THIRD WORLD USA

‘Your mouth becomes a minefield’: the Americans who can’t afford the dentist

Michael Sainato 

THE GUARDIAN

MAY 4,2021


Maureen Haley, 66, lost her home in Florida in the wake of the 2008 recession. She now lives in a camper near Greensboro, North Carolina, relying on social security and Medicare to make ends meet and pay for healthcare.

© Provided by The Guardian Photograph: Megan Jelinger/Reuters Millions of Americans have no dental insurance coverage and cannot afford to pay out of pocket for extensive dental care needs.
But Haley has problems with her teeth, and cannot afford to see a dentist to have them fixed.

“My teeth problems are the biggest problem I have each day,” said Haley. “I need root canals and implants. I have a tooth impaction. I have to massage the heck out of it to get the air out of my gums and cheek after chewing a meal. Painful is an understatement, and the worry of how this may affect my heart compounds it.”

She worries about remaining independent, and not ending up in a nursing home. On a limited income, her decisions revolve around what is most pressing, such as fixing her vehicle and drug prescriptions. The last time she was able to visit a dentist was three years ago, and she was given an estimate of over $8,500 for the work she needs.

Related: ‘Teeth have become the new boob job’: the rise of oral tweakments

Haley is one of millions of Americans who have no dental insurance coverage and cannot afford to pay out of pocket for extensive dental care needs, including nearly two-thirds of Medicare beneficiaries – about 37 million people. An estimated 74 million Americans have no dental insurance coverage. A survey by CareQuest Institute for Oral Health released in April found an estimated 6 million Americans lost their dental insurance during the pandemic.

The disparities in oral health in the US are prevalent among racial and economic lines, with Black, Hispanic and lower-income Americans experiencing higher rates of tooth decay, gum disease and oral cancer, as more than half of Americans avoid or delay healthcare, including dental care, because of high costs.

The importance of oral health is directly linked to overall health. Dental problems are linked, or suspected to be linked, to cardiovascular and other serious health problems such as diabetes and Alzheimer’s.

Loxi Hopkins, 68, of Davenport, Iowa, and her husband have severe dental issues – but their Medicare package won’t cover any of it.

She is currently in need of thousands of dollars in dental repair.

“I have lost most of my teeth. We put it off as long as possible and then only do the basic treatment,” said Hopkins. “It is a bummer to work all our lives and in what is referred to as our golden years we live with stress and often pain.”

She recently had a tooth pulled after a crown came loose and her gums became too sore to eat, and during that time she was trying to figure out how to avoid seeing a dentist because of the costs. She had the tooth removed for $235, then had to spend another $200 for an oral surgeon consultation to have the root removed – only to not be able to afford the recommended treatment for another several hundred dollars.

“I cried on the way home. I gave thought to not having the root removed because of the money. I tried and the remaining tooth was so sharp my tongue bled,” added Hopkins. “I will need to get another tooth out on my partial implant because this tooth is what I bite with and now I have to tear little bites of sandwiches and put it in my mouth because I can’t bite. I may have to live like that if I can’t save up the money to add the tooth to the partial.”

Advocates for expanding dental healthcare coverage are pushing Joe Biden and members of Congress to include expansion plans in upcoming coronavirus or healthcare relief bills. The calls to action come as the impact of the coronavirus pandemic has worsened the racial and economic inequities among those who are able to access dental healthcare. Millions of Americans have lost dental insurance or faced economic impacts related to the pandemic, causing greater delays or avoidance of care owing to high costs.

“Dental care is the No 1 medical service that Americans skip because of cost,” said Melissa Burroughs, the associate director for the Oral Health Campaign at the non-profit consumer health advocacy organization Families USA.

Everything has to be made into small pieces that need not be chewed, or pureed 

Elizabeth

“Oral health is not just a health issue, it’s a social justice and equity issue.”

For Americans like Elizabeth, a 69-year-old near Tampa, Florida, that expanded dental coverage can’t come soon enough. She and her husband struggle with dental issues they can’t afford to fix, while relying on Medicare and medicaid for prescriptions and other medical services that are covered.

Her husband’s teeth are mostly gone, Elizabeth said, while she suffers from periodontitis, a severe infection of the gums.

“I have loose, painful teeth that disallow anything substantial to be chewed without pain, and perpetual infection that cannot be treated through Medicare,” she said. “Between the cost of office visits, treatment for the infections, extraction of the rest of my teeth and new dentures, for us, it’s impossible. What little nest egg we’ve saved would be gone and we would be left without any money to cover an emergency.”

The couple already lives on income below the poverty line, and they depend on social security and Snap assistance, while worrying about major repairs they need for their home such as a leaking roof and a termite infestation, but can’t afford to have fixed, or hoping their old car doesn’t need any repairs or it would leave them stranded.

“We’re grateful for the help we get, especially the food allowance, but our ability to fully take advantage of foods that would contribute to better health are either impossible to eat or are a battle to eat. It hurts,” Elizabeth said.

“Everything has to be made into small pieces that need not be chewed, or pureed into extremely small pieces. Otherwise, you suck up the pain and eat while your mouth becomes a minefield.”