Dental care as a luxury good

Dental care apparently has become a luxury. Revenue at U.S. dental practices has dropped each of the last three years while the economy was in the tank, according to the Los Angeles Times.

Dental health is an underappreciated health issue. The mouth is often called the gateway to the body, and periodontal disease can signal more serious conditions, such as diabetes, heart disease and potential pregnancy complications.  Good oral health is also linked to well-being and quality of life. Teeth are critical to maintaining proper nutrition, physical attractiveness and have an impact on employment opportunities and income.

About 97 percent of Americans consider oral health important. However, dental care is an unmet need for many. Nearly 1 out of 3 U.S. adults has untreated dental decay, and more than 8 out of 10 have ever had decayed teeth. Fewer than 2 out of 3 adults visit a dentist annually, and those above the poverty line are twice as likely to do so. Employees lose more than 164 million hours of work annually because of dental disease or visits. The U.S. Surgeon General has characterized untreated oral disease “a silent epidemic.”

Major advances in the second half of the 20th century have had a major impact of U.S. oral health. Most baby boomers and younger adults can expect to keep their natural teeth and avoid major oral health problems throughout life. However, they also will be at more risk for decayed teeth.  On the other hand, more than 1 out of 4 elderly Americans are toothless.

Fluoride has been added to U.S. water supplies since 1945 to prevent tooth decay. Federal health officials have called fluoridation one of the 10 great public-health achievements of the 20th century and has resulted in an estimated 30-50 percent reduction in dental decay.

 Fluoridation exposure at birth affects tooth loss in their 40s and 50s, regardless of what the exposure was like in their 20s and 30s.  Fluoride improves tooth enamel, helps teeth damaged from the decay process, and breaks down bacteria on teeth.  A study of Medicaid dental patients in Louisiana showed that for every $1 invested in water fluoridation, the state saved $38 on dental costs.

However, the federal government lowered its recommended limit of fluoride in drinking water because spots on children’s teeth were indicating they were getting too much of the mineral. Fluoride is also in toothpaste, and experts suspect children are swallowing it.

A significant barrier to care is a widespread shortage of dentists, especially in rural areas. The U.S. dentist-to-population ratio declined during the 1990s, after peaking at 60 per 100,000 population. By 202, the ratio is expected to drop to less than 53 per 100,000, or about one dentist for about 1,900 people. By contrast, the physician-to-population ratio is about 286 per 100,000. The federal government in 2010 identified 4377 dental health professional shortage areas, and fewer than half of dentists were treating Medicaid or Children’s Health Insurance Program children in most states.