Seniors' Access to Dental Care Found Wanting

[Judi Lynn]

April 8, 2006
Seniors' Access to Dental Care Found Wanting
By Staff

(AXcess News) Buffalo, NY - A survey of seniors' access to dental care conducted by researchers at the University at Buffalo and Buffalo State College presents a sobering picture of the dental needs and barriers to dental care experienced by seniors.

Results showed that only 11 percent of 273 respondents had dental insurance. Not surprisingly, given that figure, more than half -- 52 percent -- listed financial need as the greatest barrier to receiving dental care.

The findings were presented at the International Association of Dental Research annual meeting held in March in Orlando, Fla.

Kimberly Zittel-Palamara, M.S.W., Ph.D., clinical assistant professor of restorative dentistry in the UB School of Dental Medicine and an assistant professor of social work at Buffalo State College, was first author.
(snip/...)

http://www.axcessnews.com/modules/wfsection/article.php?articleid=8998

[PCIntern]

1. No joke...

I'm a dentist...you have no idea how catastrophic this is and how debilitating. With the new findings about the interaction between periodontal disease and coronary artery disease, you can probably state that dental neglect due to finances would be responsible for a great many illnesses and deaths, something known in the medical "industry" as morbidity and mortality.

But what do I know? I went to dental ooops I mean, PROVIDER school...since I'm a PROVIDER, not a dentist. I get letters, the salutation reads: Dear Provider:

I'm not a 'numbers cruncher' like all these Administrators are. All bastards all the time.

[WePurrsevere]

2. It stinks for the disabled on Soc Sec disability as well....

Basically if you don't have dental as a part of your retirement package or are eligible for Medicaid basic Medicare Parts A and B won't help even though dental care is very important and closely related to a persons overall physical and emotional good health.

From here: http://tinyurl.com/er6sy

Question: Does Medicare cover dental services?

Answer: Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. In rare cases, Medicare Part B will pay for certain dental services. In addition, Medicare Part A will pay for certain dental services that you get when you are in the hospital. Call your local Medicare Carrier for more information. You can find their phone number in the Helpful Contacts section on our Website. Some Medicare health plans may offer additional dental coverage.

[PCIntern]

4. I could have a whole forum on this

of course, everyone would be busy making jokes and disparaging dentists. BTW, the guy who came in this morning swollen and in agony wasn't in the laughing mood. No Tim Conway/Harvey Korman skits going on here.

This is a most serious issue which will not be even addressed in my lifetime.

[WePurrsevere]

16. If he had an abcess I all too familiar with how they feel. :-( Perhaps you

wouldn't mind addressing something that has bothered me for a while...

I would think that dentists could be a powerful lobbying group for dental care being included as a part of Medicare, especially if they could work with the AMA or such, why don't they? They do so much for promoting preventative dental care for children but there are many Americans, especially the elderly and disabled, that truly need someone to take a stand and help them as well.

Many people don't realize that there are many out here that don't have dental or have just a bit too much to qualify for Medicaid but not nearly enough to afford decent dental care.

I grew up with a family friend who was a dentist so I don't make jokes about them, I just fight a slight phobia. B-). I also have a degree in nursing (although I've been retired for a long time), I know how this can seriosly effect folks health... dentistry is not just a cosmetic thing... it can potentially be a life saving thing.

This seems to be an area in need of some serious activism for change... maybe once the Dems get back in charge there would even be some hope eh? :)

[PCIntern]

19. Wish you were right..

Dentists are individually more humanistic and goal-oriented than physicians I have found but collectively they are a total waste. I managed political organizations within dentistry for years and it was futile. For the most part, those who become active talk a great line and then sell out their constituents, whomever they might be for personal gain of one sort or another, either pecuniary or political/social notoriety...and I DO mean notoriety in its literal sense.

Again...I could go on and on...but dont think for one minute that the nature of the political party in charge will have anything at all whatsoever to do with the direction which dentistry for the masses might take.

Sorry about that, Chief.

[WePurrsevere]

23. That's unfortunate. If as concentrated an effort was given by folks to get

dental coverage as Rx we might actually get somewhere.... *if* it were done correctly unlike with the Rx program... blech what a mess.

