Reprint of Putting Teeth Into Health Reform


In April, 2009, two COHI members, dentist Toby Kravitz and foundation director Tom Roberts, teamed up to write an op ed piece that ran in The Valley News.  The article is reprinted here, in its entirety:

Putting Teeth into Health Care Reform

There’s a communicable disease rampant in many people’s bodies.

Untreated, it can lead to organ loss, the possibility of abscesses, brain infection and even death. It is the most common chronic disease in children. If this disease occurred anywhere else in the body, the Center for Disease Control would likely have declared a public health emergency.

But the body part affected is our mouths. The organs are our teeth. The disease is caries, better known as dental decay or cavities.

In Vermont and New Hampshire, we can see the signs of an oral health crisis taking place around us: People walking into emergency rooms with so much pain that they are begging to have their teeth pulled out. Too many young adults have mouths riddled with bad teeth and need of dentures or a mouthful of extensive and expensive dental care.

A local organization, the Ottauquechee Health Foundation, provides grants on behalf of individuals who can’t afford their health care for those who live in their service area. Oral health requests now pre-dominate. Last year, two-thirds of applications and two-thirds of dollars went to dental needs.

Studies show that poor oral health impacts overall health, leading to chronic pain and making it harder to succeed in school or find a job. Yet we have a health care system that continues to treat the mouth as if it was not a part of our body. And there’s a different tolerance of what’s acceptable in the way of disease, chronic pain and risk to the body. There is a different set of insurances for dental care, both private and public. Only half the population has dental insurance.

People without sufficient insurance and people without the means to pay for dental care are going without the oral health care that they need. Those with Medicaid struggle to find a dentist who will treat them. Adults on Medicaid are faced with restricted benefits and limited access.

Although many area dentists do take Medicaid patients, donate their time or work for reduced fees for needy patients, many do not. Why don’t more take Medicaid? The reimbursement rate is less than 65 percent of the true cost, which does not allow dentists to cover their overhead rates. Others are concerned about a higher no-show rate for these appointments. The limitations on Medicaid dental benefits for adults create additional barriers.

A doctor in an emergency room doesn’t get paid any less if her patients don’t pay their bills, nor does a primary care doctor working for a hospital see their salary decline if a patient doesn’t show up. Most dentists on the other hand, have small offices, with one or two dentists, where there is a direct connection between who pays and what the practice’s income looks like at the end of the month.

Too many people do not place a priority on their personal oral health. Some have learned from their parents that they likely will lose all their teeth before they are 60 and don’t even try to keep up oral hygiene.

Concerned about oral health needs in the Upper Valley, a dedicated group of dentists, health care providers and funders have formed the Community Oral Health Initiative to look for solutions to our communities’ oral health needs.

How will we improve our oral health? There are roles for all of us to play. We all need to recognize as a matter of public policy that oral health needs to be on par with other health care needs. Then coverage for care and proper reimbursement rates need to be prioritized so that they are aligned with other health care needs.

Dentists will play a part. As the Medicaid scope of coverage and rates improve, more dentists will participate in the program. Dentists will continue to volunteer their time at free clinics like the Red Logan. And they will continue to forgive a portion of their fee to participate in Ottauquechee’s Good Neighbor grant program. If there is community interest perhaps that program might extend beyond the Woodstock area to cover the entire Upper Valley.

And each of us has a role. We can help change community norms so that all children grow up expecting to have a healthy set of teeth. We need to each take personal responsibility for our oral health care and for that of our children. The basic preventive steps—brushing, flossing, eating snacks like apples that clean our teeth in the middle of the day and staying away from high sugar foods, especially sipping on soda and energy drinks throughout the day—can go a long way to ensure we only need to visit our dentist for regular preventive appointments.

Our oral health must become a priority, both in the Upper Valley and in the rest of the country. It is a problem that is ours to solve and solutions are within our reach, so that everyone, rich or poor, has the same access to care for a hole in their teeth or gums as for a hole in their arm.

As national attention turns to health care reform, one message we ought to all agree on is that we must put teeth into health care reform.

Toby Kravitz, DDS, is a Norwich dentist and chair of the Community Oral Health Initiative. Tom Roberts is the director of the Ottauquechee Health Foundation and past chair of COHI.

Tom Roberts

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