States yank dental benefits, leaving low-income adults in hole

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at

The photo of the man sitting in a dental chair, cradling his hurting face, drew me right into the San Francisco Chronicle story.

Reported by staff writer Drew Joseph, the Jan. 31 article took a thoughtful – and painful – look at the shortage of dental care for California adults.

“Jabari Kelly showed up at San Francisco General Hospital’s dental clinic last Friday looking like he was hiding a golf ball in his left cheek. He had been in pain for three weeks.

“The 36-year-old San Francisco man had an infected wisdom tooth, and swelling had spread into his jaw and cheek. A few more days, he was told, and the infection could have advanced below his chin, possibly restricting his breathing,” Joseph wrote.

“You’ve got 32 teeth – each one can kill you,” Newton Gordon, D.D.S., of the UCSF School of Dentistry, told Joseph.

“Kelly lacks dental insurance and said he had not been to a dentist in two years. His dental problems were more extreme than most, but they illustrate the importance of preventive dental care and the larger ties between dental health and overall health,” Joseph writes.

“But millions of Californians have lost dental insurance in recent years as the state cut Medi-Cal dental benefits and the number of people with private insurance fell, sending more people to emergency rooms for care.

“Many emergency departments don’t have dentists, and what emergency physicians can do is limited. For damaged teeth, they can prescribe painkillers and antibiotics and refer patients to dentists for a tooth extraction, one procedure that is still covered by Medicaid.

“There’s literally no safety net for these adults anymore,” Beth Mertz, Ph.D., an assistant professor at the UCSF School of Dentistry said in the article.

“Once the tooth starts to go sour, unless they can find the money to pay for it out of pocket, their choice is to wait until it gets bad enough to cover it as an emergency extraction.”

The Chronicle was just the latest paper to pick up on the vanishing dental safety net for adults.

Last summer, in The New York Times, Abby Goodnough took a look at the hurting at a clinic in Boston and the wider trend.

“Banned from tightening Medicaid eligibility in recent years, many states have instead slashed optional benefits for millions of poor adults in the program. Teeth have suffered disproportionately,” she wrote, in a story also illustrated by photos of people in pain.

“Republican- and Democratic-controlled states alike have reduced or largely eliminated dental coverage for adults on Medicaid, the shared state and federal health insurance program for poor people. The situation is not likely to improve under President Obama’s health care overhaul: it requires dental coverage for children only. “

States can end up paying for the care anyway though. In a 2012 report, “A Costly Dental Destination,” The Pew Center on the States estimated that preventable dental conditions were the primary reason for 830,590 emergency room visits by Americans in 2009 — a 16 percent increase from 2006. Pew concluded that the rise in dental-related hospital visits was fueled by the difficulty that disadvantaged people have in getting regular preventive care from dentists and other types of providers.

The Kaiser Commission on Medicaid and the Uninsured also warned about the lack of care for adults in a policy brief, “Oral Health and Low-Income Nonelderly Adults: A Review of Coverage and Access.”

“Lack of resources to pay for dental services, either through dental insurance or out-of-pocket, is a major barrier to oral health care for many low-income Americans. The problem is particularly acute for low-income adults, who are more likely to be uninsured than low-income children,” Kaiser concluded.

The brief provides data and analysis of coverage and access to oral health care for low-income nonelderly adults.

What do adult dental benefits under Medicaid look like in your state? If you haven’t checked already, it might be worth taking a look.

1 thought on “States yank dental benefits, leaving low-income adults in hole

  1. Pingback: S.C. adults may gain dental benefits as part of Medicaid plan | Association of Health Care Journalists

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