American dentistry, a parallel medical universe

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

NationalJournal’s Margot Sanger-Katz reports on the sometimes woeful state of American dental care, especially for low-income children. And yes, her piece is datelined “HAZARD, Ky.” But that’s where its anecdotal focus ends and Sanger-Katz paints the bigger picture.

dentistPhoto by dbgg1979 via Flickr

The United States faces a shortage of dentists that is particularly acute in poor, rural regions. Huge pockets of the country have few (or no) providers. The federal government counts 4,503 mostly rural regions where more than 3,000 people share one dentist, making it tough for many residents to find someone to fix their teeth.

For more than 100 years, dentistry has run on a separate—and more laissez-faire—track than the rest of medicine. Dentists have their own schools and treat patients in their own offices; fewer laws and regulations govern the field. Insurance plans typically demand high co-pays and limit their payouts for invasive procedures. About half of all dental expenses are paid out of pocket, compared with less than 10 percent of costs in the overall medical system.

In some ways, what Sanger-Katz calls a “free market” has worked. Folks shop around, and they only get dental care when they really needed. Prices don’t inflate as quickly as they do in medicine in general, and American dental health is still getting better.

The other side of the free-market coin, however, is that there’s a greater gap between the dental haves and the dental have-nots, and there’s little public money devoted to closing it. “The result,” Sanger-Katz writes, “is a crisis.”

Dental disease is the largest unmet health need in the U.S. among both children and adults, according to the Pew Children’s Dental Campaign. The worst-off are the poor, the young, the old, and those in rural America. Dental disease is among the most common reasons that children miss school. It’s the most common medical reason that soldiers can’t deploy. It is a leading cause of emergency-room visits in several states.

For a deeper examination of what makes dentistry different from the medical mainstream, I recommend scrolling down to the subsection titled “A parallel track.” It’s a fascinating medical subset, and almost emerges as a sort of alternate reality in which the development of American health care took a different tack entirely. Illuminating stuff.

Sanger-Katz is writing this series as part of an AHCJ Media Fellowship on Health Performance, supported by The Commonwealth Fund.


Moves to address access to dental care: When asked to list the top challenges in rural health care, almost all respondents to a survey listed dental care in the top three, according to David Wahlberg, a reporter for the Wisconsin State Journal who moderated the Health Journalism 2012 session on “Moves to address access to dental care.” Read more about this panel.

2 thoughts on “American dentistry, a parallel medical universe

  1. Gary W. Vollan L.D.

    We are in need of more community dental clinics across our nation. Corporate ADA has power and money to change the current dental care delivery system for the better if Americans would speak out against the American Dental Associations deceiving and pacifying public relations campaign for a better public image.

    The American Dental Association’s lack of leadership, mismanagement, and decades of irreversible trends, some being history while others continue today; is the leading factor for unmet dental needs in our nation. These trends and policies include racial and gender discrimination, unnecessary extractions and placement of dentures as a treatment plan, mandated and excessive use of fluoride, the use of mercury in restorations and ADA policies which prevent Americans from receiving oral healthcare by suppressing qualified competitors that provide oral health services to those with disparities.

    The American Dental Association works against its own vision and mission statement by suppressing competition that has been trained and educated in providing oral health care services to those that are unable to pay the high prices charged by dentist, leaving Americans without needed dental care.

    The American Dental Association’s waste of time and money, spent on lobbying along with ADA’s strong arm tactics against competitors such as denturists, dental health aide therapists, and independent practices of dental hygienists needs to change for better production in meeting the oral health needs of Americans.

    This wasted money could be used in further educating the professions ADA fights against in alleviating ADA’s bogus public safety concerns. Corporate ADA could take portions of the millions of dollars it uses for lobbying and fighting against its competitors and instead send each state, grants to compensate dentists who except Medicaid recipients. The American Dental Association could provide grants for dental programs in community healthcare centers across America. This would greatly improve our Nations oral healthcare concerns and unmet dental needs.

    Gary W. Vollan L.D.
    State Coordinator, Wyoming State Denturist Association

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