Dental Trends

The dental care divide.

May 17, 2017

Last fall, we wrote a post about the dental care divide in the U.S. A recent Washington Post feature story put a human face on this public health challenge.

The Post article describes the work of Mission of Mercy, a non-profit that provides free dental care to those who “fall through the cracks” of the U.S. healthcare system. In March, the non-profit offered free dental treatment to the first 1,000 patients who showed up to the Wicomico Civic Center, on Maryland’s Eastern Shore.

Before dawn, Dee Matello lined up outside the civic center with hundreds of others. Matello and her husband own a small vending machine business. She had been living with a shattered molar for years, but didn’t have dental insurance or enough money to seek treatment. In fact, she hadn’t seen a dentist in nearly a decade. At the civic center, Dr. Robert Testani, a volunteer dentist from Catonsville, M.D., finally pulled her molar.

Over two days, 116 dentists treated 1,165 patients. Many of these patients had steady jobs—driving a forklift, tending a library, delivering mail—but no dental insurance or enough cash to pay for treatment out of pocket.

Their story is not unusual. According to the American Dental Association’s Health Policy Institute, more than a third of American adults have no dental coverage.

Louis Sullivan, who served as Secretary of Health and Human Services under President George H.W. Bush, offers a few explanations for this yawning gap in coverage.

New dentists start with significant debt, he explains, which pulls many to wealthier areas, where they have a better shot at making more money early in their careers. Poorer areas have fewer dentists—some none at all.

And dental care is kept separate from medical care, a separation that extends to insurance. Most healthcare plans, including federally-sponsored Medicare, offer little to no dental coverage. Supplemental coverage is expensive, and doesn’t always provide much in the way of benefits. So many Americans go without.

In rural areas, where it’s already difficult to find a dentist, water quality further complicates things. Many homes in those areas rely on well water, which isn’t fluoridated. A full quarter of Americans aren’t connected to a fluoridated water system, which means they don’t have access to what the Center for Disease Control and Prevention called on of the 10 great health advances of the 20th Century.

Fortunately for Dee Matello and others like her, there are non-profits that recruit volunteer dentists like the one who treated her in March. But they can’t reach everyone.