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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

Comments

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

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...

Welcome, my brother to the "We will excuse anyone, no matter how stupid, ignorant and repugnant they may be, because they are liberal" club.
Get used to it.

Posted by: Fred Jones | Feb 28, 2007 4:25:33 PM

There's a growing body of research to the effect that dental care is not just about the mouth, but has a big impact of the health of the whole body. Without going into all that here, you can see intuitively that this makes sense. Any infection that takes root in your mouth has excellent access to the body through the air you breathe and also the bloodstream, and so your immune system then gets stuck dealing with never-ending problems, because it can't properly get at the source. This is clearly an area where an ounce of prevention is worth a pound of cure, and too few people are aware of how important it is.

Posted by: RLaing | Feb 28, 2007 4:34:47 PM

When practiced in a full continuum of Holistic health care, massage also can be used to treat arthritis, hypertension, diabetes, asthma, bronchitis and neuromuscular diseases, among others.

http://www.nycollege.edu/academics/massage_therapy.php

By your 'reason', then, massage should be right on the top of your list as well...

Posted by: Fred Jones | Feb 28, 2007 4:52:17 PM

What about a right to a health club membership, cooking classes or any other amenity that might contribute to better physical or mental health?

Its ironic that young collectivist Klein's concocted "rights" actually obliterate the real political rights that Americans have always enjoyed - like the right to private property and the freedom to control one's own medical destiny.

Posted by: Stuart Browning | Feb 28, 2007 4:58:22 PM

Fred really just wants the happy ending massage. It might even be worth it for the government to pay for it as it might release enough tension that he'd stop being such a dink

Posted by: BillCross | Feb 28, 2007 5:25:29 PM

Bill - If there is a "right" to dental care, by what logic could you exclude a "right" to a massage? Sorry, calling someone a "dink" (whatever that is) won't cut it.

Posted by: Stuart Browning | Feb 28, 2007 5:31:10 PM

If we let gays marry, next it will be man on dog!

Posted by: jerry | Feb 28, 2007 5:39:38 PM

What about a right to a health club membership, cooking classes or any other amenity that might contribute to better physical or mental health?

Exactly!!]

Health Club memberships for all!!

Posted by: Fred Jones | Feb 28, 2007 6:26:01 PM

People should be able to go to the dentist for a cleaning twice a year, x-rays once a year, and standard dental procedures as necessary. I am referring to cavities, root canals, broken teeth, and gum disease. I am not referring to orthodontics or whitening. While I am sure all of these things help people get better jobs, there are plenty of people out there with good jobs and crooked yellow teeth, so I'll leave those til after the basics have been covered.

I never had a cavity until last year. I went to the dentist for the first time in about 2 years, and was shown the x-ray that indicated a deep cavity in one of my back teeth. I didn't have any pain at all, it was a total surprise to me, and the dentist didn't even know if she'd need to do a root canal until she drilled in there. Fortunately, a filling did the job, but this could have turned into something really nasty within another few months if I hadn't gone in. Something nasty that would have cost a lot more to fix.

Posted by: Stacy | Feb 28, 2007 6:46:06 PM

Young collectivist Ezra Klein, lover of all things government, ponderer of actuarial tables, self-styled health care expert, advocate of socialized medicine, emailed me last year concerning the news items that I post here at my website showing the disastrous and predictable results of government rationing of health care:

Ah, argument by anecdote, the last refuge of the scoundrel. [...] America has no shortage of terrible tales of maltreatment, deprivation, and wrongful death, but I'm not going to dip into that pond as I try to not enlist other's misfortunes as pawns in my argument. You, unfortunately, have no similar scruples.

I guess it takes one to know one.

(Cross-Posted at my site)

Posted by: Stuart Browning | Feb 28, 2007 7:00:50 PM

Sweet fucking jesus you have a lot of trolls here Ezra. What is it about you they like so much? Can't we spray the place or something? And the saddest part is, they're not even entertaining or particularly intelligent trolls, just the garden variety rethuglican/libertarian inbreds.

Sad really.

Posted by: ice weasel | Feb 28, 2007 7:38:30 PM

The anti-trolls aren't very entertaining either. Actually, the email from Ezra was entertaining enough. Such things look different depending on where you're standing.

Posted by: Sanpete | Feb 28, 2007 8:00:20 PM

A knowledgable friend once told me that dental problems were the second leading cause of death in Europe in the Middle Ages, after the Black Death.

Posted by: Doh | Feb 28, 2007 8:07:48 PM

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!"

Well, can you?

This isn't argument by anecdote - a complaint, by the way, that is awfully rich coming from conservatives. The idea is, in part, that it's stupid to wait until things go from bad to worse before we start funding health care. Where do you think that $250K came from? I apologize if I'm mistaken, but I'm assuming this family didn't have insurance that covered that either.

So because of this country's reluctance to fund preventative care, we wait until people get really fucking sick before, and then we end up spending $250K when we could have spent eighty bucks.

Such a system is not simply unjust. It's insane.

Posted by: Jason | Feb 28, 2007 8:25:33 PM

Stuart, It's a joke. i think you need the happy ending massage too. many insurance plans already cover Viagra.

Posted by: BillCross | Feb 28, 2007 8:26:45 PM

...i think you need the happy ending massage too.

I think Bill's looking for a date.

Posted by: Fred Jones | Feb 28, 2007 8:45:43 PM

There's never going to be a 'right' to free health care, because there's no such thing as free health care. There is however such a thing as publicly-funded health care, and maybe that is what people should be debating the merits of.

