No teeth means no job

Earlier this year, the managers at a Salt Lake City counseling office were struggling to fill a position at their front desk. They'd blazed through a string of potential candidates sent by a staffing agency, but none had the qualifications they were looking for. And then the agency sent a candidate named Shelly (not her real name), a 35-year-old mother of three who'd re-entered the work force because her husband was laid off.

“Everyone in the office loved her, ” recalls Miriam Brown, who also worked the front desk. As a temporary employee, Shelly was pleasant to work with, competent and kind to the patients. “We all told our boss to hire her because she was so great."

Instead, management hired someone else.

At a staff meeting, Brown asked her manager why Shelly wasn’t hired permanately. The response shocked everyone in the room. The office manager said Shelly had bucked and crooked teeth. “He said it wasn’t the image we wanted to project at our clinic,” Brown said.

This is not an isolated incident. Studies show bad teeth prevent otherwise qualified candidates from getting jobs or promotions. Although the U.S. is on the cutting edge of innovations in dentistry, many Americans have poor oral health and crooked or missing teeth and don't go to the dentist because they don’t have insurance and can’t afford to pay out of pocket for care. The scope of the problem is widespread: close to half of Americans are without dental insurance, according to data from the Department of Health and Human Services.

Limited access

Access to dental care in America is limited in two basic ways. First, many don’t have access to insurance, and second there is a shortage of dentists who are willing to treat the poor.

About 130 million Americans, 43 percent of the population, have no dental coverage whatsoever, according to a 2012 report from the U.S. Senate Subcommittee on Primary Health and Aging. The data show that although spending on dental services amounts to just under 5 percent of total health care expenditures, 44 percent of dental bills are paid for directly out of patients' pockets.

This sheds some light on why low-income families are more likely to suffer from compromised oral health: they don’t have the wiggle room in their budgets to pay for dental services. Instead of heading to the dentist when they experience tooth pain or injury, they go to the emergency room.

A study published in the Annals of Emergency Medicine found that in 2009 more than 800,000 patients visited emergency rooms across the country seeking treatment for preventable oral diseases.

The poorest Americans, recipients of Medicaid, are eligible for dental benefits, but many report difficulty finding a dentist willing to see them. Many dentists don’t accept patients on Medicaid because the reimbursements don’t cover the cost of doing business, according to a representative from the Washington State Dental Association, who said that on average, 60 percent of dentists' fees are eaten up by overhead. "I can't afford to do Medicaid," said Cesar Sabates, president of the Florida Dental Association.

In fact, only 20 percent of the nation’s practicing dentists provide care to people with Medicaid, and of those who do, only a small percentage devote a substantial portion of their practice to serving the poor, according to the report by the U.S. Senate Subcommittee on Primary Health and Aging. This helps explain why only 38 percent of children on Medicaid received dental services in 2009, according to Bernard Sanders, who authored a 2012 Senate report on the American dental crisis.

Compromised health, crooked impressions