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February 28, 2007

The Right To Dental Care

Generally, when I speak about universal health care, I'm implicitly including universal dental care, as the idea that the health of your teeth is somehow separate from the health of your joints seems self-evidently ridiculous. Maybe I need to be more clear:

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.[...]

Deamonte's death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

Dental care also has another function. Neglected teeth rot. Rotted teeth fall out. And toothlessness is a signifier, in our culture, of poverty and backwardness. It harms an individual's ability to get jobs where they'll be a public face of an organization -- and I'm not talking spokesperson, I'm talking Costco door greeter -- and triggers an instant devaluation of the individual's skills in the eyes of employers. And that's not to even get into the insecurity and self-esteem costs it inflicts on the individual, and how those costs harm their personal and professional comportment. It's morally unconscionable that we permit these economic and medical inequities in our society. Just ask Deamonte Driver's grieving mother.

February 28, 2007 in Health Care | Permalink


If going to the dentist didn't involve so many mandated procedures (or being free to offer basic dental procedures didn't require so much expensive training), this sort of tragedy would never happen.

Perfect example of trade union selfishness crushing the little guy.

Posted by: Chris | Feb 28, 2007 12:43:14 PM

Will declaring a right to dental care really get us to the point that folks actually get to see a dentist? I'm concerned that might not be so. My reason is that the more socialist a country is, the worse people's teeth seem to be. In the former DDR an american acquaintence of mine was singled out as an American without speaking or waving the flag, just because she had those supper straight big teeth that come only from wearing braces.

Most of my Ostie friends had pretty crappy teeth. We probably just need to train three times the number of dentists than we now do. Is this feasilbe?

Posted by: Neil Paul | Feb 28, 2007 12:48:43 PM

Don't forget that dietary habits have at least as much to do with dental health as do regular cleanings and check ups. There are many traditional diet regimens around the world that are extremely calcium deficient, or Vitamin C deficient (leading to severe gum disease), or in many cases both at the same time.

Posted by: sprocket | Feb 28, 2007 1:12:29 PM

Niel, I think it's more a cultural and educational thing than a socialist/capitalist thing. The whole idea that one would go regularly to a dentist for purely preventive care is kind of a new idea. Go back a few still-living generations in this country, for instance, and you'll find many people who believe tooth loss is a natural consequence of aging. But that just means that providing access to dental care is only part of the answer. Increasing awareness about dental care and hygiene have to play a part as well.

Posted by: nolo | Feb 28, 2007 1:14:20 PM

Chris: What're you talking about? What routine procedures should dentists stop doing, and how on earth are unions responsible for this?

Posted by: APS | Feb 28, 2007 1:20:01 PM

Chris apparently hasn't noticed the existence of dental hygienists.

Posted by: nolo | Feb 28, 2007 1:22:39 PM

This, along with mental health care, is one of those things that the private health insurances companies will fight to the bitter end. Hey, it's bad enough you plebes want to live forever, now you want to have a nice smile?

I have excellent health insurance, maybe some of the best you can get. There's no dental coverage. You can buy it, as an add on but it covers almost nothing and is used up in one routine visit, don't even think about fixing any problems. So it's not just the underemployed that can't get decent dental care, it's anyone who doesn't have a lot of money. Dental care in America is a cash on table proposition (well, that is if you dentist doesn't offer you some nice financing).

What's the solution? I have no idea. But the problem is much more vast than I've ever heard discussed.

That said, if there is anything more primitive and backwards in the health care world than dentistry, I don't know what it is. It would seem, to me, that all the adavances in care have, at best, been refinements of existing procedure. No real developments. I've said this before but if our medical care was analagous to our dental care, we'd go the doctor and get bled by leeches. Sure, they would be nice, clean, farm-bred leeches from a jar. But leeches nonetheless.

Posted by: ice weasel | Feb 28, 2007 1:31:48 PM

It has been shown that
massage has tremendous health benefits. I demand my government make massage therapy available to all the poor. It's unfair that the poor have no access to this important therapy.

Posted by: Fred Jones | Feb 28, 2007 1:42:59 PM

Ezra, I'm sure you recall and are referring to the woman in The Working Poor who lacked teeth and was unable to get any type of promotion or position heavy on customer interaction. It was really poignant and sad, but illuminative.

Incidentally, I've been telling an equity analyst friend to read the book since I read it when it came out, and he finally is. I saw him on Sunday and he says it's giving him nightmares. The book did what endless hours of discussion and debate (including citing the book many times) couldn't.

Posted by: Mitch Schindler | Feb 28, 2007 1:52:16 PM

A great way to attack the social problem of those with no teeth is to try to pass laws that would prevent discrimination based upon one's smile. This seems like a good cause for the liberal American left. It's very similar to their other causes. How unfair of these poor people to be passed over for jobs, promotions, etc because of their smile *AND* it's already being done with race, gender and whether you're a homo or not.

Why not 'smile appearance'?

Posted by: Fred Jones | Feb 28, 2007 1:56:00 PM

This is simple hackery. If you want to promote free dental care then offer an argument, not an emotionally charged anecdote.

Posted by: the invisible pimp hand | Feb 28, 2007 2:00:41 PM

pimp, it strikes me as being imperative to offer the arguments/anecdotes that will be most effective in having the desired policy effect.

Case in point, Mr. Schindler's friend who was persuaded more by one book than by hours of policy discussion.