While we're on the topic, outside of the ivory towers or academia, there's no such thing as a 'free market', either. Government intervenes all the time, all over the place. We ought to accept that as well, and talk about where and how it should intervene, and where and how it should not. The United States has corporate socialism pouring out its ying-yang. Why not a little for people as well?

Posted by: RLaing | Feb 28, 2007 9:17:18 PM

A knowledgable friend once told me that dental problems were the second leading cause of death in Europe in the Middle Ages, after the Black Death.

And all the way through to the Victorian era: the Gentleman's Magazine listed the week's causes of death in London from the early 1700s, and 'teeth' always figured highly.

Let's make the issue clear, and not a jerk-off session over 'Fred' and his right to a happy ending. The provision of basic dental checkups, particularly to children and the elderly, is a pragmatic social good. Dentists would much rather provide cosmetic treatment for people with lots of money for porcelain veneers. It will take either a degree of compulsion -- no treating the kids, no license -- or stuffing their mouths with gold to address this.

Alas, we now have the spectacle of 'Fred' the sociopath and his little friend engaged in mutual masturbation, the greatest love of trolls and the death of blog commentary (see: Drum, K.) But that's his point: to stalk those he disagrees with and shut down decent discussion. What a fucking pathetic spectacle. 'Fred' thinks he has a right to shit over this blog, and it's a pity that he's allowed the privilege.

Posted by: pseudonymous in nc | Mar 1, 2007 12:26:06 AM

I think that all the name calling of trolls and demands they be banned is far worse to blog commentary than the actual troll itself.

I prefer reading the arguments of Fred Jones than the name calling, shout downs, holier than thou nonsense of pseudonymous in nc.

pseudo, unless your name is Ezra Klein, no one appointed you troll master of this blog. I for one see you all over and always the first to point the finger of "troll"

I accuse you pseudo of being the troll. By constantly pointing the finger, you hijack the conversation and suppress a dialogue. And you do it so everyone will give you kudos for stopping another troll.

I disagree with what Fred has said here in this particular thread, but I have seen many other of his posts, and I know he at times is absolutely right.

So please take your holier than thou, pretentious, pompous name calling, and jam them up your ass.

Posted by: Plato | Mar 1, 2007 1:31:50 AM

If Ezra thinks there is a problem with trolls, Ezra can switch to a commenting system that requires verified logins and allows him to bad trollish logins.

I would prefer to operate on good faith basis, as long as it is possible that a post was made in good faith then assume it was made in good faith.

Ignore posts that you think are there to bait you.
Reward posts that you think are commendable.

Challenge posts that you think need a good challenge.

Thank all posters for participating in and making the comment threads interesting.

STFU when you have nothing of value to add.

Posted by: Plato | Mar 1, 2007 1:38:44 AM

Yes, please. Directly up the ass. For the children.

Posted by: sidereal | Mar 1, 2007 1:42:51 AM

If you want to spend all day policing thought and searching out thought crime and naming people enemy of the state, then I think you want LGF, HotAir, ProteinWisdom, Patterico, FreeRepublic, Ann Althouse, Red State, TownHall, etc.

I would like to think that in the reality based community, we seek out challengers and challenge them right back. It's a way to keep ourselves honest and understand what we think our policies are saying. And might even edumacate the SOB.

I'm off to bed. Prediction: I will be called a troll.

Posted by: Plato | Mar 1, 2007 1:43:41 AM

Plato: The problem I have with what Fred's been saying in the thread is that he hasn't been really engaging with/arguing with Ezra and the various commenters. Instead, he's just trying to be disruptive (unless you think his comment that the liberal solution to this problem is a law forbidding discrimination against people with bad teeth is anything other than an attempt to be disruptive). In short, he's being a troll.

Having people ignore him more might work, but it really seems like the best thing to do would be to ignore him completely, which would basically be the same thing as banning him. I don't want the comments section here to be an echo chamber, but I do think that banning people sometimes makes sense, and that it does here.

And no, I don't think you're a troll. You're trying to argue with the commenters you disagree with, not just mock them. Fred isn't doing the same.

Posted by: Paul | Mar 1, 2007 2:17:33 AM

unless you think his comment that the liberal solution to this problem is a law forbidding discrimination against people with bad teeth is anything other than an attempt to be disruptive

I think he might be thinking he was taking the concept to its logical extreme in order to point out its flaws.

I think that's a reasonable way to argue that can be misunderstood. It might be at the basis of my dialogs, if I had enough of a background in history and philosophy to really understand what Plato's dialogs were all about.

I think folks should lighten up.

I think name calling is not a reasonable way to argue. Name calling is a fantastic way to get to group think.

I think Ezra would be appalled if his blog forum became a site for group think in the same way that Ann Althouse's comments and sigh, yes, even Atrios' comment sections are policed for ideological purity.

Posted by: Plato | Mar 1, 2007 7:27:24 AM

I've forgotten some of my Latin, look I've been dead for 2354 years now, let's see how much C++ you remember 2354 years from now.

Fred's argument is a form of reductio ad absurdum and raises a real issue from the micro-economics perspective. Fred is suggesting there is an agency problem here.

I may disagree with him. I may think he made his point once and there is no need to make it again. I may think he has a real point that no one else is addressing and so it is reasonable for him to emphasize it.

I don't see any troll behavior here, apart from pseudo's statements that were made deliberately to provoke a response.

On a scale of -1 to -10, I think spammers are a -10. Blog whores a -3, and policing for ideological purity a -11. Yeah, so sucky it goes to -11.

Trolling is only a -4.

Posted by: Plato | Mar 1, 2007 9:01:39 AM

"I've forgotten some of my Latin, look I've been dead for 2354 years now, let's see how much C++ you remember 2354 years from now."

