by Conor Friedersdorf

A reader writes:

My family suffers from a genetic disorder that causes enamel dysplasia.  In a nutshell, by body does not know how to create the protiens that create enamel.  Therefore my teeth are spotted, pitted, and destined to rot out regardless of the amount of cleaning I do.  This condition is a dominant gene.  My father had it, and my three siblings all have it.  My sister had fillings put into her baby teeth and three of my 12 yr old molars came in with cavities.  Any future children are likely to have this.  Don't even get me started on my own internal moral debate about bringing children into this world knowing they too might have to deal with this.  If there was a way to isolate this gene out of my kids I'd take it in a heartbeat.

I've been to three dentists and all agree that my molars need to be capped and all my other teeth need vaneers to prolong the life of my teeth as much as possible.  They look at me with a straight face and tell me I need $50k of dental work, and all three have been suprised when I refused treatment without any coverage.  I get the, "...but it's your teeth!"  Yeah, it's my bankruptcy too. 

All of them want to do all the work at once so they can set a proper bite, so phasing this over time isn't an option.  I still get two offices pestering me as to when I'm going to start in a way that makes me feel like they are more concerned about the money than my teeth or finances.  My medical insurance says it's dental, and my dental says it's cosmetic.  Even if my dental covered it, they only cover $2000 a year.  Oh and I might have to get all the caps and vaneers replaced every 10 years.

So I sit here, knowing my teeth will start rotting soon.  I figure I'll just take it one tooth at a time (hopefully).

Says another:

I'm a doctor at a public hospital that is a safety net provider for the uninsured, in addition to a Level 1 trauma center.  It's a front row seat at the circus that is our health care system, one that affords an unusually clear view of its myriad cracks. 

With eye care, the major problem I've encountered is getting glasses.  It's a long wait for a routine exam here, but the real obstacle is that $70 for a new pair of single-vision glasses can be a princely to the point of unobtainable sum for someone who is poor.  Bifocals, that scourge of middle age, are even more expensive.  For nonrefractive eye problems, I haven't seen much in the way of access problems, even for uninsured patients.  The optometrists and ophthalmologists work together well.  Salaried providers are perhaps less likely to get into the inter-specialty turf wars that can flare in the fee-for-service world.

Dental care is another matter entirely.  Brain abscesses or meningitis from bad dentition isn't common, although I have cared for patients with those conditions over the years.  There are plenty of other interactions between oral and general health that we have a hard time managing properly, however, because of inadequate access to dental care.  One of the medications I prescribe more commonly than I would like (but less commonly than five years ago, so I suppose that's progress) causes significant gum disease.  It is partly preventable with assiduous dental hygiene, but some patients get into trouble despite that.  Moreover, homeless patients, even ones who take their medications regularly (and more of them do than many people might realize), can have trouble flossing twice a day.  Some of these side effects can be mitigated with more frequent dental cleanings, but even the modest sums the local dental schools charge in their student clinics are beyond the reach of many of my patients.  When the necessary procedure is a root canal, extraction, or something pricier, the barriers to care are even more frustrating, because the underlying problem is often more acute. 

The horrendous effects of methamphetamine on dental health are well-described.  It's frustrating to see someone manage to beat meth, no easy task, but not be able to get the reconstructive dental work without which a job will remain out of reach, quite possibly increasing the risk of relapse. 

When the economy tanks, more patients seek our help because they lost their jobs and then their insurance, right when the budget ax is falling.  Having worked at my hospital through several economic downturns, I have become accustomed to people who were solidly middle class a year ago, or even less, on our wards and in our clinics, saying, "I thought all you guys did was take care of gunshot victims and drug addicts... I never thought I would find myself here... thanks.."   I almost wonder if an uptick in these patients might be a leading indicator of an economic downturn.  These are also people for whom the lack of a pair of glasses or timely access to dental care, something they never imagined for themselves, has become a reality.

And one more:

In 2003 my mother started taking the anti-osteoporosis drug Fosomax to help rebuild her bones. In 2005 a not-so rare side effect of the drug caused her to jaw to start deteriorating to the point where a massive infection of her jaw, gums and teeth required rather dramatic reconstructive "dental" surgery. In late 2006 she was diagnosed with Pancreatic Cancer. Shortly after this study from Harvard and Dana Farber Cancer Institute linking pancreatic cancer to periodontal disease was published my mother was dead.

There are many other medical ailments, some potentially fatal, that are likewise associated with dental diseases. Nobody will ever convince me that oral health is not 100% part of medical health. And an insurance company that says otherwise can go to hell.

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