August 6, 2019
Financial limitations often prevent people from getting timely dental care. More than half of Americans delay dental — and other types of medical — care due to an inability to afford it. In fact, 80 percent of Americans delay dental care (1) knowing that it will cost them more in the long term.
When left unaddressed for too long, dental problems become serious for far too many people. You probably wouldn’t expect to hear about a friend going to the hospital emergency room for a bad tooth ache. In fact, dental pain accounted for 2.1 million emergency room visits in 2010, according to the American Dental Association (ADA) (2). The majority of these cases, as with most dental decay, could easily have been prevented with routine care and hygiene.
The divide between dental and medical insurance coverage
Part of the problem is lack of affordable dental coverage to offset costs. People with dental benefits are more likely to visit a dentist, take their children to the dentist, and have better overall health, according to the National Association of Dental Plans (NADP) report, The Haves and the Have-Nots: Consumers with and without Dental Benefits. (3)
Yet, about 74 million Americans have no dental coverage - that's almost one-quarter (23%) of the population, or more than double the percentage that lacks health insurance.
This scenario forces many to make a tough choice: get needed dental care now or potentially pay more in unforeseen costs later.
The majority (about two-thirds) of people who have dental insurance get it through their employers, as a separate add-on to health coverage. For those without employer provided plans, or the ability to pay out of pocket, dental care can be far out of reach.
Medicaid coverage of adult dental services varies by state, and doesn’t cover all forms of dental care. And, adult dental care is not an essential health benefit under the Affordable Care Act (ACA). However, the ACA does include some dental care for children as an essential health benefit and state Medicaid programs cover it.
The good news is that 5.4 million adults gained access to dental benefits as part of the Medicaid expansion under the Affordable Care Act. However, dental care for adults is still considered an optional benefit in Medicaid, and Medicare does not cover routine dental care.
The result is that far more Americans (children and adults) go without dental coverage as compared to medical benefits. According to the ADA Health Policy Institute (4), 12 percent of children and 33 percent of non-elderly adults go without dental insurance, compared to 6 percent of children and 20 percent of non-elderly adults who lacked health insurance, based on 2013 data.
The affordability gap is much worse for low-income Americans and those living in rural areas.
In Illinois, one third of children in rural areas have untreated tooth decay. Illinois children living in poverty are five times more likely to have fair or poor oral health. And just over half (55 percent) of children on Medicaid even saw a dentist in the previous year, according to the 2016 report, Oral Health in Illinois. (5)
Luckily, there are a number of local initiatives to expand access to dental care, especially among the most vulnerable. Many are focused on integrating oral health with primary care or providing dental services in settings such as schools or offices of the federal Women, Infants and Children program.
Progress at the national level has been slower in the absence of broader policies. Separate insurance systems, incompatible electronic health records, and a lack of education continue to be obstacles in the way of effective coordination of care among dentists, physicians and other providers.
The costs of poor dental health go well beyond just having bad teeth
The negative impacts of poor dental health go well beyond just having bad teeth -- they also affect health, employment and well-being. Yes, there are direct treatment costs, but there are also many hidden and unexpected costs of poor oral health. They are not as clear and concise as a dental bill, yet they are very real. These crippling long-term costs affect nearly everyone but particularly impact the low-income and under-served families of Chicago.
Poor oral health has long-term effects that are associated with serious illnesses like cardiovascular disease, certain types of cancer, pneumonia, dementia and Alzheimer’s disease, and birth complications.
There are many connections between oral health and chronic diseases such as Alzheimer’s, diabetes and other serious conditions.
For instance, there are many factors that lead to or increase the risk of periodontal disease. Genetics, unhealthy diet, unhealthy habits such as smoking, and poor oral hygiene all play a part in creating the conditions that may lead to periodontal disease.
The potential impacts start early in life
Early childhood tooth decay (cavities) is the most common disease of childhood and often is accompanied by other serious conditions affecting children, their families, the community and the health care system. A national survey (6) in 2010 found that roughly 1 in 7 children ages 6-12 had suffered a toothache (commonly caused by tooth decay) in the previous six months. Poor and low-income minority children and those with special needs were significantly more likely to have had a toothache.
