aTypical Joe: a gay New Yorker living in the rural South

Friday, August 26, 2005

Dental frights

Even with insurance my deductible and co-pays for routine medical procedures so far this year have cost me thousands of dollars. What was not routine, and cost another couple thousand in deductibles and co-pays and met maximums, was my dental needs.

On vacation a tooth cracked; that called for a crown. Later, another cracked, this one requiring a root canal. I felt lucky; they were concerned the crack went to the root which would have required pulling the tooth and an implant.

That would have cost more thousands of dollars. There are ways around the implant, more expensive in the long run because an implant is permanent, other alternatives are not.

Malcolm Gladwell begins his New Yorker article on the bad idea behind our failed health-care system with a graphic description of tooth decay, then follows up with these anecdotes from ”Uninsured America:”

Gina, a hairdresser in Idaho, whose husband worked as a freight manager at a chain store, had “a peculiar mannerism of keeping her mouth closed even when speaking.” It turned out that she hadn’t been able to afford dental care for three years, and one of her front teeth was rotting. Daniel, a construction worker, pulled out his bad teeth with pliers. Then, there was Loretta, who worked nights at a university research center in Mississippi, and was missing most of her teeth. “They’ll break off after a while, and then you just grab a hold of them, and they work their way out,” she explained to Sered and Fernandopulle. “It hurts so bad, because the tooth aches. Then it’s a relief just to get it out of there. The hole closes up itself anyway. So it’s so much better.”

People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn’t, of course. The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes. The pain of tooth decay leads many people to use alcohol as a salve. And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier. If your teeth are bad, you’re not going to get a job as a receptionist, say, or a cashier. You’re going to be put in the back somewhere, far from the public eye. What Loretta, Gina, and Daniel understand, the two authors tell us, is that bad teeth have come to be seen as a marker of “poor parenting, low educational achievement and slow or faulty intellectual development.” They are an outward marker of caste. “Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ ”

My brother and his wife both have visibly rotting teeth and holes were other teeth once were. They also believe that America has the best healthcare system in the world.