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  • January 3, 2018

book shows unvarnished look at dentistry

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A new year is here, and among all the “best of” lists to bombard us, a book that came out last year may have missed your notice.

It doesn’t contain revelations that would surprise anyone in dentistry, but the anecdotes and numbers are disturbing nonetheless. And so is its message of hopefulness.

Mary Otto, a Washington Post reporter turned health care journalist and author, published Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health Care in America last summer to good reviews for its unvarnished look at dentistry and how we Americans view and get dental care.

What galvanized Otto’s book was an assignment she had at the Post. A young boy in Baltimore, 12-year-old Deamonte Driver, died of a brain infection caused by a tooth abscess while his mother frantically searched for a dentist who would treat the child, whose family was on Medicaid. Shocked to think that someone could die in America from a preventable condition, Otto decided to dive deep.

Otto traces dentistry’s earliest days – from 1840 when two dentists founded the first dental college in Baltimore after their request to incorporate dental treatment was rejected by physicians at the medical school - on up through heated policy debates about dental therapists and the Affordable Care Act. Along the way, she highlights changes and historical turns that consolidated the notion that medical care and dental care were separate and unequal.

“The whole system has grown up around that separation,” Otto said in an interview with The Pew Charitable Trust. Insurance systems were separate, and many dentists were – and still are – wary of integration.

The pervasiveness of oral disease in America, she said, can be traced back to the 1800s when poor people would sell their teeth to the rich, whose teeth had rotted away from eating sweets the poor could not afford. Today, untreated dental conditions due to lack of access or money can be linked to stymied job prospects, low self-esteem and education achievement and stunted social mobility.

Access to oral care is a big issue among dentists today, as many work to broaden care to the underserved. Yet Otto points out that there is a pointed dichotomy: a cosmetic dental industry that puts on $1,000 veneers, “contours” gums and whitens teeth vs. free clinics in Appalachia or mobile Indian health clinics in Alaska whose dentists struggle to see all the people who have no access to regular dental care. Are dentists “providers of beauty,” as one dentist told Otto, or health professionals who deal in the important work of filling cavities and pulling decayed teeth?

According to Otto, one-third of white children go without regular dental care. For black and Latino children that number soars to close to half. Rural areas pay the price too: 49 million people live in “dental professional shortage areas.” And those on Medicaid often have great difficulty finding a provider.

While there is much to worry about, Otto does take heart with some advancements.

The 2000 report by the Surgeon General David Satcher continues to resound in the health professions, Otto says. Dr. Satcher’s argument in “Oral Health in America” that physical and oral health are inexorably intertwined began to break down walls, Otto said. Dr. Satcher advocated for a system that would meet the oral health care needs of all Americans and “integrate oral health effectively into overall health” treatment.

In Otto’s interview with The Pew Charitable Trust, she said, “People still keep going back to that report for understanding and guidance after 17 years. The biological and political understanding of oral health are two forces that are continuing to drive the system to integration.”

Yet she sounds a cautionary bell on the ongoing efforts to dismantle the Affordable Care Act, which now allows for pediatric dental benefits, and the idea of converting Medicaid funding to block grants, potentially dooming dental benefits that children in that program have had since the 1960s.

There are many more scenarios Otto highlights in her book, some disturbing and some encouraging. Fortunately, the story of dentistry is still being written. No journey is a straight line, but healthy debate and an understanding of how and why dentistry is at this crossroads hopefully will allow for continued progress.


The views expressed in this column are those of the writer and not necessarily the opinions of the Chicago Dental Society.

CDS presents Front Desk, a column addressing problems dentists and staff members experience in the office.

Front Desk is prepared by Stephanie Sisk, a freelance journalist.

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