Nah, you wouldn't even have known Latin: as it was in your day, it was a language spoken in a belligerent city-state in some barbaric backwater. [There's a great series of books by Gene Wolfe on a Latin soldier wandering around the Mediterrean when it was still a Greek pond.]

"Fred's argument is a form of reductio ad absurdum and raises a real issue from the micro-economics perspective. Fred is suggesting there is an agency problem here."

You're being overly charitable in interpretation, here.

We can distinguish between quack and marginal therapies/care and those that are actually essential for good health later in life. Decent dental makes a big difference to health, especially during the later years: being able to chew with original gnashers rather than dentures increases the ability to get nutrition. Many elderly are deficient in micronutrients, and that leads to depressed immune systems, increased fatigue, etc., etc.

On the agency issues: there are *always* agency issues in healthcare, the asymmetrical of information makes that unavoidable. The difference is that by chosing the employer insurance system, we put yet another asymmetry problem into the mix.

Fred wrote:
"There are really two issues in this thoughtless statement."

Jones, that is really rich coming from you, the ultimate in the knee-jerk hipshooter.

"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??"

In one of the same ways that other countries do it, and manage to pay less of a fraction of GDP than we do. In case it escaped you, the taxpayer ('cos that's who'll ponied up $250K to fail to save a life when $80 would have saved it. In this specific case, that's a 3125% return of investment, plus the kid would have lived. You seem to think that's a bad investment. Remind me not to hire you to run my portfolio.

Posted by: No Longer a Urinated, etc. | Mar 1, 2007 10:40:53 AM

Nah, you wouldn't even have known Latin: as it was in your day, it was a language spoken in a belligerent city-state in some barbaric backwater.

That could very well be. Um, so what did I speak then?

Posted by: Plato | Mar 1, 2007 11:00:51 AM

But that's his point: to stalk those he disagrees with and shut down decent discussion. What a fucking pathetic spectacle.

Indeed, pseudo. You stalk Fred pathetically.

Greek, Plato. You really have forgotten things. But your English is good.

Posted by: Sanpete | Mar 1, 2007 11:42:38 AM

D'oh!

Posted by: Plato | Mar 1, 2007 11:48:07 AM

Blah, blah, blah. Stacy: you've put it nicely. I had typically (for the era) poor dental care as a child, and as an adult, spent a lot of money and time just bringing my teeth up to baseline. I've had root canals and crowns and fillings. Sometimes I had dental insurance, but usually not. When I had it, it was helpful to take the edge of the cleaning and x-ray expenses, but it maxed out pretty quickly.

Now my teeth and gums are healthy. Oh, for sure, they are not Hollywood ready, not by a long shot. But I haven't had a cavity in nearly 20 years. I've had some old fillings that had to be replaced, and there was the expense of getting a bite-guard so I didn't screw up my teeth even more by grinding them at night. (Darn! I should wear it while online.)

But if we could get low-cost clinics to enable people access to twice-yearly cleanings, plus free dental floss, toothpaste, and fluroide rinses donated by suppliers, and if we made a real outreach project to tell people that it's really, really important to learn some basic stuff they can do to protect their teeth (oh, hey, maybe we could attach the same importance to it as to abstinence), we'd see a change for the better. Misery would lessen. That's worth doing.

See, what gets me about this little boy, beyond the most important thing of him being dead, is the glimpse into his life. I think some of y'all don't get it (Stacy does, for sure): there are a lot of people who think of dental care almost as an extra. I know when I was growing up, very few kids had braces. That was strictly for rich kids, and there weren't many of them in my town. The rest of us lived with our buck-teeth, or had our "crowded" mouths relieved by tooth extraction.

And I don't think people in general are aware of how quickly a dental infection can lead to catastrophic, acute illness. (Same with sinus infections. And the non-elderly don't always understand how lethal pneumonia can be, either.) Your tooth hurts, it's a drag, but that's what teeth do sometimes. So you stand it.

And the idea that all the child needed was an $80 tooth extraction? Well, first of all, $80 as a total cost is unlikely. But sure, yeah, pull that tooth stat if it means the child lives. But y'all are aware that in most middle or upper-middle class families, dental care involves saving the tooth, not pulling it. You save it, because alignment gets messed up otherwise. If you can't save it, you try titanium-based implants.

This child might as well have been living in an alternate universe. And that sucks. There have got to be a lot more dental clinics. I'm sure dentists already donate their time, but we've got to make it more like plastic surgeons. All of our elective lipo and rhino and various -plasties finance the free or low-cost procedures done for the poor and afflicted, like in Project Smile, to fix facial deformities. We need to do more to encourage that for dentists. Maybe as part of forgiving student loans or something.

Posted by: larkspur | Mar 1, 2007 12:02:34 PM

Health Policy is my business, and there are a lot of different levels to this terrible story.

First, Medicaid payments for dental care are usually very low and few dentists will accept Medicaid patients.

Second, dentists do not feel a cultural responsibility that comes with a profession. Docs frequently have some sense that they are under an obligation to provide some service as a social good. (okay not always, but sometimes) The dentists don't have this inculcated in any way during their training. On the contrary, they are taught to operate their practices solely as a business: no cash, no service, even when it's life-threatening for the patient.

Third, Dental Societies are a huge guild and they have stopped any attempts to change scope of practice which would allow dental hygienists to practice independently. Breaking the restrictions on dental hygienist's practice would be the single biggest advance we could make to make dental care available to the underserved.