Tooth decay early in life can be especially impactful for many reasons. According to one study (7), early childhood tooth decay has been related to impaired development, low educational performance, poor behavior, family stress, diminished quality of life, and even disability and death.
Lost school days
Then there is the potential for lost days in school due to dental issues. A 2015 National Children's Oral Health Survey (8) by Delta Dental Plans Association found that 30% of U.S. kids ages 6 to 12 miss more than 9 million school days due to oral health problems. The study also indicated that parents consider oral health as a top concern for their children, along with grades, personal finances, physical and social activity.
In another study in North Carolina (9), children with poor oral health were nearly 3 times more likely to miss school due to dental pain.
Employment costs related to poor oral health
Poor oral health can affect adults' job prospects and social lives. Missing or damaged teeth can cause understandable anxiety in a lot of people. Unfortunately, this anxiety often prevents many who are unemployed from seeking employment.
According to the ADA report, Oral Health and Well-Being, (10) 38% of people feel life in general is less satisfying due to the poor condition of their mouth and teeth. The same report finds that 1 in 5 adults experience anxiety and 23 percent feel embarrassment due to the condition of their teeth and mouth. Another 1 in 4 adults avoid smiling altogether. Even 22 percent of young adults avoid social activities due to the appearance of their teeth.
For low-income adults, the numbers are even more sobering. About 35 percent of low-income adults feel embarrassed over the condition of their teeth. And 29 percent of low-income adults and 28 percent of young adults feel like the appearance of their mouth and teeth affect their ability to interview for a job.
Having an imperfect smile may also result in reluctance from hiring managers to hire people for certain roles. Hiring managers may make assumptions about people with visibly neglected teeth. They may be concerned about the company image if the person is hired and has to physically represent the company. In turn, technically qualified candidates may be overlooked for a job due to poor oral health. A CNBC report found (11) that most employers "make instant judgments based on appearance, including someone’s smile and teeth.” A 2008 study (12) found that people with missing front teeth were viewed as less intelligent, less desirable and less trustworthy than people with a healthy smile.
As unfortunate and unfair as it may seem, a low-income person of working age in Chicago who suffers from a common dental-related illness such as gum disease or tooth decay may potentially go through long periods of unemployment simply due to the appearance of their smile.
Datausa (13) suggests the most common jobs in Chicago are in pest control, service work, moving, and business operations – all jobs that rely upon face-to-face interactions on a daily basis. These jobs pay an average annual salary of $32,000 to $45,000 in the city. Therefore, it is conceivable that poor oral health may contribute to income losses of $2,600 to $3,750 a month for an unemployed person.
Treatment costs and other health impacts
Direct treatment costs can be substantial for a variety of common conditions that result when oral hygiene or preventative dental care are neglected.
For example, gum disease treatments can range from $500 to $10,000 in total depending on the severity of the disease. Restorative dentistry, or the procedures needed to repair missing or damaged teeth, can be substantial in cost as well. While tooth filling costs are comparatively low these days, more complicated treatments such as crowns can cost $600 to $1000, while implants can cost $2,000 or more.
Note: dental treatment fees vary by a number of factors, including individual care needs, location and negotiated rates between providers and insurers.
Just under half of dental PPOs, (the most common plan), have a maximum annual benefit above $1500, while the rest are capped at less than $1500. Deductibles for these products are usually between $50 and $100, based on data from the National Association of Dental Plans. (14).
In underserved Chicago, Medicaid is an essential resource for low-income people who seek dental care. But treatment reimbursements through Medicaid dental care can be marginal.
According to Oral Health Illinois (15), the average visit charge for a Medicaid enrollee was $1,011. Illinois has the lowest reimbursement rate in the nation for adults covered through Fee-for-Service Medicaid. The reimbursement rate in 2010 was $223 versus a national average of $420.
While this is half the national average, it was noted that it is higher for preventive procedures. Unfortunately, this may deter providers from performing complex and/or restorative procedures. Most dental services remain uncovered for adults with Medicaid, with preventative coverage only recently being reintroduced.
