Healthy Teeth, Healthy Me

Maintaining good dental health is not just about having a bright smile; it plays a crucial role in our overall well-being. The health of our teeth and gums can have far-reaching effects on our general health, from cardiovascular health to cognition. Regular check-ups and cleanings are not only part of maintaining good oral health, but also help to prevent serious systemic disease.

Impacts of Poor Dental Health on General Well-being

1. Cardiovascular Disease: Poor oral health has been linked to cardiovascular diseases such as endocarditis and clogged arteries. Bacteria that constantly form layers of plaque around our teeth become more harmful as they stay there; once plaque hardens, it forms tartar. The process over time can lead to inflamed gums and gingivitis, advancing to periodontitis, or gum disease. What makes poor dental hygiene so dangerous is the associated increased risk of bacteria entering the bloodstream through inflamed gums, sticking to platelets that can form blood clots, which can eventually block the flow of blood to the heart, triggering a heart attack.

2. Respiratory Complications: Bacteria stemming from gum disease can infiltrate the respiratory system, prompting infections, pneumonia, and related complications.

3. Diabetes: Gum disease and constant tissue inflammation weakens the body’s ability to utilize insulin and maintain proper blood sugar levels.

4. Pregnancy Concerns: Periodontitis has been associated with adverse pregnancy outcomes such as premature birth and low birth weight.

5. Age-Related Considerations: Age definitely plays a factor as cavities and gum disease may increase as we become older due to diminished saliva production, receding gum lines, and poor vision as well as physical limitations, which contributes to inadequate flossing and brushing. Ultimately, poor dental health can lead to tooth loss, which impacts a person’s ability to eat a balanced diet.

6. Cognitive Implications: A troubling statistic from a study done in 2010 found that people with gum inflammation were nine times more likely to score lower on cognitive tests and were linked to an increased risk for developing Alzheimer’s disease.

In 2020, the American Dental Association (ADA) adopted a policy that viewed dentistry and oral health as an essential service due to its role in preventing oral diseases leading to systemic health issues.

Why is Getting Decent Dental Care So Challenging? And Has Finding a Dentist Become Harder?

The Threat of Hidden Motives

Finding good dental care or a reliable dentist can be challenging, for various reasons. Dentistry, like any profession, can have unethical practitioners, leading to a lack of trust and reputation within the field. Some dental offices have been acquired by investors who set unreasonable financial expectations, incentivizing profit over quality care. Sadly, this has led to many people paying for and receiving unnecessary procedures.

One such example is of a three-year-old boy in Ohio, who had to endure seven root canals without having had x-rays taken; his mother explained that she trusted the dentist, whom she saw as a professional. This “professional” proceeded to drill the preschooler’s teeth in May of 2013; the final invoice came out to $1,273 compared to the $61 Medicaid would have covered under a routine checkup and cleaning. The dental office, Dental Express, had been acquired by North American Dental Group, which is a large chain backed by private equity investors. A year earlier, the company had set aggressive revenue targets that had to be reached or the dentists risked getting kicked out of the group.

While most dentists and people would describe this as child abuse, as more dental offices are joining this network with North American Dental Group growing to more than 200 offices in 13 states east of the Rockies and having a million patient visits a year, any dentist could be vulnerable to succumbing to unethical actions when prioritizing profits over health, ultimately placing patients at risk.

Thankfully, this is not the norm and that dental group is currently under investigation due to a number of complaints from dentists, employees, and patients who were diagnosed with a “mouthful” of cavities only to later be told that nothing was wrong with their teeth.

Financial Barriers

The cost of dental care can be prohibitive for many individuals, especially those without insurance or from lower-income backgrounds, leading to disparities in access to quality oral health services. Costs run high typically for most dental procedures. Some of the costs may be attributed to dentistry being a profession that, similar to medicine, requires years of school and training that is costly.

Dental insurance also has its limitations, which I’ll go into later, but it functions more as a maintenance plan rather than comprehensive coverage, with limited annual benefits that haven't increased significantly over the years to be able to meet the increased out-of-pocket costs for patients.