Take a look at what's going on in Alaska: It's very hard to get dentists to practice in the Alaska wilderness and frontier areas. The Dental Society and the ADA have sued in an attempt to stop a Dental Health Aide program there. This isn't a choice between getting great care from a dentist and mediocre care from an aide. It's a choice between no care and any care at all, and the ADA is on the side of no care.

ADA Sues To Halt Alaska Dental Aide Program

(AP) Anchorage, Alaska Alaska dental health aides who perform extractions, surgeries and other irreversible procedures in rural communities without proper credentials are in violation of state licensing laws, the American Dental Association said in a lawsuit filed Tuesday.

The lawsuit, filed in state Superior Court in Anchorage, Alaska seeks to halt the unique program run by Alaska Native organizations that allows dental health aides to perform services usually done by licensed dentists.

Much of the work is done in rural villages, where there are no dentists and the rate of tooth decay for Alaska Natives is 21/2 times that of the rest of the nation.

This isn't just an Alaska story. Every State has restrictions meant to help Dentists make money, and if you've ever read any of my other posts you know I'm no libertarian, but the Dental Societies stink and we could help by loosening restrictions on hygienists.

Posted by: SteveH | Mar 1, 2007 12:17:40 PM

I smell a rat in this conversation. So you guys are saying that dental care is so vital (reference story above and many comments) that it should be treated like medicine because there are so infections that can start in your mouth and influence your body, but at the same time we need to move away in dentistry from trained practitioners who take biochem, microbiology, pharmacology, lab courses, histopath, oral pathology, etc. to be able to understand this vast interconnection of the body. This doesn't make sense! You can't have it both ways.

Posted by: JohnH | Mar 1, 2007 2:32:26 PM

Before we get all worked up, did Diamonte's parents really NOT have the money?

Do they smoke? Drink alcohol? Have a cellphone? Cable TV? $5,000 a set 'spinners' on their car(s)?

Before we decide that routine dental care is a 'right', lets find out if the child died from child abuse.

Posted by: Flight-ER-Doc, MD | Mar 1, 2007 3:33:18 PM

JohnH asked: "I smell a rat in this conversation. So you guys are saying that dental care is so vital (reference story above and many comments) that it should be treated like medicine because there are so infections that can start in your mouth and influence your body..."

Yes, but there's no rat. Do you see a PA or an NP when you go for medical care? Did you get rooked? No. If you need primary care, you can get care that's just as good from an NP or PA as you can from an MD or DO. When you need basic, preventive dental care a dental hygienist can do exactly the same things a Dentist would do. But they can't open an office and do those things cheaply on their own thanks to scope of practice laws. If you think the ADA is trying to keep Alaska from using Dental Health Aides because there are dentists who are going to go there and provide that care, then I've got some beautiful beachfront land to sell you.

Posted by: SteveH | Mar 1, 2007 4:15:49 PM

And this reminded me of a terrific essay I read several years ago from the director of the Center for the Health Professions at the University of California, San Francisco.

Centering on …Dentistry as Canary?

The United States faces a hidden health care epidemic of near-crisis proportion. But this epidemic has not received the attention it needs or deserves. The crisis is in oral health... the Surgeon General's report (1) on oral health care illuminated the problem. Despite advances in dental science and practice that have resulted in great improvements in our nation's ability to provide oral health care, dental disease of all varieties has reached epidemic proportions. More significantly, however, disease is becoming localized with greater intensity among populations that have limited access to care because of inability to pay, age, cultural dissonance, and/or physical isolation...

First the dentistry profession must ask itself whether it wants to be the leadership profession for the nation's oral health concerns, or the leadership profession for bungalow solo private practices in the nation's suburbs... If dentistry chooses the status quo, it will likely continue its recent advances, but will find that its success has waning relevance to the country's oral health needs. Soon, many dental professionals' nightmares that oral health care will be provided outside the dental professional model will become a waking reality.

It's pretty clear which path the dentists took. Now it's up to us to make sure they don't stand in the way of people getting needed care.

Posted by: SteveH | Mar 1, 2007 4:23:42 PM

I saw a PA once on my 40th birthday, and I got rooked. The whole rooking too, latex glove, ky jelly. I rooked back and forth before she was through, and was she ever thorough!

Posted by: anon | Mar 1, 2007 4:30:07 PM

$5,000 a set 'spinners' on their car(s)?

Fuck you. Also, fuck you. Say that to a black person's face next time you bill them, 'Doc'. Just make the dentists' appointment in advance. Weren't you at the WaPo comments saying, 'heh, well the n----rs shouldn't spend so much money on bling'?

Also, Sanpete: blow me. You may like arguing with a few bona fide sociopaths who loiter here and turn this space into their personal shitting grounds. I don't.

This doesn't make sense! You can't have it both ways.

Um, I really don't understand your point. In a system where dental checks are part of a comprehensive preventative care strategy, they provide a low-overhead baseline level of contact with someone in the system who may not be able to diagnose you, but can spot potential symptoms.

Posted by: pseudonymous in nc | Mar 1, 2007 6:13:00 PM

Man, you folks have totally lost sight of the distinction between morality and economics here.

Ezra appeals to an emotional response, but his ultimate point is an economic one that can be summed up in a phrase: penny-wise, pound-foolish.

Put aside the morality of the child's death. We ended up paying $250K for this kid, not $80 or $200 or whatever. There is now excellent evidence that bad teeth and gums correlate with bad health overall. I say "correlate with," but the latest evidence suggests that dental problems actually are a cause of wider health problems.

Also put aside the morality of the parents. Whether or not they were negligent, there are millions of people out there in roughly their circumstances who make decisions roughly like they did. Even if you want to let these people hang, out of contempt or principle, it is stupid to do so because you will end up paying more for it. When a hospital provides uncompensated care, of course it does get compensated: by everyone else who uses the hospital and pays more for the experience because the hospital acts to cover its costs.

