Dental disease: the silent epidemic


(THE UNION)   What is one of the more common reasons a person shows up in the emergency room at Sierra Nevada Memorial Hospital? A broken bone? A baby with a high fever? A heart attack?

Guess again, said Dr. Brian Evans, the hospital’s emergency department medical director.

It’s a toothache.

“Unfortunately, we commonly see severe dental disease, even in young patients, and much of it could have been averted with proper preventative care,” said Evans. “These people do not have access to proper dental care and the downturn in the economy has likely contributed to this problem.”

According to a report released last week by the Senate Subcommittee on Primary Health and Aging, there is a dental crisis across the country, as millions of Americans are unable to get even the most basic dental care. For the more than 130 million Americans who do not have dental insurance, paying out-of-pocket for a dental check-up is often too costly.

“Peoples’ lives are being disrupted because of chronic toothaches, yet they are unable to find affordable dental care for themselves or their children,” wrote Subcommittee Chairman Sen. Bernie Sanders (I-Vt.). “This is the United States of America. We can do better.”

Recent findings:
– More than 47 million people live in places where it is difficult to access dental care.
– More than 130 million Americans do not have dental insurance.
– One quarter of U.S. adults ages 65 or older have lost all of their teeth.
– About 17 million low-income children do not see a dentist each year.
– Only 45 percent of Americans age 2 and older saw a dental provider in the past 12 months.
Source: “Dental Crisis in America: The Need to Expand Access,” a report by the Senate Subcommittee on Primary Health and Aging released Feb. 29.

Among the findings in the report, “Dental Crisis in America,” one-fourth of adults in the United States ages 65 and older have lost all their teeth, and more than 47 million people live in places where it is difficult to access dental care. In 2009, there were more than 830,000 visits to emergency rooms across the country for preventable dental conditions, a shocking 16 percent increase since 2006. In addition, poor dental health has a profound impact on overall health, including an increased risk for diabetes, heart disease and poor birth outcomes.

While many Americans are forced to live with extreme pain, for millions simply having bad teeth has prevented them from getting a job, the report found.

Sixty-year-old Patrick Wright, a Grass Valley independent truck driver, knows what that’s like.

“My teeth were so bad that I never smiled from the age of 13 on,” he said. “Having bad teeth knocks the bottom out of employment. It gives people the perception that you must not be an expert in anything, and everyone thinks you must be on crank. When I laughed, children would recoil in horror. I was embarrassed.”

At age 58, Wright was finally able to scrape together a down payment for the $7,000 needed to fix his teeth. It changed his life, he said, but he knows others aren’t so lucky.

Medi-Cal no longer covers dental benefits for adults and Medicare won’t cover any dental care whatsoever, said Karin Hoflland, a Nevada County coordinator for the nonprofit Health Insurance Counseling and Advocacy Program, leaving many out in the cold.

“I talk to a lot of people who are retiring and losing their insurance — they’re not sure what they’re going to do,” Hofland said. “You’d think preventive care would save the government a lot of money in the long run.”

Cindy Maple, executive director of Hospitality House, which provides services for the homeless, said the Sierra Family Medical Clinic’s grant-funded mobile dental van has changed the lives of some of the area’s homeless. Unfortunately, she said, the volunteer-run van is only able to help five guests cost-free every two weeks.

“Honestly, almost everyone we serve has dental problems — the worst being missing or rotten teeth from lack of care or previous drug use,” Maple said. “Before the dental mobile van we saw a lot of people in extreme pain from infected teeth. It was horrible for them and they didn’t have the insurance to even go to a doctor, let alone a dentist.

“Finding work with missing or broken teeth is almost impossible for people. For low income folks, not having coverage for dental care means no dental care. At Hospitality House, the mobile clinic meets a good portion of the need, but there are still a lot of unserved and disconnected folks out there.”

The need for dental care in Nevada County increased dramatically in 2011, said Francine Novak, director of operations for the Western Sierra Medical Clinic, which serves low-income families, as the demand went up 24 percent from the previous year.

“According to the USDA report of county-level poverty rates, in 2010, 11 percent of residents were reported to be living in poverty, and that rate increases to 17 percent when looking at people 17 years of age or younger,” said WSMC Dental Director Justin Pfaffinger, DDS. “For this reason and the historically known deficit in our county to reach this population group, offering dental services for children have remained paramount.”

The elderly have a more difficult time with transportation, added Pfaffinger, and those in elder care facilities often don’t get the critical dental care they need.

“There are hygienists with advanced training who visit these senior centers,” he said. “However, in a recent visit to one of these centers for a patient of mine, I found that there had not been a visiting dentist in recent memory and, according to one of the caregivers, most all of her patients with a denture report some sort of discomfort either from their denture being loose, broken, or having a sore spot in the appliance.”

It has been more than a decade since the U.S. Surgeon General called dental disease a “silent epidemic,” Sanders noted in a written statement. “One-third of Americans do not have dental coverage. Dentists must start serving more low-income people.”

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