February 19, 2020

Speaking tooth to power

Sometimes I’m kind of slow on the uptake. That statement probably won’t come as a surprise to anyone reading this.

One of many examples of this has to do with oral health. I used to think of this mostly in terms of things like abscesses and toothaches, two treatable maladies that can get serious if untreated. The former can kill you, while the latter can make you wish you were dead.

As I’ve eventually learned, that’s just the start of it. Poor oral health is associated with serious and even potentially fatal diseases, like endocarditis (an infection of the inner lining of the heart chambers and valves), cardiovascular disease, kidney disease and pneumonia, as well as pregnancy and childbirth complications. On the flip side, diseases such as diabetes and osteoporosis can affect oral health.

There’s also a big connection between oral health and mental health, aside from the obvious fact that constant pain is a downer. Embarrassment over one’s teeth can lead to social isolation. There’s even a connection between poor oral health and memory loss.

This is a particularly serious problem in West Virginia. In 2014, a survey found that people here who earned below the federal poverty level were nearly 20 percent less likely to receive dental care than people who weren’t poor.

In 2018, the Centers for Disease Control and Prevention found major disparities in accessing dental care along lines of race, income and educational attainment in the Mountain State. Around 45 percent of adults hadn’t visited a dentist in over a year and 22 percent had gone more than five years without a dental visit.

Specifically, 68 percent of people earning less than $15,000 hadn’t had a visit in over a year, compared with 26 percent for people earning more than $75,000. In terms of race, 55 percent of black West Virginians had gone more than a year without a visit, while, for white residents, it was 44 percent.

Huge gaps in accessing dental care can also be seen when we look at educational attainment. Sixty-eight percent of people who had gone a year or more without visiting a dentist didn’t graduate from high school. That number was 50 percent for high school graduates, 40 percent for people who attended some college or technical school and 23 percent for college or technical school graduates.

There’s another way in which West Virginia is an outlier: According to the West Virginia Center on Budget & Policy, the state is one of only 16 that doesn’t offer dental coverage to adults receiving Medicaid, beyond extractions — and those are limited to two per year. Most others offer a range of coverage that can include preventative, restorative and periodontal services, as well as things like dentures, oral surgery and orthodontia.

This lack of coverage is expensive in more ways than one. For one thing, dental problems make it harder for people to gain and keep employment. For another, the diseases associated with poor oral health are way more expensive to take care of than an occasional but regular trip to the dentist.

According to one study, regular oral care led to a 40 percent reduction in diabetes-related costs for type 2 diabetes patients and a 73 percent reduction of related costs for individuals with coronary artery disease.

Then there’s this: People without dental coverage wind up in hospital emergency rooms for treatment and pain control associated with these problems. Hospitals generally aren’t set up to deal with them, and what help they give is often 10 times more expensive than a trip to a dentist.

Adding oral health coverage to the state’s Medicaid program would also be a smart investment. For every such state dollar invested in the program, West Virginia would receive around $3 in federal funding. For the state’s Medicaid expansion program, the return on investment is even better, bringing in $9 federal dollars for each dollar in state investment.

It would be hard to find that kind of payoff these days for any investment. Especially a legal one.

We can and should do more for oral health in our Medicaid program than just pay for extractions. Let’s face it, we’re not exactly running a tooth surplus in this state.

Covering oral health would reduce unnecessary suffering, help more people enter and stay in the workforce, bring in more dollars to the state’s economy and save money in the treatment of serious chronic diseases.

There is some good news here. Senate Bill 648, which would extend Medicaid coverage for oral health, just cleared the Senate Health Committee. In a time of polarization, legislators across party lines have begun to recognize both the problem and the solution.

It may take the voices of ordinary West Virginians to help that bill cross the finish line. It would be an example of (groan) speaking tooth to power.

(This ran as an op-ed in the Charleston Gazette-Mail.)

No comments: