A bolt of lightning shoots from your temple, through your tooth, around your jaw, down to your knee. As it goes through the tooth, an explosion occurs, filling your entire head with raw, concentrated agony.
Just as your brain begins to process this, a leg forgets its purpose. You barely realize you've dropped to the ground when a scream you didn't know was there forces your mouth back open, allowing the air pressure fluctuation to begin the cycle again. All you can see is white.
After a week-long hour or so, it ends. You can go about your day, but it will happen again. Probably tomorrow. Maybe today. It will happen with no warning, and it could happen at any moment. You are acutely aware of this, every second of every day, until you save up enough money to get it pulled out of your head.
H/T Gallifreyan Jedi.
The Washington Post examines one of the most overlooked aspects of inequality in this country—the high cost of obtaining even basic dental care. Dental care is a subset of health care, but historically separated out in the U.S. health care “market,” even though dental problems can quickly cascade into serious medical conditions. Those of us with decent dental coverage through our employers usually receive it through a plan separate from our health care coverage. And just like health insurance, the coverage provided in employer-based dental plans varies drastically.
But even meager coverage is better than no coverage at all. And no coverage is what millions of Americans—many working steady, full-time jobs—are forced to cope with:
As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter.
Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left.
More than a third of American adults have no dental coverage. Medicare does not cover dental issues—Medicare-eligible seniors must purchase separate dental insurance, which usually caps benefits at $1500 per year, even as dental costs have skyrocketed. Although states require coverage for children on Medicaid and CHIP, many non-eligible kids have to go without care because their parents can’t afford the plans offered through their work. One of the benefits of the Affordable Care Act (and one of the measures callously repealed by the Republican House of Representatives last week) was a requirement that dental care be included in health insurance plans for those up to age 19. Thanks to Donald Trump and the Republican Party, those benefits (and dental coverage for five million adults) are likely to be taken away.
Although it may not occur to some of us, teeth are social indicators, especially to those whose teeth are in poor condition. While straight, white teeth connote “success,” they are a luxury unavailable to nearly 50 million Americans who live in areas where there are few dental professionals around. Many of those 50 million are among America’s working poor. The Post visited Salisbury, a town on Maryland’s Eastern Shore, where people line up in the hundreds outside the town’s civic center for free dental work provided by volunteer dentists from five surrounding states. One of the women interviewed for the article described how the poor even judge each other by the condition of their teeth:
“If I see someone with perfect teeth, I think, ‘Oh, man, they’re out of my league,’ ” Matello said.“Us poor people ‘status’ each other. We’re like, ‘Ah, dude, you don’t have any teeth!’ Or if you see someone with little jagged yellow stubs, you think, ‘Oh, man, you have lived here your whole life, haven’t you?’ ”
In rural areas people often rely on individual wells for their drinking water, and as a consequence they miss the cavity-preventing benefits of fluoridation enjoyed by many suburban and urban residents. This simply aggravates what is becoming a near epidemic-scale of poor dental health among the less affluent in this country. One study by the Federal Reserve found that a quarter of Americans went without dental care they needed because they could not afford it. The Post interviewed the head of a rural clinic outside Salisbury who said local hospitals are being totally overwhelmed by people complaining of often severe dental problems:
George Acs, director of the dental department at Chesapeake Health Care, a clinic near Salisbury, said people with oral pain and infections are inundating hospitals. Last year, more than 2 million U.S. emergency room visits were attributed to neglected teeth.
“What I am seeing is absolutely horrifying,” said Acs, who recently testified about the problem before the Maryland state legislature.
The problem is that ER rooms are generally not equipped to handle dental complaints. As a result, the standard practice is to medicate the patient (one doctor calls it “a perpetual cycle of antibiotics and opiodes”) on the assumption that they will then, somehow, get themselves to a dentist:
That cycle is feeding a nationwide epidemic of opioid addiction. Meanwhile, Higgins said, Americans’ increasing reliance on all kinds of drugs is further ruining their teeth. Many drugs cause dry mouth, which leads to more cavities. When she started her practice 35 years ago, she said, people took far fewer prescription drugs. Now patients hand her computer printouts with long lists of them.
Simple lack of access is one of the biggest problems poorer people face. Even more than other medical doctors, new dentists are often saddled with significant debt (typically as high as $260,000) and as a result they tend to gravitate towards more affluent areas where they can earn a living and pay off their loans. They are often solo practitioners with high overhead costs and simply can’t afford treating people of limited means. A major obstacle discouraging more rural dentists is the minor problem of getting paid—either by Medicaid (with notoriously low reimbursement rates) or insurance companies that deliberately lowball their allowed costs for routine procedures. In some states (such as Delaware), Medicaid doesn’t reimburse for dental at all. These are the states where you see long lines of people suffering from painful dental problems, waiting for free care, a process one woman describes as both “demeaning” and reminiscent of a “Third World country.”
Many of the same people standing in those lines and interviewed for the article supported Trump last November. Word of what “Trumpcare” actually meant to their situations filtered down to at least one of them:
[F]our months into Trump's presidency, [Dee] Matello sees Trump backing a Republican health care plan that appears to leave low-income people and the elderly worse off.
“I am hearing about a number of people who will lose their coverage under the new plan,” Matello said. “Is Trump the wolf in grandma's clothes? My husband and I are are now saying to each other: ‘Did we really vote for him?’ ”