Here is what I will never get: how those who hate universal coverage think that it makes sense economically or in terms of the aggregate quality and efficiency of the health care system. No system in the world provides lower value than ours (where "value" is measured by performance/outcomes relative to the cost). Conservatives never have an answer to the fact that every other system in the world costs between 40% and 60% less than ours per capita, and they have outcomes that are on average about the same. They also have about the same number of physicians per capita.

All but perhaps the richest 1% will save money, and yet conservatives think that they have some great economic insight like "government is always inefficient" or "markets are always better" or some such nonsense.

Now watch, any conservative who responds to this will throw up some red herring like "yeah, but they have long waiting lists." Only a few countries do, and only for a few things. And don't let's bring up the tired Canadian examples again. Let's look at Germany or France or Japan or Belgium (as Ezra has done at length). Better yet, let's look at the big picture and see that it is our markets, far more than our mandates, that have failed us.

In the pre-managed care and pre-mandate era from 1940 to 1990, health care costs increased at a far faster rate than they do today. Even accounting for overall inflation costs were less under control when we had more of a free market than now, when we have less. Also don't forget that before HMOs got big, almost everyone had "major medical," which we would not call a high deductible plan. Cost sharing didn't do crap, because 90% of costs are for people who blow through the deductible with hospital stays or chronic conditions.

It's the market failure, stupid.

Posted by: jd | Mar 1, 2007 9:55:25 PM

typo correction:

I wrote, "...before HMOs got big, almost everyone had 'major medical,' which we would not call a high deductible plan."

I meant that we would NOW call it a high deducible plan.

Posted by: jd | Mar 1, 2007 10:00:52 PM

Dental care as a universal benefit. Sounds nice. Where can I sign up?

The problem here, it seems, is that in Maryland, dentists don't want much to do with Medicaid. If they treat dentists in any way like they treat specialist surgeons, I can understand why: they don't just pay poorly, they frequently don't bother to pay at all. Maryland is probably not unique, but its practices as concerning Medicaid payments to doctors are especially bad. Much of the care is farmed out to large managed-care companies whose practices as concerns claims handling would land their managers in prison were they not the agents of those doing the imprisoning. The government employees who administer the Maryland state Medicaid system and the compaines who bid their contracts manage to do well on the public dollar, but the willing participants in the program get screwed. I live and practice in Maryland, and I can tell you that the state fund to pay claims has run dry months before the end of the fiscal year, an the legislature has not responded. Claims just don't get paid at all. So lots of doctors, many of whom have eaten their fill of unpaid claims, won't touch the Medicaid plan. They've been burned and they know better. Just try and find a pediatric ophthalmologist who will take that plan--very few who do choose to do so for long. I don't blame the dentists at all. It isn't their duty to donate their work and their business operating expenses so that the taxpayers of Maryland don't have to read sad newspaper stories. If there is blame to be laid for this tragedy, it starts with the parent and then goes to the state, whose priorities with so many state agencies is to provide full employment for state employees and only after that, service to the public.

As for what benefits should be covered, none that won't be paid for fairly, which means at least as much as would be paid by someone not travelling on the state's dime. Anything else is confiscation.

Dentistry as a cartel? Someone should tell them. There is a lot of money being wasted needlessly on Yellow Pages advertising and billboard and magazine ads. I don't think they are any worse than any other licensed occupation. And licensing, last I checked, was a requirement imposed by the state as a guarantee to the public of minimum training and practice standards, not a guarantee of high incomes. You could say the same things about consultant engineers or plumbers.

Oh and the threat that if the ADA doesn't loosen up on its practice and training standards is particularly rich. Who in their right mind would expect them to endorse anyone but a dentist to do dentistry? And as for inviting pretenders to do their specialty, the only other professional occupation in a position to take on dentistry--the medical profession, which could actually do just that by making dentistry a medical specialty obtained by residency training, just like ENT or ophthalmology--seems to have no interest in doing so (an there are countries where this is how dentists train, first as doctors). Go figure. It certainly hasn't worked the other way around.

Posted by: Okulus | Mar 2, 2007 12:07:48 AM

The "Americans have great teeth" myth never seems to die, no matter how many rotting sets of chompers appear on "Cops".

American teeth are probably about as awful as those in other first-world countries.It's just that the teeth that appear in American media are better screened.

Posted by: bargal20 | Mar 2, 2007 2:32:19 AM

You may like arguing with a few bona fide sociopaths who loiter here and turn this space into their personal shitting grounds.

You need a mirror.

Posted by: Fred Jones | Mar 2, 2007 9:32:52 AM

Before we get all worked up, did Diamonte's parents really NOT have the money?

Do they smoke? Drink alcohol? Have a cellphone? Cable TV? $5,000 a set 'spinners' on their car(s)?

Before we decide that routine dental care is a 'right', lets find out if the child died from child abuse.

These are fair questions. None of this was explored in Ezra's emotional post.

Posted by: Fred Jones | Mar 2, 2007 9:37:31 AM

Perhaps pseudonymous in nc would like to argue that "grills" are a right and should be paid for by the taxpayer instead of the drug trade.

Posted by: Fred Jones | Mar 2, 2007 9:38:52 AM

"You can't have it both ways."

John, different people are making different arguments. I don't have a problem with the guild status of dentists, and I don't think that allowing dental hygienists to practice independently would solve the problems SteveH seeks to solve.

