Oral Health Group

Dentistry as Commodity, Not Service

March 1, 2007
by Catherine Wilson, Editor

Dentistry, like medicine before it, has become a commodity, one not all can afford.

I’m sure you know the story. It was all over the papers, television, radio and the Internet: a 12-year-old American boy, Deamonte Driver, died recently when bacteria from an abscessed tooth entered his brain. His mother was uninsured and his family had lost its Medicaid. Even with Medicaid, dentists who accept Medicaid are difficult to find. Medicaid generates a lot of paperwork.


What would have been a relatively routine US$80 extraction turned into two surgeries and more than six weeks of hospital time. Cost? US$250,000.

Fewer than 16 percent of Maryland’s (where Driver died) Medicaid children received restorative services — such as filling cavities — in 2005, the most recent year for which figures are available.

For families like the Drivers, the systemic problems are often compounded by personal obstacles: lack of transportation, bouts of homelessness and erratic telephone and mail service.

Deamonte’s younger brother, 10-year-old DaShawn, saw a dentist a couple of years ago, but the dentist discontinued treatments after the boy squirmed too much in the chair. Tooth decay is still the single-most common childhood disease nationwide, five times as common as asthma, according to experts. Poor children are more than twice as likely to have cavities as their more affluent peers, research shows, but far less likely to get treatment. The shortage of dentists who will treat indigent patients remains a major barrier to care, according to the National Conference of State Legislatures.

With the exception of treatment for serious dental problems in hospital, dental care is not included in the Canada Health Act. In Ontario, only those on social assistance — the Ontario Disability Support Program and Ontario Works — receive dental coverage and its offerings are limited at best.

No one knows how many go without dental benefits, but nearly 900,000 Ontarians survive on low incomes, meaning they are either on social assistance or in low-paying jobs.

The dental school at the University of Toronto offers low-cost treatments. The dental hygienist program at Toronto’s George Brown College offers low-cost cleanings and its denture program has space for 800 clients a year. It is currently trying to attract more clients for the denture program.

Deamonte’s death and the ultimate cost of his healthcare underscore an often overlooked element in the debate over universal health coverage: dental care. Blaming the victims, blaming the poor, is just not cool. Newt Gingrich recently and very publicly blamed the residents of New Orleans’ 9th Ward for a “failure of citizenship,” by being “so uneducated and so unprepared, they literally couldn’t get out of the way of a hurricane.”

I suppose Deamonte couldn’t get out of the way of meningoencephalitis and subdural empyema. Or so it says on his death certificate.

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