For a low-income individual in Chicago, out-of-pocket costs can be substantial when they have been diagnosed with a condition like periodontitis. If they opt to receive treatment, the vast majority of their bill is unlikely to be covered by Medicaid. Restorative treatments that return much needed form and function to teeth may be neglected altogether due to their cost and the lack of coverage.
Oral health is closely connected to overall health
Oral health—the health of your teeth and gums—has a major impact on overall health, medical costs, and quality of life.
Healthy People 2020 identified oral health as one of the 10 leading health indicators, along with other indicators such as access to health, nutrition, cancer, HIV and heart disease. Good oral health not only enables you to functionally perform as a human being (i.e. speaking, smiling, smelling, eating), it is also important for communication, human relationships and financial prosperity. Poor dental health has serious consequences, including painful, disabling, and costly health conditions.
Many of the determinants that impact our oral health, such as diet and hygiene are controllable with the right habits. Tooth decay (cavities) is the most common chronic childhood disease, yet it is preventable through healthy diet choices and good hygiene habits. However, without these healthy choices and habits, plaque buildup eventually leads to cavities, gingivitis or severe gum disease that puts teeth and gums at risk – and even other parts of your body. This is especially the case for those who have the biggest obstacles in getting access to dental care – rural and lower income households. According to the ADA's Health Policy Institute surveys of the U.S. population, one in five low income adults say their mouth and teeth are in poor condition – and one in three of them say the condition of their mouth and teeth affects their ability to interview for a job.
The connection between Alzheimer’s and dental health
A growing body of research has identified a connection between oral health and chronic diseases such as Alzheimer’s, diabetes and other serious conditions affecting millions of people.
Research at the UIC College of Dentistry is helping to unveil some of the mystery behind the onset of Alzheimer’s Disease to pave the way for new treatments and bridge the “gap” that has traditionally separated the medical and dental professions. The goal is to use these findings to lowering the risk of diseases such as Alzheimer’s Disease and diabetes, especially as you age.
Prevention is the key to reduce the long-term costs of poor oral health
You have no doubt heard it your entire life: brush and flush twice a day; and get regular dental exams to avoid cavities. Now we know, it also makes good financial sense.
The fact is, proper and consistent oral hygiene and preventive care will go a long way in curtailing many costly conditions. Cigna Health calculates that adults who practice good preventive oral health care can save 31% in dental costs over 5 years. Likewise, adults who don’t receive preventive care can expect a 43% increase to their annual dental costs over the same period of time. (16)
While it can sometimes feel like an inconvenience, spending the relatively small amount of time and money on hygiene and preventative oral care today will save immeasurable costs tomorrow.
University of Illinois at Chicago College of Dentistry
At UIC, we help our patients take control of their oral health through regular checkups, treatments, and providing them with the information to make their best decisions. Need help taking control of your oral health? Schedule an appointment today!
Dental Products Report article, 5-11-15.
From the Emergency Room to the Dental Chair, ADA-Action for Dental Health.
The Haves and the Have-Nots: Consumers with and without Dental Benefits. National Association of Dental Plans (NADP).
Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services. Marko Vujicic, Thomas Buchmueller and Rachel Klein; Health Affairs VOL. 35, NO. 12.
Lewis C, Stout J. Toothache in US Children. Arch Pediatr Adolesc Med. 2010;164(11):1059–1063. doi:10.1001/archpediatrics.2010.206.
Beyond the dmft: The Human and Economic Cost of Early Childhood Caries. Paul S.CasamassimoDDS, MS*SaratThikkurissyDDS, MS*Burton L.EdelsteinDDS, MPH*ElyseMaioriniBS* , June 2009.
National Children's Oral Health Survey. Delta Dental Plans Association. 2015.
Impact of poor oral health on children's school attendance and performance. Jackson SL1, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Am J Public Health. 2011 Oct.
Oral Health and Well-Being in the United States, ADA Health Policy Institute.
JoNel Aleccia, Daily Beast article, 6-13-13.
Social perceptions of individuals missing upper front teeth. Willis MS1, Esqueda CW, Schacht RN. Percept Mot Skills. 2008 Apr;106(2):423-35.