KDA Today

KDA Today

For Immediate Release

Date: Feb 23rd, 2018
Contact: Dr. Ansley Depp
Phone: 800-292-1855
Email: info@kyda.org

Let’s Talk about Teeth.

Let’s talk about teeth.  No, not the pearly white things that we stare at and treat each day, the book. I just finished rereading the book Teeth.  The book was written in 2017 by Mary Otto.  Mary is a health journalist who often writes for the Washington Post.  Mary wrote the cover story about 12-year-old Deamonte Driver who died in 2007 from a tooth infection.  The story so affected her, she quit her job to research and write this book. 

From the book jacket: “Teeth takes readers on a disturbing journey into America’s silent epidemic of oral disease, exposing the hidden connections between tooth decay and stunted job prospects, low educational achievement, decreased social mobility and the troubling state of our public health. Otto also goes back in time to understand the roots of our predicament in the history of dentistry, showing how it became separated from mainstream medicine, despite a century of growing evidence that oral health and general bodily health are closely related.” 

Reading this book is not for the faint of heart, yet, I highly suggest you read it.  Mrs. Otto does not portray dentists or organized dentistry in a flattering light.  She describes the beginning of dentistry as a professional organization with a story many of us have heard in dental school.  

Chappen Harris and Dr. Horace Hayden approach the physicians of the College of Medicine at the University of Maryland with the idea of adding “dental instruction to their medical course”.  However, the physicians rejected the proposition in a letter to Harris “giving as an excuse ‘that the subject of dentistry was of little consequence, and thus justified their unfavorable action.’”  Mrs. Otto suggests since that letter was never found that perhaps this story is untrue. She seems to suggest that the story was fabricated and implies it was dentistry’s fault that medicine and dentistry have diverged. 

Mrs. Otto tells the story of the birth of Medicare and Medicaid in the 1960s. She writes that “most” dentists don’t take Medicaid, though the national number of dentists participating is 42%.  She blames the dentist for being frightening and “standing above the patient in a position of power” and concludes that dental schools don’t do enough to teach the dentists to be less threatening.  She recognizes that dentists lose money when Medicaid patients miss their appointments.  But, then she appears to question why dentists blame the patient when they miss.

One professor in the book remarks, “We have these students being prepared with public funds.  They are being educated with public funds.  And they will go work in private offices and they will decide who they can see.”  Am I missing something here?  Most students I am aware of are coming out of school with $250,000-plus of debt.  I am not seeing a public entity pay for their school, nor pay their start up business costs.  Perhaps, if states were funding dental education better to offset the rising cost of tuition, we might see students coming out with less debt and able to service and support more Medicaid patients.

In the book, she remarks that dentists now make more than physicians per hour, quoting 2010 stats.  However, she does not make note that, according to the ADA, since 2005, dentists’ average income has declined nearly 13% from $215,876 to $188,580 in 2016.

In stark contrast, family medical practitioner salaries have risen over 54%, from an average of $150,000 in 2005 to $231,000 in 2016, as reported by Merritt Hawkins & Associates, the nation’s leading physician search and consulting firm.

She credits the dental insurance third-party payment system as a democratizing agent, “bringing quality-control measures and fee schedules to dentistry and making services more accessible to millions”.  However, she does not mention that dental insurance has had the same maximum benefit since its inception in the 1960s, nor does she mention that the premiums for dental insurance have risen significantly for the same flat maximum benefit.  One interesting fact in the book is that the price of crowns for a patient in 1956 ranged from $60 to $150 per tooth.  I used an inflation calculator to compare those prices with our average fees in 2017.  Based on the calculation, those same crowns today should cost $551 to $1,380, which is in line with average fees within our profession. So maybe dentistry has done a good job of not outpacing inflation?

Mrs. Otto champions the mid-level provider as the answer to many problems, noting successes in New Zealand and Canada.  She believes that our dental system rewards surgical procedures rather than prevention.  Yet, she does not mention that our prevention practices in our offices far outweigh what medicine does.

She does mention that the ADA has lobbied in recent years to increase the funding for Medicaid and she does reference success stories like the state of Maryland, which has raised Medicaid fees and increased their providers. 

Although it was in the context of promoting mid-level providers, she does restate an ADA quote that sums up our stance on what is required of society to address the challenges we face.

“Underlying the extent of untreated disease is a societal failure to understand and value oral health.  When the nation decides to put its resources into preventive measures like community water fluoridation; first dental visits by age 1; oral health education, assessment and sealant programs in schools; better integration with the medical community; and realistic funding of care for those in greatest need, it will have made a dramatic step toward ending untreated oral disease.  Absent these things, dental therapists will not have an appreciable positive effect on the public’s oral health.  And if such measures are put in place, the debate over therapists will be moot.  They will not be needed.”    

This could not be more pertinent when on January 12 of this year, Kentucky won approval for its new Medicaid waiver to require participants to work or volunteer to “earn” their dental benefits.   With the expansion of Medicaid in 2012, Kentucky was able to offer dental benefits to more adults and decrease the number of ER visits.  Now, as of 2018, dental and vision benefits for the expansion population has been relegated to the status of a “reward benefit”. To have a tooth extracted, an able-bodied adult Medicaid recipient from the expansion population will need to have earned dollars to be put in their Rewards account to have a tooth pulled or a routine cleaning. Once again, we have made it more difficult to see a dentist for preventative services and will likely see an increase in ER visits for emergent visits. 

Until government, education and society recognize the importance of putting their money where their mouth is, no pun intended, society will never achieve the true oral health that Mrs. Otto and every dentist champions.

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