Staffing Challenges

Turnover in dental offices is a challenge and finding quality staff is difficult, something my own dentist who bought his practice in San Diego eight years ago recently told me. It’s interesting to note that the dentist-to-population ratio across the U.S. averages to be around 61 dentists per 100,000 population; California and Alaska are some of the higher ratios with 78.9 and 80, respectively, while District of Columbia had the highest at 104, followed by Massachusetts at 84.2.

According to the ADA, three quarters of dental practices have complained about the process of finding and hiring good dental hygienists and assistants being “‘extremely challenging’” ever since the pandemic; around 8% of the hygiene workforce left during that time as many were adults in their 60s, some with work injuries whom I have helped as an advocate in the past, and not willing to risk their health or just felt “burned out,” retired early; the rest have come back only part-time and the ones that kept their full-time status saw an increase in wages, but that created another problem in which workers left their employers due to being offered more money elsewhere.

One article stated that replacing an employee costs around 16% to 213% of an employee’s salary, the wide range of course due to the given industry one is in. And turnover in dental offices remains a challenge with one survey finding the rate of turnover could be as high as 30% for dental assistants. The good news is organizations like the ADA are writing congress for policies effecting changes that include increasing student loan reform, tax reform for small business owners, investing in future workforce, as well as consolidating insurance plans. Also, the ADA expects 50% of dental practices in 2024 to begin recruiting across all job functions and the hope is that practices are able to maintain a work environment that fosters employee satisfaction and retention.

Why is Dental and Vision Insurance Separate from General Health Insurance?

Dental and vision care have historically been treated separately from general healthcare with past public health policies viewing dental and vision care as less critical compared to other medical needs. This separation has led to challenges in integrating these essential services into standard health insurance plans, often driven by cost containment efforts.

But having separate optional dental and vision insurance plans actually increases costs for some. I have always seen this separation as akin to buying a car with “optional” tires and engine or a cracked windshield. Without all parts working properly, the car can be deemed non-functional; so too our physical health and overall well-being can be severely restricted by not having complete coverage. Our teeth are not separate from us, if they are, then we are probably in need of dentures. If our vision fails, our mobility, independence in activities of daily living, our means of making a living, and our social network become restricted, if not completely absent.

It has been said that the medical field never accepted dentistry as part of its practice, much like podiatry, which theoretically is why they have different schools, techniques, and separate insurance coverage. Even mental health is considered by some insurance companies as an “optional benefit” and not included in their coverage. This separation can make coordination between different insurance providers complex and time-consuming.

Many dental practices offer their own insurance plans now where you pay them monthly for maintenance services like cleanings and check-ups, but also offer discounts for certain services and procedures. This could be beneficial and eliminate the need for a separate insurance plan, but you would need to find a convenient office and a dentist you trust.

Volunteering

The California Dental Association (CDA)’s non-profit foundation has hosted CDA Cares, a program that connects patients in need of dental care and without insurance with volunteer dentists; currently, the program has 26,877 volunteers providing care to 30,247 people with $25.19 million worth of dental services provided.

Advocacy in Dental Care

I once had a patient who injured his head and neck in a forklift accident at work and he contacted me to attend his appointments and assist him with arranging the surgery he needed to be approved by the insurance company. Throughout this process, we discovered that he had chipped a few teeth in the accident and had developed major tartar accumulation and a few cavities. You see, after his injury, COVID happened, and any “non-essential” procedures or doctor and dentist visits were postponed indefinitely, and my client had not seen a dentist in more than two years since the accident. Although COVID restrictions had been lifted by then, his work injury had placed him completely off leave and he had no benefits left, neither dental nor medical. Prior to his surgery, he also discovered his blood pressure was on the rise, which may or may not have been linked to his less-than-ideal oral care.

As a result, I worked overtime trying to find him a solution as a dentist would need to see part of him through his worker’s comp insurance and another part for regular dental check up and care. I was able to find him an affordable local dentist who could see him and provide comprehensive care for all under $100 per visit. This was the second dental provider he saw for a second opinion, as the first one, recommended by the worker’s comp insurance company, suggested a list of procedures that would mostly be non-covered, and the out-of-pocket expenses were unaffordable for my client. I urged him to follow through with the appointment to address his dental issues and prevent any serious complications.