Now if only there were more dentists like you that actually cared about people... :) Thank you for taking the time to respond, it's appreciated. B-)

[PCIntern]

24. There are a lot of us out there

you'd be surprised. many of us are Democrats...one thing dentists know, since we talk to all kinds of folks all day who lie to us continuously (usually about their oral hygiene habits or medications taken), is bullshit.

[boobooday]

3. Not just seniors - I know very few people who have comprehensive dental

I have a friend from India, where they have universal dental care. Everyone pays, but it is affordable.

They have beautiful teeth. It should be included in all health insurance, because it is an important part of overall health.

[PCIntern]

5. Don't generalize here

many people in India use Curbside dentists - literally. These folks work on the sidewalk extracting teeth.

You're referring to the haves, not the have-nots. It's the same as here, except extraordinarily primitive in most areas.

[boobooday]

8. Very true --

Although I would bet the middle classes there have better teeth than the middle classes here. Plus they don't eat as much tooth dissolving junk as we do.

My friend was from the middle class, and she described storefront type dentist offices, where cleanings were around 20 bucks, and a root canal was about $100 (equivalent). I could afford that.

[mbperrin]

6. Doesn't surprise me - we couldn't afford dental if we weren't

only 3 hours from Acuna, Mexico. I've had my $240 crowns for more than a decade now, with no complaints. The richest country in the world is in the grip of organizations whose job is to restrict access to all medical, raise the prices and rake the money for themselves, leaving the actual doctors, dentists, et al., holding the bag on the image problems.

Middle-man-leeches are killing us, folks.

[PCIntern]

7. Right on, bro!

You are Ed Zachary correct.

[boobooday]

9. My Dad lost a tooth from his dentures in Monterrey

He said he went into a little shop and a guy there did a beautiful job fixing him up for like 20 bucks.

[PCIntern]

12. booboo:

No question they have all kinds of interesting and different delivery care systems, as they say, than we do. That being said, 'patch and pull' is the most common from of treatment, esp. the latter.

Their system, like many others, is basically unregulated, and what the lay person perceives as a bargain - often correctly, mind you - can wind up being a catastrophe. And I'm not talking about replacing Bioform teeth on dentures either.

[FlaGranny]

15. My husband and I have a joke,

"If we won the lottery, we MIGHT have enough money to get our teeth fixed." We do have one of those discount insurance plans. The last time I went to get my teeth cleaned, it never happened. The dental tech insisted I get medication implants because of deep pockets. I had half of them done, then ran out of cash, and never did get my teeth scaled. My gums are NOT red or inflamed, do not bleed, and all my teeth are tight. I can't say that was always the case. In my younger years I had a lot of problems with gum disease and I know I have deep pockets. So, because of the expense of the medication implant, which they insisted on first, I haven't had my teeth cleaned. They claimed they gave me a good deal (discount), but it cost me several hundred dollars. I supposed I should have insisted on the scaling (free on my plan) instead of the medication, but who wants to be on bad terms with their dentist and his tech? I'm in the process of changing to another dentist. This one seems to be in the business of selling services. I did have a good dentist a few years ago, but he retired. No luck in finding another one who is reasonable and trustworthy.

I just now remembered a dentist from the past, who told me I had many cavities. After several trips and fillings I ran short on money and stopped going. He said I still had several cavities to fill. I went to a new dentist about a year later, and he told me I had NO cavities. I wonder how many holes that guy drilled unnecessarily in my teeth.

[PCIntern]

17. Dentists have a joke...

"You have a 9 mm hole in your gums...how deep are your pockets?"

Your story is not unusual...most of us are fairly honest. You must know that there is a gray area of supervised neglect and Dr. Feelgoodism. Many dentists are willing to give your restorations more time to deteriorate before they refill the teeth. This is often appropriate, sometimes not. It all depends on the dentist, the patient's condition,the true nature of the teeth and of course the philosophy of restorative dentistry as practiced by the individual.

Liars and cheats everywhere of course, but certainly not all, especially the really hungry ones.

[FlaGranny]

18. That's a good one.

:-)

I know that dentist from the past was drilling where there were no cavities. I didn't need any fillings after that for years, but I sure did worry until I saw a new dentist.

Have had some really good dentists over the years, too.

Oh, by the way, we tried like crazy to talk our youngest son into becoming a dentist so we could have good teeth, but he wasn't interested. Sigh.