It's hard to convince people that "dental health" is just another kind of "health care" alongside curing sicknesses and doing heart surgery, but it is something that has to be done, because the consequences to ignoring it are serious.

Posted by: Tyro | Feb 28, 2007 2:07:34 PM

nolo: try going to the hygenist without being forced to pay for the dentist and whatever mandated scans he wants you to pay for, too.

Posted by: Chris | Feb 28, 2007 2:15:26 PM

My mother is a dental Hygenist in a big city....recently (a couple of years ago), a flood of dental schools appeared. Now, the fallout is becomming apparent.....there are a flux of new denist's offices and hygentists....as in too many. The Dental proffession there is starting to resemble the car repair industry - with many dentists over prescribing work to get by....and the low end insured are the ones that get bit by this the most....She routinely sees people that have had a ton of unnessesary work before they freak and venture out to someone else.....so, no, just throwing more Dentist's at this is not the answer - and its just as simplistic as blaming Unions or poor people....It always comes back to reasonable health care. Giving people the freedom to take care of things where they choose (to a degree) - not just forcing people with shitty insurance to go to shitty doctors....plus education of better diets etc in the schools....which also means stopping the money from soda companies, fast food companies etc. from sponsoring school disctricts....and as always, people with no insurance or health care cost society 500 times as much just in medical bills alone for non preventative work...not even factoring in the detriments of having a sick population.....I am truly sorry that people like Chris and Fred are bitter bitter people who take pleasure in the thought of other people suffering...but just stick to Jerry Springer and let the mature people tryin to forge a better country and society please.....

Posted by: Zedd | Feb 28, 2007 2:26:42 PM

Chris: Do you really think that cleanings are all you need to get good preventive dental care (never mind treatments)?

Posted by: APS | Feb 28, 2007 2:26:57 PM

That is, leaving aside the services you'd need if you were being treated because of, say, an abcessed tooth.

Posted by: APS | Feb 28, 2007 2:29:24 PM

"It has been shown that massage has tremendous health benefits. I demand my government make massage therapy available to all the poor. It's unfair that the poor have no access to this important therapy."

AFAIK, lack of a massage hasn't caused a kid to die of a brain infection. Did you even read the post?

If you getting a massage would make you less of a moral dwarf, then I'll front you a shiatsu.

Posted by: No Longer a Urinated State of America | Feb 28, 2007 2:34:44 PM

NLUSA: Don't feed the troll.

Posted by: APS | Feb 28, 2007 2:37:55 PM

Tyro, if the story had been presented in the context of a wider argument in favour of free healthcare I wouldnt have batted an eyelid. As it stands however it reads a little like "look into this child's dead eyes and tell me you dont support free healthcare, bastard!"

Posted by: the invisible pimp hand | Feb 28, 2007 2:45:29 PM

I have pretty typical health and pretty typical dental health. Nothing major.

Over my life, dentists have relieved a lot more pain a lot quicker than doctors ever have.

I think a good argument can be made that the nation's karma and productivity can be vastly improved if we just alleviate all the suffering that originates when someone has pain in their mouth. Talk about cranky nasty SOBs. Who needs that?

Posted by: jerry | Feb 28, 2007 2:48:49 PM

"Tyro, if the story had been presented in the context of a wider argument in favour of free healthcare I wouldnt have batted an eyelid."

Pimp, do you read this blog regularly? Your complaint is essentially nonsensical in light of the fact that Ezra devotes an exceedingly high percentage of his posts to arguments wide and narrow in favor of universal healthcare.

Posted by: JBL | Feb 28, 2007 2:52:31 PM

Don't you think the article says as much about the need for better parenting education and the effect of having to work multiple jobs while parenting as it does about the lack of universal dental care, which I support with some major caveats.

Having been a victim of over-prescribing doctors and dentists because I have almost always had good insurance, I want to hear some suggestions of how to handle this problem since it will only get worse under universal health insurance unless it is addressed.

Posted by: Emma Zahn | Feb 28, 2007 3:00:26 PM

APS: there's no doubt that a trip to the hygenist once in a while would be better than neglect -- certainly a huge improvement over the case cited in the article.

Posted by: Chris | Feb 28, 2007 3:10:26 PM

Why not just the most BASIC of health tests and health care FREE and WIDELY AVAILABLE?

Last month the most "popular" "get the government off my body" feminists on the web were for mandating a unproven vaccine on adolescents. If you disagreed with them (you know who I'm talking about Ez) they called you a godbag and a misogynist, even when it was pointed out that what everyone agreed was that what women need more is an annual pap smear and that even with the vaccine women would still need an annual pap smear and that with an annual pap smear hpv is largely detectable before it becomes a problem and largely treatable.

Preventive health care is much cheaper and more effective than emergency health care.

Posted by: jerry | Feb 28, 2007 3:34:52 PM

AFAIK, lack of a massage hasn't caused a kid to die of a brain infection. Did you even read the post?

There are really two issues in this thoughtless statement.
1) Does anyone really believe that a child's death is a usual and common occurance from lack of cheap and easy access to dental care?
2) Is likely death the standard you wish to use when deciding which healthcare service to include in the "ought to be free" category? How 'bout nutrition training? Parenting school? Is everything on the table?

I would like some guidence as to what you think should be freely accessible and why. Next, I would like you to tell us all how you intend to pay for it all. After all, isn't that the problem now? And you wish to add all of these other services on top of that??

It's really nice to have a big heart. It's even nicer to have a big brain.

Posted by: Fred Jones | Feb 28, 2007 4:22:10 PM

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