Posted by: No Longer a Urinated State, etc. | Mar 2, 2007 11:07:23 AM

"Alaska dental health aides who perform extractions, surgeries and other irreversible procedures"


Wow lets back up a minute. You say that the ADA is unfairly restricting basic dental care to those who would get none without dental aides present.

so tell me why these "aides" are allowed to do surgery?

Nobody should be doing oral surgery unless they are a properly trained board certified dentist.

Posted by: joe blow | Mar 2, 2007 6:47:43 PM

BTW, dentists make more money on average than doctors nowadays.

The reason for this is simple: unlike doctors, they didnt allow a government takover of dental care. We dont see politicians on capitol hill ranting and raving about any "right" to dental care.

The reason dentists make more money than doctors, despite having less training (dentists are not required to complete a residency) is because they arent controlled by insurance or Medicare.

Less than 40% of the dental care market is based on insurance. Compare that to medicine which is over 95% insurance dominated.

Doctors dont really have the option of not taking Medicare, because Medicare is such a large sector of the market that most doctors wouldnt be able to have a practice without it. Dentists on the other hand, dont need Medicaid or Medicare to make up their practice, since less than 10% of dental care dollars are spent by Medicare/Medicaid. Therefore, the dentist has the power to say "fuck off" when the Medicare/Medicaid patient comes along. Doctors dont have nearly the same power or autonomy that dentists have.

Posted by: joe blow | Mar 2, 2007 6:51:10 PM

joe blow, are you incapable of embarrassment?

First, dentists were never in a position to "allow" government involvement in their profession. Do you think the dental lobby is stronger than the medical lobby? It had nothing to do with dentists and what they have the power to permit, and everything to do with the fact that dentistry has gone under the radar of major policy interventions because dental care has always been more affordable, the preventive care model developed earlier than in medicine, and dental care seldom is a life-and-death matter, at least in the public perception.

You also don't get basic statistics right. Medicine is not "95% insurance dominated." Did you mean that 95% of Americans have insurance? We know that to be false. More like 15% don't have insurance, and some of those who have it have low benefit policies. Or did you mean that insurance pays for 95% of medical care? That's equally as wrong, for obvious reasons (the uninsured, high deductibles and elective procedures like cosmetic surgery among them).

Here's a final thought: dentists make about as much as doctors, despite less training, because they capture a much larger share of total revenue that comes through their door. They tend to have their own x-ray machines and they tend to do all the services on site rather than send people to specialists or prescribe drugs, etc. So even though dentistry is far lower cost than medicine generally, the revenue of dentists is comparable to that of doctors because dentists get a far higher share of dental revenue than doctors get of medical revenue. Do you really think the government or insurance are responsible for this different distribution of money between dentistry and medicine?

Posted by: jd | Mar 4, 2007 12:37:42 AM

I believe the real disaster here is that many people have to suffer. I am not talking about the poor specifically, although they are the largest sector hit by bad teeth.

It is deplorable that in this society we let citizens of the greatest country on Earth suffer with their mouths hurting while only a small percentage of people in this country can afford the beautiful smile.

I myself have many teeth that need assistance. I cannot afford the luxury of paying thousands of dollars to get my teeth attended to. I do not know what I will do.

I don't know if I can legitimately blame the dental profession for my demise. Yes, they make a lot of money and tend to create more needs than maybe necessary. This is unfortunate and scares many people because of the concern of finding a good dentist that is honest may be impossible.

I was brought up in a family that did not put a lot of emphasis on good teeth or taking care of them. There was no fluoride or preventative dental care education and my parents just did not know the importance of proper dental care.

The only way I was ever able to get any relief is when I paid for it myself and this was very difficult.

Poor people also do not the funds to even eat correctly because the foods that are really good for your body and teeth are so expensive. I point to the people that are on food stamps.

Okay, so many will argue that poor people have put themselves on the negative success ladder. I submit there are many circumstances that prevent people from achieving a better station in life and it is by no fault of their own.

Most of the success and failure in this culture is based for the most part on upbringing and family finances. Oh yes, one can cite situations where a less fortunate has succeeded. I believe this is the rule rather than the exception. I believe most people without much that have ajob, work very hard for the little they have.

Thank God, I did provide my kids with the best I could afford with respect to their teeth. I probably neglected my own in the process. I am saddened all the time when I look in the mirror. I hate myself for letting this situation ever get to this point.

It is not just the money it is the feeling of hopelessness that takes over your emothions.

I pray every day for an answer to the dental problems faced by so many. I believe it will be the next health crisis if it is not already.

It is probably too late for me as other health issues may shorten my life anyway. I am not bitter just disappointed. I wanted my life to count for more as is the desire of many who find themselves in similiar situations.

If anyone has any ideas that could help it would be a God's sent for me any many other folks like me.

Posted by: Chisholm | Mar 15, 2007 1:21:48 PM

Dentists Neglect Low-Incomed 364 Days a Year

New York – February 2007 -- One day a year, dentists country-wide celebrate “Give-Kids-A-Smile” day, (GKAS), with much self-promotion and merchandising. But for the rest of the year, most dentists refuse children on Medicaid or other government-sponsored insurance (1). In a study of 35 state Medicaid programs, investigators revealed that only 16% of dentists, on average, actively participated in state Medicaid programs.(1a)

According to the American Dental Association, "specialists' average net income was $315,160 ... From 2000-2004 general practitioners' net incomes increased 11.7 percent, while specialists' incomes grew by 20.6 percent." The Wall Street Journal reports dentists work fewer days and fewer hours than most physicians while making more money. Dentists, whose education is government subsidized, should be required to treat more low-income children. If they cry "freedom of choice," remind them choice is irrelevant when they promoted fluoridation.