;-)

[PCIntern]

21. FlaGranny:

You are residing in the state in which there are more dental thieves than anywhere in the US. Wotta racket down there - most of your practice has a lifespan of just a few years in the retirement areas so they rip people off left and right. Jesus, I'm a dentist and, as that great man said the other day to the pResident, I'm ashamed of what goes on down there. A patient whom I normally ee was charged 3 thousand dollars for a partial, plastic mind you, no caasting no metal, for which I might have charged him 700.00. If he got on my nerves that is.

The last person you want treating you is your offspring. I taught in the dental schools here for years and all the students would bring their parents in as patients and attempt to completely screw up their mouths. This was due to lack of experience and judgement, of course, not malevolency. Then years later, I would see the parents of the students who hadn't brought in their parents when they were in school and they'd be completely effed up, because there was no one there to stop them from making bad decisions. The funny part is, the hardest part of modern dentistry is knowing how to say no.

Just like Nancy Reagan.

Funny how we always come full circle back to politics.

[FlaGranny]

26. Hey, PCIntern,

The place where that unnecessary drilling took place was NOT Florida, but New Jersey, and I was about 25 years old at time time.

As for my son, well, what can I say, except that he is one of the most meticulous and careful people I've ever known. He can tackle just about anything, but is sometimes slow because everything has to be perfect. :-) He would have made a great dentist. He already had many premed courses for his eventual degree in biomedical engineering. He's now a senior programmer. End of shameless bragging. :-)

[PCIntern]

28. Hey FlaGranny

NJ it is...but you still live presently in the most perilous state for 'oldsters' as they used to be called in dentistry/medicine.

As far as perfection goes in dentistry, it is a fascinating issue and if I had more time, I would be pleased to discuss it. I taught for years and have very distinct sentiments on these and other issues which may be slightly contrarian, but then again, here I am at DU!

[boobooday]

31. The same thing happened to me. As a child.

My poor mother, who never had dental care as a child, didn't know any better. He put me through about five visits and soaked my parents good before they figured it out.

[boobooday]

30. There are also providers of shoddy dental care in the U.S.

All I'm saying is, accessibility is important. I haven't seen statistics on the number of catastrophes in various countries.

'Patch and pull' is probably the most common form of treatment in the U.S. as well, isn't it? I was once a welfare mother, long ago, and that was basically what was available to me. Except patching was pretty much out of my price range too. Now I'm a grad student, and again don't have dental insurance, and the dental work I managed to get done when I had insurance (and some of it was shoddy) is needing a serious upgrade, and I can't afford it. My husband needs orthodontic care, (not cosmetic) but that isn't covered by our health insurance.

That's why I yearn for affordable and accessible dental care. And I don't think it is more expensive here because it is regulated, and I hope to God that it isn't regulation that keeps us safe from poor dental care, but professional standards. And I don't think that a trained dental professional in Mexico or India takes his or her profession any less seriously than a dental professional would here.

It's a sore subject for me. Literally. I understand where you are coming from, but I would go across the border for affordable care in a heartbeat.

:hi:

[PCIntern]

33. I have not a single argument with anything you say

my only point here, and it amplifies those on the board who have been victimized in one way or the other is that other countries don't necessarily offer a bargain if longevity is the issue AND WE HAVE THE EXACT SAME PROBLEMS HERE. this is not the Mecca for Dental treatment for the masses, believe me. Also, I for one am not laughing all the way to the bank - I'm running to the bank to cover checks written.

[boobooday]

35. Yeah, we agree

I know it isn't the dentists who are getting all the money, but my issue is that I just can't afford the care I need right now. So that isn't the issue for me. I think there are a lot of people in the same boat.

[grasswire]

10. it dawned on me the other day

...that the fact that I have to get a $100 office call to get a prescription for a medicine that I have had before and know very well to be the right treatment, with the government in the middle as the restricting agent, is a racket. A racket! Licensing is a racket!

[Ciggies and coffee]

32. You got it, I will throw in some more

The states delegate the authority of who can be licensed (and where you can study and how long you must attend school) directly or indirectly, to the professional associations of the trade in question.
Naturally the professional associations have an interest in ensuring that a limited number of new entrants to their respective trade are minted each year. Too many would create too much competition, and dilute their exclusivity. Don't even think of opening a new medical or dental school, let alone allowing people to become licensed via apprenticeship.

I would have a lot more respect for the parties involved if they came out and admitted the same, instead of repeating that old bullshit line
of "protecting the public from unqualified practitioners."

As for the drug companies, in 1938 a federal law was passed which let the companies themselves determine whether their version (brand) of a chemical was to be sold with a prescription or over the counter. (Provided the substances were not the couple of items in the then small, but growing drug war) Their competitors could sell the same compound over the counter if it was not subject to patents.

A decade or so later, a bill gave the FDA the sole authority to determine which compounds required a prescription. I am sure that the drug companies, which had plenty of lawmakers in their pockets back then, would not have allowed this law to pass unless there were fatter profits to be made by restraining the free market, and killing or gobbling up competitors.

Throw in the expansion of third-party payment for medical costs (Insurance coverage from employment) and the medical customer was insulated from the true cost of what he/she purchased. This price insulation provides extreme leverage for the providers of medical products and services to raise their prices at a much greater rate than they could if things were done on a cash basis. The insurance industry took a nice cut, and a "match made in heaven" is how it could be described.

Mix this soup together and it is no wonder that medical expenses are so high. Instead of looking at the true cause, one partner in crime points the finger at their accomplice while they all laugh on the way to the bank.

[Sgent]

11. At least in my state

add Children as well.

The only dentists in my area that accept Medicaid (within 5 counties) work for the a community health center -- and they do basic dental work, but anything more comprehensive than a filling is almost always going to be pull the tooth or root canal. They just can't afford the unreimbursed expenses that go with any other materials.

A basic dental visit exam/cleaning via Medicaid pays $25 -- so I don't blame the dentist's either.

[donsu]

13. I'll vouch for that - on medicare you can get eyes fixed but not teeth

guess we cost more to keep if we are blind. without teeth we can always soup and mush.

[WePurrsevere]

27. Unless they've changed recently they don't cover basic eyeglasses & ..

routine eye exams. Eye exams are covered usually only if medical problem (like I have MS & get optic neurosis) and those must be done by an MD. At least surgery for something like cateracts and the first pair of necessary lense are covered though.

I guess the gov would prefer us blind, deaf and toothless eh?

[donsu]

38. you are right , I should have specified

nt

[WePurrsevere]

39. Their not covering NEEDS like glasses, exams, dental health, hearing.....

aids, electric wheelchairs/scooters (if you only need them for outside your home), etc is a very sore spot with my husband and I.

Hopefully I didn't come across as rude in any way, it's not intended. This stuff tends to really get my hackles up since it involves allowing seniors and the disabled a basic QUALITY of life as well as the quantity.

[cosmicdot]

14. the 2000 Surgeon General's report on Oral Health ...

found "108 million lacking dental insurance. Only 60 percent of baby boomers receive dental insurance through their employers, and most older workers lose their dental insurance at retirement."

That was in the year 2000.

http://www.surgeongeneral.gov/news/pressreleases/pr_oral_52000.htm


The first-ever Surgeon General's report on oral health identifies a "silent epidemic" of dental and oral diseases that burdens some population groups and calls for a national effort to improve oral health among all Americans. The report, commissioned by Health and Human Services Secretary Donna E. Shalala, also focuses on the relationship between oral health and overall good health throughout life, the mouth as a "mirror for general health and well-being and the association between oral health problems and other health problems."

http://www.surgeongeneral.gov/library/oralhealth/default.htm


Even with dental insurance, the dental bill can still be expensive (50% of, say, crowns?).
Do many dental plans have annual maximums?
Those dental 'plans' (not insurance) exploiting the situation seem to lack 'benefits' on big ticket items.


Six years after the report's issuance ... the Bu$h mal-administration must have misplaced the report.

[pitohui]

20. another couple here that gets dental care in mexico

we can afford routine cleaning in usa even tho it's way overpriced but for big jobs we do have to travel to mexico

we have been v. pleased

[PCIntern]

22. That's great...

no kidding.

out of curiosity, I wonder what the DDS is paying his or her hygienists and assistants, which materials and brands are used as impression materials and filling materials, what lab is used and what alloys are included in the crowns, bridges, and partials.

I'm not being disparaging, really. But my experience has been that the non-precious crowns have nickel in them often, which may be a problem if ther is a sensitivity to that metal, and the resin restorations are highly variable in quality of manufacture, not a trivial issue, I promise you.

