
Humans may be prejudiced by nature, but a new study has found that who we choose to hate may depend on our overall intelligence. The finding reconfirms the idea that it may be human nature to dislike those who are different from us — including those who look and think differently. According to the study, people… Continue Reading →
It won’t be available anytime soon, of course, but it’s great progress:
Regenerative dental fillings that allow teeth to heal themselves have been developed by researchers, potentially eliminating the need for root canals.
The treatment, developed by scientists from the University of Nottingham and Harvard University, earned a prize from the Royal Society of Chemistry after judges described it as a “new paradigm for dental treatments.”
The tooth filling works by stimulating stem cells to encourage the growth of dentin—the bony material that makes up the majority of the tooth—allowing patients to effectively regrow teeth that are damaged through dental disease.
Lola Gayle, STEAM Register Cortisol is a hormone released by the body in response to stress that can be very bad for your health. The higher your cortisol level is, the more stressed you’re likely to be. Now, researchers from Drexel University have found a way to quickly lower high cortisol levels: sit down and do… Continue Reading →
This Ben Whitley piece is not all that convincing to me. My experience is that doctors are all too eager to punish the same outcomes with midwives they would excuse in physicians. Birth isn’t 100% predictable, as ob-gyns are happy to point out when it suits them:
In light of what is being called the biggest malpractice settlement in 10 years, midwives and doulas are being called out by medical professionals and the general public for lack of training, as well as little recourse when things go wrong. If midwives want to practice as physicians then they should be prepared to carry the same risks as trained medical professionals.
Even though most births under the care of a midwife are successful, some do go wrong and can produce devastating consequences. The question must be asked, for the ones that do go wrong, could they have been prevented and, if so, do the injured families have any recourse for the malpractice?
An Oregon couple received a $13 million settlement for their son, delivered by midwives at Legacy Emanuel Medical Center, in what is being called a botched water birth. This settlement is the largest in a decade for a hospital birth malpractice case.
The family’s lawyer, Rich Rogers said the couple was informed by the midwives that the mother was an ideal candidate for a safe water birth, when in fact she was not, due to the baby having an abnormal fetal heart rate upon entering the hospital.
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About 800,000 people in the United States suffer from a stroke each year. Of those who survive, about 70 percent will be left disabled, making the cardiac event a major cause of adult disability. While there are therapies to help improve patients’ mobility, they’re only effective within the first few hours of an event. Recently, researchers… Continue Reading →