THE BLOG

Why Growing Numbers of Americans Are Embarrassed to Smile

04/03/2015 10:16 am ET | Updated Jun 03, 2015

Fifteen years ago this spring, Surgeon General David Satcher issued a call to action to address what he called America's "silent epidemic"--the growing incidence of dental disease in this country.

Unfortunately, we as a nation have not made much progress over the last decade and a half. Just last weekend, thousands of people lined up to get charity dental care at the California state fairgrounds in Sacramento. Some had spent the night waiting in line.

Similar events will be held from coast to coast in the coming months, including at the Wise County, Virginia, fairgrounds near where I grew up. Seeing thousands of people waiting hours in the rain to get free dental and medical care in barns and animal stalls a few years ago changed my life. I realized that some of those people could have been relatives. I quit my job a few months later to become a patient advocate.

In his landmark 2000 report, "Oral Health in America: A Report of the Surgeon General," Satcher wrote that while the United States had made great strides in other areas to improve the health of Americans, "there are profound and consequential disparities in the oral health of our citizens."

Those disparities persist, according to a survey conducted by Wakefield Research and released last week by the Children's Dental Health Project, a Washington-based independent nonprofit organization. Not only that, but lack of access to affordable dental care has spread to the middle class.

It doesn't have to be this way. In fact, there are initiatives in three states that are making a difference, and advocates in Vermont are hoping their state will become the fourth this year.

Nearly four of 10 adults surveyed said either they or a family member had delayed seeing a dentist during the last year because of the out-of-pocket costs they would have had to pay. And a third of those adults said they or a family member currently have a toothache or other problem with their teeth or gums that should be addressed.

The CDHP survey showed that, as in 2000, members of racial and ethnic minorities continue to suffer disproportionally.

Thirty-four percent of blacks and 36 percent of Hispanics said their teeth are in such bad shape that they're embarrassed to let others see them.

It is not just the poor who are now foregoing regular dental care. The researchers found that a surprisingly large number of relatively affluent Americans said they, too, are self-conscious about their teeth.

One in five of those surveyed with annual incomes of $75,000 or higher answered "yes" when asked if they "sometimes avoid smiling or do other things that make it harder for people to see what your teeth look like."

When asked if during the past 12 months they or another family member had delayed seeing a dentist because of the out-of-pocket costs they'd have to pay, 26 percent of people making $75,000 or more said they had. Also answering "yes" to that question were 38 percent of people with household incomes of $35,000 to $74,999, and almost half (46 percent) of people with incomes of less than $35,000.

The problem of lack of access to dental care affects every state, from the largest to the smallest.

A December 2014 report by the California state auditor found that more than half of the children enrolled in that state's program for low-income children (Denti-Cal) were not getting regular dental care. It also found that 32 of California's 58 counties have dental access problems because of a shortage of dentists.

On the other side of the country, the Vermont Department of Health recently estimated that low-income children in that state are more than twice as likely to experience untreated tooth decay. As a consequence, many of them wind up in hospital emergency rooms--the most expensive place to get care--when the pain becomes unbearable. The state's Medicaid program reported spending $2.5 million of taxpayers' dollars annually to treat emergency tooth decay problems for children under the age of 6.

As in California, Vermont officials and healthcare providers say there simply are not enough dentists to meet the need, or at least not enough who are willing to see Medicaid patients.

"I can tell you that access to oral health care is the single largest problem facing our patients," Peter Youngbaer, director of the People's Health and Wellness Clinic in Barre, told Vermont Public Radio in February. He said that 44 percent of the patients who visited the clinic in 2014 had not seen a dentist in at least five years. Many of them said they had never seen a dentist.

To alleviate the problem, several patient and consumer advocacy groups are hoping Vermont will follow Maine's lead in permitting mid-level dental providers to practice in the state. Maine last year became the third state in which mid-level dental therapists can practice. Alaska and Minnesota are the other two so far.

The Vermont Technical College plans to offer a program to train dental therapists, who would work under the general supervision of a dentist and provide a limited scope of services, ranging from preventive care to simple extractions and fillings.

Beth Nolan of Voices for Vermont's Children told Vermont Public Radio that her organization supports expanding the dental workforce because efforts to recruit more dentists to treat low-income patients have not been successful.

"Without an alternative workforce model for dentistry, low-income patients will continue to be denied access to care," she said.

Satcher agrees. He has joined a growing number of healthcare professionals advocating for expanding the dental workforce throughout the United States.

"States should explore all options that could expand access to care," he wrote in a commentary, "including allowing midlevel dental providers such as dental therapists to practice."

Author's Note: This blog post is part of a series examining America's oral healthcare crisis. Be sure to read the previous post, "Why I'm OK Having a Mid-Level Dental Practitioner Work on My Teeth."