A Premium for Pearly Whites

by Elana Hayasaka

Why does health insurance cover everything but your teeth?

There it was, a black speck no bigger than a poppy seed, right smack in the middle of my bottom molar. I scraped at it, squirted it with mouthwash, and scrubbed at it with my toothbrush, but to no avail. At age 25, I had my first cavity.

I’ve visited a doctor’s office three times in the past year for other relatively minor issues. A quick flash of my medical insurance card and all was well. But even with a decaying hole in my sore mouth, I hesitated making a dental appointment. As a student with loans and a fixed budget, it came down to paying rent or seeing a dentist. Even though I have a “comprehensive” health insurance package, like most private insurance policies, it does not include basic dental procedures. For those less fortunate than myself, the options are even grimmer. Medicare generally excludes dental coverage, and Medicaid funding cuts have reduced or eliminated dental coverage in many states—including Massachusetts.

According to the US Census Bureau, 15.7% of Americans went without medical insurance in 2004. While this is a tragedy in itself, for every American without medical insurance there are three without dental insurance: half of the total US population. Some may say that dental insurance is cosmetic or not nearly as important as medical coverage. After all, a toothache is not as serious as a heart attack, and who’s heard of anyone declaring bankruptcy from having a cavity? But by excluding dental coverage in health plans, we are excluding a relatively cheap and easy way of promoting good health, as well as a way to cut healthcare costs in the long run.

Tooth and mouth problems not only cost the uninsured a chunk of cash, they cost business a bundle. Each year, Americans miss more than 164 million work hours because of tooth and mouth pain caused by poor oral health, according to a 2003 study from George Washington University. Most of these problems are easily—and cheaply—preventable. Regular trips to the dentist not only uncover and fix problems before they become serious, they can provide information and feedback on how patients can improve their overall oral health to prevent problems from even happening. Uninsured Americans are far less likely to visit a dentist, according to a recent report from the Surgeon General. Instead, they often end up in emergency rooms where they are treated with painkillers and/or tooth extractions, which end up costing more than either a preventative check-up, or a simple filling. Additionally, the treatments received in ERs do little to address the underlying problem—poor oral health. These patients will likely suffer again.

Not including dental health in medical insurance policies implies that dental health is inherently different and less critical. However, studies have shown that the same gingival bacteria that cause tooth decay may also trigger heart attacks. In fact, a number of recent studies funded by the National Institutes of Health have shown links between oral health and serious medical problems including an increased risk for heart disease, stroke, respiratory diseases, and arthritis. Furthermore, poor oral health results in a more obvious problem—mouth pain, which can lead to eating problems, poor nutrition, loss of sleep, breathing problems, and interference with daily tasks, according to the Surgeon General’s report.

Many doctors and dentists agree that good oral health is a tenant of good overall health. It can also serve as a quick indicator of illness. In a survey from the American Academy of Periodontology, 96% of dentists responding said that they’ve referred patients to an M.D. to evaluate another medical condition after examining their teeth. Cardiovascular disease, diabetes, and osteoporosis were the three top reasons for referral.

Poor oral health can also lead to problems with mental and emotional health. People notice teeth—are they straight? Are they white? Are they all there? Our society frowns on Austin Powers-type snaggletooth grins. Those unable to afford braces or teeth cleanings are placed at a social disadvantage that could affect self-esteem, career advancement, and even relationships, according to the Surgeon General’s report.

Recently, Massachusetts politicians have produced a number of plans to make health care affordable for all residents. They claim that their plans will achieve “universal health care” or “comprehensive health care for all.” But without dental coverage, none of these options are truly “comprehensive” or “universal.” For many Americans, the question remains: pay the dentist bill or pay the rent?