Instead of treating low-incomed individuals, dentistry promotes water fluoridation as a false remedy for tooth decay disparities between haves and have-nots.

Unfortunately, that’s failing:

New York State Department of Health statistics (2) illustrate fluoridation’s inability to equalize cavity rates between low and high socio-economic-status (SES) groups, and that fluoridation and tooth decay rates are not inversely related (3) See chart: http://www.freewebs.com/fluoridation/chart.htm

For example, non-fluoridated Nassau, Suffolk and Rockland Counties’ third-graders decay rates: 50%, 54% and 46%, respectively. In slightly fluoridated Albany County 38% have cavities.

Highly fluoridated NYS Counties include Monroe, Erie, Chemung, Broome, Wayne and Jefferson. Third-graders decay rates: 56%, 59%, 55%, 63%,66%,66% and 69%, respectively..

Despite fluoridated water reaching about ¾ of New Yorkers, 54% of third-graders have cavities and more untreated decay than third-graders nationally (33% vs 26%). Only one-fourth of NYS dentists submitted Medicaid claims (4).

Third-graders in 100% fluoridated New York City had more untreated cavities (38%) than their state and national counterparts (4).

Before organized dentistry became fluoride fixated, a 1950 Connecticut study, before fluoridation, clearly linked more fruit, vegetable and milk consumption to less cavities (5) Dentist Weston Price reported a similar correlation world-wide in his 1938 book, “Nutrition and Physical Degeneration.”

Today Connecticut mandates fluoridation. Yet 48% of 4-year-olds suffer untreated cavities (6) partially because 85% of dentists won’t or can’t treat patients with low-paying government-sponsored insurance (7).

A very recent Illinois study (7a) shows that, despite a state-wide fluoridation mandate, 70% of Spanish-speaking-only third-graders have cavities compared to 50% of English-speaking-only third-graders. Clearly water fluoridation had no effect in reducing minority oral health disparities in Illinois just as it hasn't in New York State, Connecticut and elsewhere.


After 60 years of water fluoridation reaching 2/3 of Americans via public water supplies, virtually 100% via the food supply and fluoridated dental products a multi-billion dollar international business, up to ½ of U.S. schoolchildren sport fluoride overdose symptoms as dental fluorosis – white spotted, yellow or brown, sometimes pitted teeth (8) But tooth decay is still a national epidemic, especially among low-income Americans who can't find dentists willing or able to fix their rotting teeth.

Regardless of fluoride intake, modern science continues to show that young children with fewer cavities eat more produce (9). Only 12% of US kids eat enough fruits and vegetables.(10) And, the poor are priced out of healthful eating. (10a)

“Will dentists hand out food vouchers and dietary advice on GKAS Day or just more fluoride?” asks Paul Beeber, President, New York State Coalition Opposed to Fluoridation. “It’s not all about avoiding sugar as most dentists preach,” says Beeber.

“With fluorosis rampant, dentists could make more kids smile by stopping fluoridation,” says Beeber

Dental Health Aide Therapists (DHATs) could be the solution to the oral health crisis. DHATs are to dentists what Physician’s Assistants and Nurse Practitioners are to Physicians. DHATs work successfully throughout the world and can drill, fill and pull teeth in the mouths and geographic areas where dentists can’t or won’t go, more cheaply and as effectively. (11)

Unfortunately, organized dentistry is suing to stop the first New Zealand trained U.S. DHAT from supplying much-needed dental care in Alaska where officials are unable to entice dentists to live or work. (12a) Defying organized dentistry, the first U.S. school just opened in Alaska to train more DHATs (12)

Children need dental care not more fluoride. In fluoridated Arlington, Texas, 61 percent of children examined had active decay After dentists donated their services, tooth decay was cut to less than half of what it was when the program started.(13)

Nationally, up to 48% of poor children, 8-year–olds and under, have unfilled cavities, whether their water is fluoridated or not. (13a).

Fluoride varnish is now used on children as soon as teeth emerge.

Fluoride varnish contains a highly toxic 22,600 parts per million (ppm) fluoride (14) compared to one ppm in fluoridated drinking water that’s not advised for under one-year-old babies (15) and 1,000 ppm in toothpaste that’s not to be used by children less than two years old. (16)

“Fluoride. It just doesn’t make sense anymore,” says Beeber.

References:

http://tinyurl.com/6kqtu

Posted by: nyscof | Mar 21, 2007 3:46:22 AM

Are the folks give all these "facts and figures" part of our Dental Organization at all?

I have worked in the dental profession for now over 20 years since 1986 when I entered the USAF. From the 80s to the 90s, I have seen the various methodology and techniques for educating and training both the local populace and the healthcare providers themselves.

Dentistry is still a young profession compared to the Medical field. We are learning more each year and changing methods and products as we find better and more improved methods.

The single most important aspect in dentistry that makes and breaks the system is compliance...Although the military does not deal with "Poor" population and such, we find that most Americans are quite uninformed or misinformed about those things which could well save their healthy smiles and keep the teeth they have forever.

I have seen the reports and the endless supplies of books by various "Experts" who say this is not good, that is not good...but when it comes down to the end result here is what you have...

Most Americans couldnt care about their own personal hygiene, if they do, they will find a way to take care of it...dentistry is one of those fields where if it does not hurt, its not a problem...even if you have 10 cavities or your teeth are so black and broken that your personal appearance is quite lacking. If it does not hurt, its ok. This mind set has been around forever.

The number of times I have been on-call on a Saturday or Sunday and have had to treat a patient who did not want to come in on Friday or Monday because they were too "busy" is ridiculous. If I could have charged each and every patient $50 per visit just to be seen, I would have had 50-75% less nuisance calls on the weekend. The true emergencies were very rare....a sports injury, car accidents, broken tooth and coming in right away...