Still, generally better than nothing which most US citizens face. I'm all for it, I just know that I could run a practice really cheaply if I used all 3rd tier materials and paid low wages. My hygienist, for example, makes 75K a year plus...My fees BTW are dictated generally by insurance companies, so my gross income has a theoretical ceiling unless I wanted to work all 168 hours in the week.

But then when could I post on DU??

[pitohui]

25. well for starters

instead of having an employee clean my teeth and do the x-rays, the mexican dentist did it himself, i have to admit i'm somewhat troubled in usa by the big tendency not to even have the person who went to dental school in the room while most of the work is being done

the materials we had the same choices as the usa, however, this would vary by dentist, i wouldn't just walk into the first dentist office i saw on the other side of the border, we researched and got references and discussed our options for tooth-colored ceramics, low-mercury fillings etc.

everybody's gross income has a theoretical limit, my husband is paid by the hour and could never hope to earn what your employee makes just cleaning teeth all day, so while i don't want to sound unsympathetic, the truth is, i guess i AM unsympathetic because it seems the point of most usa dentistry is to pay for huge ads, fancy teevees, and $75K a year employees when in the real world most of us could never dream of earning such incomes -- and yet we have teeth too and would like to keep them

[PCIntern]

29. understood

with all due respect, it's really a lot more complicated than people think, but I'm not denying that you got good service. I'm pleased to hear that, sincerely - I want you to believe that.

I just know that it's not all roses out there

[davsand]

34. I was once told that Dentists charge so much because of high overhead.

I can't even remember where that came from, but the upshot was that Dentists are forced to charge so much because they have a huge overhead with equipment and labor costs.

--------

We have an excellent program locally that is trying to address the issue of dental access. They have made a difference for many people--but it really is a drop in the bucket given the need that is present.

Check them out:

http://www.smilehealthy.org/html/facts.html


More local communities could organize this kind of program if they want to, but it is like a lot of other issues--so much need and so little time and interest.


Laura

[PCIntern]

36. It's true...

You're going to have to take my word, but why should I lie on a board wherein I've only always been known for fairness and accuracy? No time today to go into this but you can't imagine what nonsense I have to pay for and what things cost.

And insurance reimbursements average 60% of real fees so you get the idea...

I tell lawyers...imagine billing 200 an hour and only get paid 120 and you are subject to all kinds of arcane regulatory nonsense and delays in payments for specious reasons. Yoe'd go out in no time and find a real job.

I'm tempted some days myself...

[davsand]

37. In many ways this is similar to a lot of law practices.

Your comparison to lawyers was quite timely. I was thinking about that when I wrote my initial post on this subject. I used to organize Pro Bono legal programs (until our funding dried up, that is...)

Most legal practices outside metro areas are small businesses. You have a few lawyers, maybe, working in a firm, but a lot of times it is one or two guys sharing a secretary and an office suite. Overhead is very much an issue for them too.

What makes it really painful for those guys is the fact that a lot of people don't really want to need them (like a Dentist!) and there is a real temptation not to pay the fees unless you get the outcome you want. Collections are a very real issue sometimes.

Something I am curious about with Dentists, however, is the question of peer pressure to perform low or no cost services. I know that in the legal profession there is a very real guilt laid on lawyers to provide some type of pro bono service. The American Bar Association actually has (or had--I dunno where it is at now...) a stated goal that all lawyers should aspire to provide 40 hours minimum of pro bono service per year.

Is there a similar pressure in the dental profession?

40 hours of service per year--that is one week of vacation, essentially. I'm not being snarky here--but not many people in any job are willing to take one year of vacation and devote it to free work or any charity.

I used to say that lawyers were not all "sharks in suits" but I have to tell you that there were a lot of times that I got blown off while recruiting because they told me they just didn't have time to work that one pro bono case. Additionally, I'd get told that they did "pro bono" work because clients sometimes didn't pay.

Is that a similar problem in the dental world? I assume it is.

I see Dental Access as being very much a public health issue--which I think is an idea we probably share based on your previous comments. What do you, as an insider, see as a solution? Can this be a viable project as part of a local public health department anyplace other than here in Champaign County Illinois? Are we on the right track?

Regards!


Laura