I'm a primary care physician and over the years I have seen a significant number of patients coming to me with dental problems which fill me with frustration. Today I thought I will just write about it. I even taught my students that oral health reflects underlying socioeconomic status and health habits. Don’t forget to notice dental caries and evidence of gingivitis I reminded them. I resorted to making friends with some nice dentists. Recently, email was circulated to publicize the two-day free dental clinic that came to town in July 2017. I thought to myself sarcastically--another band-aid solution and then walked in to clinic a familiar patient of mine who has diabetes and arthritis, who lives with pain every day of his life but this time, he said he had been so miserable for months from dental pain. He could not sleep; he thought the poison was all over his body. I did my due diligence to make sure he did not have an abscess or blood infection, gave him a short course of antibiotics and yes gave him the information for this free dental program. I had given him repeated referrals to the only free dental clinic in town that I know of, couple other ones with sliding scale fees and usually he would postpone, next appointment another month of 2 away, could be the pain got better or he just managed to ride the pain until it resurfaces another day.
The ADA has identified access to dental health care as top priority for years. The National Academies published a report in 2011 on improving access to oral health care for vulnerable and underserved populations. I don’t know why we treat our teeth differently than the rest of our body. We tend to carve out, compartmentalize our body as if certain body parts are luxury items and disposable? The same thinking possibly has impacted how mental health is often disconnected from physical health and so we have separate coverage for vision health and contraception, etc. Public health dentistry has done a decent job with our children through programs such as dental sealants but we have neglected adults who need good teeth to eat, to chew, to engage socially, and to avoid downstream complications such as infection and surgery. My patient had 3 teeth pulled out that day. He was told that they could not do more because they did not have enough time. He was so grateful to have the “poison pulled out of him.” This time, he got a follow up appointment with the free dental clinic to get the remaining teeth removed…in 3 months.
Speaking of complication from dental infection, when I was on inpatient service recently, I took care of a young woman with intellectual disability and severe hip arthritis. She was residing in a skilled nursing facility and sent to the ED for facial swelling. The oral surgeons took her to the OR to drain the abscess and extracted 2 teeth. They told the father that there was a third infected tooth near the abscess site which will need to come out in the near future but that could be done as outpatient. The father was furious. He did not understand why the surgeons did not remove all the infected teeth because bringing his daughter back and forth is not an easy thing. With the hip arthritis, she is not able to walk and arranging for transportation is a big deal for him. Moreover, he was also worried about insurance coverage. At the time, there was talk of repealing ACA, cutting Medicaid, etc. (still going on now I guess). The surgeon could not give the father a good explanation. All I could do was just to listen and assure him that I will do everything possible to coordinate a return appointment. I did not follow up to see if it happened…I was afraid to know.
We need to advocate for dental coverage as part of health insurance benefits. Interestingly, my limited research into dental coverage in other OECD countries shows that they too are skimpy on coverage for adults and that dentistry coverage is separated from the rest of health care even in countries with universal coverage. UK’s NHS provides some coverage but apparently there are still significant out of pocket costs. Sigh.
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"