Everyone can blame govt for not doing more and more, but we, the people need to stop for one second and really look at ourselves...and this is not just for dental problems but also medical ones...

Stop blaming everyone else and look at yourself. Are you eating well? Or are you one of those junk food addicts? If you are obese and getting worse, your medical condition will soon follow...why blame the medical personnel for your lack of restraint of that 3rd BigMac or that 4th helping of icecream...

and dentally....

Do you brush each day, twice or three times a day? What about flossing....do you ever floss? Why blame your problems on your "Family History"? Grandma had soft teeth so I have them....bullcrap! Grandma didnt take care of her teeth and by default you think that by not doing your own job you can just blame it away...

Stop pointing and blaming others for your own troubles...take responsibility for your own actions and inactions...

After 20 years of dentistry I still hear the same excuses by now a new generation of patients who were diligently taught by their parents...break the cycle, accept your own faults and fix them.

As for Poor and Rich and inbetween...well, its like everything else.....and as for Dentists making all that money and not wanting to accept all the programs...

Visit a dentist and ask what they paid for college and later dental school...ask if they actually had a program that allowed them to subsidize their education

Alot of folks love to say everyone gets it, but not everyone does...

Did your college cost you $150-$250,000 dollars? That is about the average cost of dental school roughly....if you got lucky and got subsidized you might be able to shave off perhaps 50%....so $75k-125k...thats more than most folks have to pay for a college degree. Now the other part is that even if you make it, you have to pass the tests and when you move you will end up having to take new tests if you are moving outside of the region of your licensure.

I knew alot of young dentists who came into the military because they could not afford to start a practice due to the high cost of their education...so they struck deals to become military dentists and were able to postpone their repayments of the school bills by serving...most of them paid monthly still for their small O-3 Captain pay to help offset their bills and gain practical experience working in the military.

It is not always greener on the other side of the fence folks...although anyone can say anything to show information favouring any side, there are always two sides of a coin...and although there are definitely dentists out there who make quite a bit of money, most are well established and usually are in some form of partnership or consortium...the majority of smaller single office dentists probably make a decent living, but not as well as most folks think they do.

The only stickler I have with civilian dentists is that many are taking the patient's constant needs and frivlous wants and slowly giving them exactly what they want even at the expensive of perfectly uneeded treatment.

You, the patient are to blame for this....you keep wanting those Perfect White Teeth even though you smoke 2 packs a day...you know perfectly well you should stop but you go and pay for treatments that are really not needed...those fillings which would normally outlast you or take years before needing replacement are now replaced very frequently due to "staining" and you want that white smile so you want them removed and replaced...ensuring a larger filling in place and each time getting just larger and more susceptible to further staining....

People crying Wolf about amalgams....Yeah you get mercury poisoning alright...In your brain that has already been poisoned enough...Most of you drink and eat more poisons daily from the hormone enhanced meats to the specially sprayed chemically enhanced fruits and veggies than you would ever see in anything the dentistry field could come up with. I enjoyed the 60-minute shows that showed how ridiculous people would actually be...and now, the civilian population is so crazed by this foolishness that they are willing to replace every tooth in their head with composites...I applaud you...you are giving the dentists the one thing they needed the most...more work. Amalgams to date are just as safe as anything else we are using...you can blame your headaches to your significant others, your children or perhaps to doing whatever you shouldnt be... now if you unlucky enough perhaps you are a rare breed that is allergic to something..who knows...but the majority of people are self-indulgent and will pay for glamour.

Keep the "Bad Dentists" in work...those that feed of 1 more filling, 1 more tooth pulled...Its you who created them, so live in the mess you created.


To those who really want help...

Evaluate your lifestyle....look at what you do daily
What is your diet consist of, what do you do to take care of yourself....physically, mentally? Do you get enough sleep, do you exercise, have you quit smoking and drinking or doing other things harmful to your body?

It is not a quick cure all....there is no MAGIC PILL for you...it will require dedication and work to get yourself to were you need to be...and guess what

Even after all you do, life can throw you a wrench and give you cancer anyways....its life, make the best of it, use it to its fullest...and stop bitching and moaning that this person, that agency and whatever are not taking care of you, pampering your every need...get off your arse and take charge yourself. Do not rely on a system to help you out, help yourself...get yourself healthy, keep yourself healthy and who knows you may find that even if you do not make $100K a year or even $25K a year, you are still able to take care of yourself.

As for all those mandated procedures....here is what you need:

A yearly if not every 6-month checkup with a cleaning at a cost of perhaps $100-250 per visit to include usually the x-rays or perhaps a little higher if not or in states where inflation is killing you anyways
(Examination of your teeth, finding any caries and taking care of your calculus, stains and whatnot during the last 6-12 months you have put on your teeth)
**With exams usually come x-rays...cant tell always were those cavities are located without taking a closer look; not everyone needs x-rays every year...some folks due to their dilligent cleaning nature are able to skip a year between taking them...while others, require them each year and perhaps even more often if they are in some sort of active caries prevention program**

Besides the above, the only other requirement will be to fix things you did not take care of yourself

Fillings, perhaps so bad now you need an extraction, and if the extraction will cause a problem with tooth movement and appearance now you will need to look at either dentures or perhaps crowns or bridges to help offset that area...if you can save the tooth, save it and get a crown...if it cant and you can close the gap with a bridge, get a bridge....if you have lost enough of a certain area of teeth, you may need either a partial or perhaps full denture...these items should NOT be a CONSTANT thing....if you take care of yourself.

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