The smile factor

December 01, 1993

Anyone who has ever suffered through an abscessed tooth knows first hand that a toothache can be as debilitating as any other bodily complaint. Yet many of the same Americans who would never dream of putting up with a throat infection without medical help routinely put off seeing a dentist when a tooth acts up. Meanwhile, the problems worsen. Why? In large part, because far more Americans live without dental insurance than medical coverage.

The Clinton health care proposal does not solve this problem. It provides preventive and emergency care for children. Adults, however, get only emergency coverage. That means millions of Americans will see a dentist only when problems reach a crisis and cost far more to treat than a routine preventive visit.

Yet even Clinton-style coverage would be an improvement over the current situation, in which about 150 million people have no dental insurance, several times the number without health insurance of any kind. The big worry, of course, is the cost this would add to the nation's health care bill. But as in other areas of medicine, dental prevention saves many times its costs in emergencies and restorative work down the line. The common estimate is at least $8 saved for every $1 invested in prevention. Add to that the savings to employers whose productivity is affected by workers suffering from toothaches and other distracting conditions.

Great strides have been made in dental health in recent years. Americans can smile more confidently because of something as simple as fluoride in the water supply. For earlier generations, fillings were routine even for children who obediently brushed their teeth each day. Now, with reasonable care, cavities are a rarity.

But the Public Health Service reports that even with better education about tooth care, cost is still a significant barrier for many people who need dental services, with minorities suffering disproportionately from cavities, loss of teeth and other problems. In Baltimore City's school-based health clinics, nurses have found that untreated tooth decay is a frequent complaint from students.

The good thing about dentistry is that procedures rarely have to be repeated. A filling, for instance, should last for many years. That's the kind of bottom-line argument dental care advocates will be making on Capitol Hill as the health care debate progresses -- their persuasion strengthened, no doubt, by a winning smile.

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