The case was a good example of how a focus on one part of health and body in exclusion of another can lead to serious illness later in life. As a result, proper care is essential and includes:

1. Brushing and flossing teeth at least once, but preferably twice a day.

2. Going in for regular checkups and dental cleanings twice per year (or more if the dentist deems it necessary due to higher risk for gum disease).

3. Seeking a second opinion if a high number of expensive treatments in excess of what seems reasonable are recommended by your dentist.
   

In Conclusion

So, I hope to bring awareness to this issue and remind the public of the importance of maintaining proper dental hygiene. Though it may be hard to find a good dentist or an office you feel comfortable with and can trust or afford, advocates can help with your search. If there are any obstacles preventing access to oral or medical care, then it may be time to call on the assistance of an advocate that can help guide and advocate for you and your overall health.

Schedule Your Free Consultation With An Advocate Today

References

1. Pham, M. (December 29, 2023). Breaking Down Why It’s So Hard to Afford Dental Care Today. Retrieved on March 19, 2024 from https://affordabledentistnearme.com/why-is-it-so-hard-to-afford-dental-care/

2. Willsky, K. (February 24, 2022). Why Affordable Dental Care Can Be So Hard to Find. [Review by Dr. Nassim Assefi]. Zocdoc. Retrieved on March 19, 2024 from https://www.zocdoc.com/blog/why-affordable-dental-care-can-be-so-hard-to-find/

3. The Dental CFO. (March 13, 2024). The Biggest Challenges Dentists Face in 2024. Practice Consulting, Human Resources. Retrieved on March 19, 2024 from https://www.thedentalcfo.com/blog/the-biggest-challenges-dentists-face-in-2023

4. Glick, DDS, A., Tello, DDS, A., and Glick, DO, J. (May 8, 2023). Dental Insurance: A Time for Disruption. Ontario Academy of General Dentistry. Retrieved on March 19, 2024 from https://www.agd.org/constituent/news/2023/05/08/dental-insurance-a-time-for-disruption

5. Cosmo Insurance Agency. (n.d.). Unraveling the Mystery: Why Dental and Vision Insurance Aren’t Mandatory. Retrieved on March 19, 2024 from https://cosmoins.com/unraveling-the-mystery-why-dental-and-vision-insurance-arent-mandatory/

6. CareQuest: Institute for Oral Health. (September 6, 2023). New Report: 68.5 Million Adults in the US Don’t Have Dental Insurance…Retrieved on March 19, 2024 from https://www.carequest.org/about/press-release/new-report-685-million-adults-us-dont-have-dental-insurance-may-rise-914

7. Freed, M., Cubanski, J., Sroczynski, N., Ochieng, N., and Neuman, T. (September 21, 2021). Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage. KFF. Retrieved on March 19, 2024 from https://www.kff.org/health-costs/issue-brief/dental-hearing-and-vision-costs-and-coverage-among-medicare-beneficiaries-in-traditional-medicare-and-medicare-advantage/

8. CDC. (December 22, 2020). Oral Health. Retrieved on March 19, 2024 from https://www.cdc.gov/oralhealth/basics/adult-oral-health/index.html

9. UF Health. (March 4, 2016). Poor dental hygiene can lead to serious health problems. Retrieved on March 19, 2024 from https://ufhealth.org/stories/2016/poor-dental-hygiene-can-lead-to-serious-health-problems

10. American Dental Association. (2024). Retrieved on March 21, 2024 from https://www.ada.org 

11. Bintliff, C. (September 16, 2022). The Big Quit: Dental industry staffing struggles during the pandemic and beyond. Retrieved on March 21, 2024 from https://www.dentistryiq.com/front-office/article/14282694/the-big-quit-dental-industry-staffing-struggles-during-the-pandemic-and-beyond

12. Academy for Dental Assistants. (January 21, 2022). Dental Employee Turnover 2022. Retrieved on March 21, 2024 from https://academy4da.com/dental-employee-turnover-2022/

13. California Dental Association. (2024). CDA Cares: Volunteer-Powered Dental Care Events. Retrieved on March 31, 2024 from https://www.cda.org/about/cda-foundation/cda-cares/