Toussaint column: The closed-mouth secrets of American dentistry
Recently, I read a heartbreaking plea on a local Facebook group. A Glenwood Springs resident (I’ll call her Mary) asked for a dentist to volunteer to pull her husband’s tooth. It had been aching for six-plus months, causing fevers, nausea, fatigue and sleeplessness.
I could have (tritely) posted back, “I feel his pain.” I was ravaged by toothache much of last summer.
Like nearly 130 million Americans — including 22% of kids younger than 17 and 70% of seniors — I don’t have dental insurance. But thanks to finding the right dentist and aging into Medicare, I can afford dental care now.
I ruefully remember several years ago when the late Jim Calaway asked me to contribute to a dental fund for CARE shelter animals. I’m sure Jim would have been appalled to discover that my husband Mason and I had just debated whether to replace my broken hearing aid or his missing tooth. Neither was covered by our insurance. (The hearing aid won. I needed it to keep working.)
Although it took three appointments to fix my rather-tricky cracked tooth last summer, Dr. Connor Rivers of Mountain Family Healthcare finally pulled that molar. Thus ended months of misery.
That extraction cost me about one-fourth of what Mary was quoted by a Glenwood dentist!
Since moving here eight years ago, I have changed dentists three times — a marked departure from my earlier patterns. While living in San Francisco, I stuck with Dr. Richard West for 32 years.
The reasons for my dentist-hopping are multiple: I do want dental care. I don’t want bleaching or $1,000-per-tooth veneers. I don’t want to be pressured to have all my fillings replaced. Chocolates seem an inappropriate “gift” after tooth cleaning, and I don’t want cheery electronic greetings from the dentist on my birthday.
If my parents had been more securely anchored in the middle class or if I had grown up a decade later when braces became common, I probably would have far better teeth now. I was born missing two teeth. As a result, my bite shows uneven gaps. As a self-conscious teen, I learned to smile without showing any teeth.
In 2017, author Mary Otto outed the sad secret that hides in our mouths. Her book, “Teeth: The Story of Beauty, Inequality and Oral Health in America,” carries this message: America’s starkest class divide might be the one between those who spend thousands on a gleaming smile and those who suffer preventable tooth decay.
Otto started her book with the story of Deamonte Driver, a 12-year-old Maryland boy who died from an infection caused by one decaying tooth.
Although I can fully understand how toothache could drive someone to knock out his/her own tooth, I didn’t know that tooth decay could be deadly.
I know that bad teeth impact our ability to speak and eat, as well as to compete for jobs. But tooth decay also can complicate diabetes. Dental issues also contribute to cardiovascular disease, respiratory infections, infertility, erectile dysfunction, cancer, kidney disease, rheumatoid arthritis and even dementia.
Nonetheless, 40 percent of Americans lack dental insurance.
A deep look into how that came be, and into how dentistry works in the U.S. now, provides a glimpse into what a purely for-profit medical market might look like. It’s not a pretty picture.
These days, dentists generally earn more per hour than doctors, and they do so by emphasizing many of the cosmetic and high-pressure practices that have driven me out of two local dental practices (that shall remain nameless).
Most dentists are ethical, but cons aren’t uncommon. Most of the estimated $250 billion Americans lose each year to dental fraud result from dentists billing for services never rendered, for fictitious patients and inflated claims. It also comes from worthless or unneeded treatments. (My brother, who worries about mercury poisoning, has had all his silver fillings replaced. I wonder about that. We had the same childhood dentist, and mine are fine.)
Many rural areas lack dental care. Dentists can’t make a secure living there because there aren’t enough rich folks, and Medicaid and Medicare don’t pay enough. As a result, Remote Area Medical Volunteer Corps, a charity that was set up to serve Third World countries, has wound up serving Americans. In the 34 years since its founding, it has held thousands of free clinics across the U.S. It’s holding one in Paonia on Aug. 3-4.
Another nonprofit, the Colorado Mission of Mercy, will hold a free dental clinic at Glenwood Springs High School Oct. 4-5. That “no questions asked” clinic will be staffed by 200 volunteer dentists and hundreds of hygienists, and will offer more than $1 million in donated services.
I hope Mary’s husband finds his way there.
Nicolette Toussaint lives in Carbondale. Her column appears monthly.
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