Inside America’s oral health crisis: An interview with author Mary Otto
Written By David Silverberg
Journalist Mary Otto never thought she would devote a good portion of her latter career as a reporter to delve into the oral health issues plaguing the U.S. That is, until she learned about a 12-year-old boy who died from an untreated tooth abscess. On a January day in 2007, Deamonte Driver came home from his Maryland school complaining to his parents he was suffering from a headache. He got some medicine for the headache and a dental abscess that was bothering him. He went to school the next day. But two days later he was rushed to the hospital with a diagnosis of meningitis. He couldn’t talk. He was fighting for his life. The boy needed brain surgery, and this time the abscessed tooth was taken out. It was a molar on the upper-left side of his mouth, one of the first permanent teeth to erupt when baby teeth are shed, and particularly prone to decay. This tooth was ruined, infected to the core, and bacteria from the abscess had spread to the boy’s brain.
He died six weeks later.
Covering this story for the Washington Post, where she worked on the metro desk from 2000 to 2008, Otto knew an important issue when she saw one. And this story led to another, such as Maryland instituting broad reforms to its Medicaid dental program for children. She decided to spend years investigating more problems that have hurt countless American families seeking dental care. The result was her 2017 book Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, which examines “the enduring tension between the need of Americans for dental services and the lack of services available to millions of us under the current system.”
What happened to that Maryland boy shook her to the core, Otto says in an interview with Muzeum Dental. “As I was writing this book, I kept on learning about the many children in Maryland, and elsewhere, who were not getting routine dental care and I learned about the deeper systemic issues affecting oral care in the U.S.”
The U.S. government estimates around 49 million Americans live in an area where there is a shortage of dentists. Also, more than 114 million people lack either private or public dental benefits. As you would expect, poorer Americans are left without dental care that wealthier American can afford.
Otta sought to provide enough historical context in Teeth to explain how dentistry was separated from regular medicine decades ago, and how the profit motive has encouraged dentists to focus on more costly procedures (e.g. cosmetic) rather than preventive services such as cleanings. For the book, she attended a convention of dentists, writing what dental marketing guru Roger Levin told the assembled dentists: “All too often, dentists have laxly marketed, missing opportunities to sell procedures.” For example, he said, “Mrs. Jones. You owe it to yourself to find out how dental implants can improve the quality of your life. ... Let us review our four wonderful payment options.” Dentists want to ensure the patient pays the bill before the procedure is finished, he advised.
There has to be a shift in our mindset when we consider the importance of oral care, Otto says.
“Our teeth are a deeply personal part of our body,” Otto stresses. “We don’t just use them for survival, to eat, but they are a tool of self-expression when we smile.” What is often overlooked in public health, no matter where you reside, is how tooth decay is a chronic illness. “It can affect something like diabetes,” Otto notes, “because studies have shown that diabetics have better outcomes if periodontal disease can be managed.” One of the things that surprised her while researching the book was learning that since dental benefits for adults are considered optional under federal law, “they are often among the first items to end up on state budget chopping blocks during difficult times, just when people need them the most.”
Racial inequality plays a role here, too. Black Americans aged 20-44 years, earning below $23,050 US, faced nearly double the rate of tooth decay (41.4%) as whites in that same age and income group, as Quartz writes. Tooth decay for Hispanics in that category reached 35%. Asian Americans in that age and income bracket were the opposite; they had less tooth decay than white Americans.
Canada may have comprehensive health care but dental isn’t included. About 32% of Canadians have no dental insurance and this number increases with age.
Dental care in Canada is provided by a variety of charities, private plans and government-sponsored programs that typically target low-income families, Global News writes. Many countries across the developed world use a similar multi-faceted model, but Canada’s coverage rate of around 70 percent lags behind, says Carlos Quinonez, head of the dental public health program at the University of Toronto.
When asked about how the coronavirus pandemic affected oral health care in the U.S., Otto replies, “The impact of this remains to be seen; here in the United States dental providers are being urged to limit most services in response to the pandemic.
On March 18, the Centers for Medicare & Medicaid Services (CMS) recommended that dentists delay non-essential services in order to reduce the spread of disease and to save protective equipment (PPE) needed by healthcare workers responding to the virus outbreak. Around the same time, the American Dental Association (ADA) called upon dentists nationwide to ‘postpone elective procedures for the next three weeks.’” It’s hard to guess what’s coming next. “It is a very uncertain time for oral health workers and patients, too,” Otto says.