Public health officials are quick to point out that dental issues are medical issues. An example of the high cost of neglected dental care is the death of Deamonte Driver of Maryland. The 12-year-old boy died in 2007 from an infected tooth. Although he had Medicaid, his mother was unable to find a dentist in their area who would see her children and accept their coverage, and by the time his aching tooth got any attention, the abcess had spread to his brain. An $80 tooth extraction could have saved his life.
As Driver's story illustrates, dental checkups can detect the signs of microbial infections, immune disorders and some cancers. The phrase “the mouth is a mirror” underscores information about general health that comes from examining oral tissues.
Poor oral health may also interfere with vital functions like breathing, swallowing, eating and speaking, which further compromise the well-being of the afflicted. For example, without teeth to chew, it can be difficult to get adequate nutrition.
There is a social cost of going without dental care, too. Numerous studies show a strong correlation between appearance and income. Research by Daniel Hamermesh, professor of economics at the University of Texas, found that better than average looking people earn 5 to 10 percent more than average looking people, who earn 5 to 10 percent more than below average looking people. “Teeth are an important component of physical appearance,” Hamermesh said.
In an effort to isolate the economic value of teeth, Sherry Glied and Matthew Neidell of Columbia University School of Public Health looked at the link between fluoridation and income. “Childhood access to fluoridated water leads to better teeth,” Glied said. Glied and Neidell found that women who grew up in communities with fluoridated water earn 4 percent more than similar women who did not.
But income isn’t the only thing impacted by the appearance of a person’s teeth. Researchers have noted pronounced negative associations with crooked, discolored and decaying teeth. Approximately 40 percent of respondents to a 2012 study by Kelton Research said that they would not date someone with crooked teeth. And about 73 percent said that people with straight teeth are more trustworthy.
When Israeli researchers digitally manipulated the teeth on the subjects in photographs and asked people to give their first impressions, they noted similar patterns of discrimination against people with poor oral health. People with crooked, discolored and missing teeth were judged to be of limited intelligence, low class, bad parents, less professional, less physically beautiful and lacking social skills.
Currently, low-income and minority families experience more oral disease, yet they receive less care, according to Bernard Sanders, author of a 2012 Senate report on the dental care crisis in America. "It is our ethical and moral imperative to commit to providing access to dental care for all, both to improve health and to reduce overall costs,” he wrote.
Sanders advocates introducing a new work force model by adding dental therapists, the dental equivalent of a nurse practitioner, to the system. More than 50 countries around the world, including Canada, Great Britain and New Zealand, use dental therapists. Minnesota is the only state where dental therapists are authorized to practice. "I am trained to the level of a dentist, but trained to do fewer things," said Minnesota's first registered dental therapist, Christy Jo Fogerty, in a Frontline documentary, "Dollars and Dentists," that aired earlier this year.
Preliminary studies suggest dental therapists substantially increase access to dental services and provide high quality, lower-cost care, according to Sanders. Analysis by the Pew Research Center found that private practice dentists who add dental therapists to their teams would maintain or improve their bottom lines.
Still, the American Dental Association is fiercely opposed to the proposal. Lobbying efforts by the organization have successfully blocked the expansion of the dental therapist model to other states.