By Dianne Finch
Mike Bush eats only one meal a day to avoid chewing (Photos: Dianne Finch)
Mike Bush is 45, unemployed and struggling with paranoid schizophrenia. But he has an even more pressing problem at the moment: lunch.
Bush’s teeth are so bad that he eats only one meal a day to avoid chewing.
“I shy away from meats and things. I told my dad that I’m running out of teeth to chew with. No big deal,” he said. “I’m probably going to end up with dentures.”
Bush, who lives in Bedford, Mass. started seeing a dentist three years ago for the first time in decades.
But his timing wasn’t ideal. In 2010, just after getting his initial dental exams and cleanings, MassHealth, the state’s program for low-income residents, cut its budget dramatically. Critical dental benefits were eliminated from the plan: fillings, crowns, root canals, and dentures were no longer covered. Extractions, for better or worse, were spared.
The problem isn’t isolated to Massachusetts. In states across the country, adult dental services provide an easy target for cash-strapped lawmakers looking for cuts, according to a 2011 report by the Institutes of Medicine, “Access to Oral Healthcare for Vulnerable and Underserved Populations.”
One reason, the report points out, is that Medicaid requires dental coverage for children, but not for adults. It referred to a February 2011 letter to states from the U.S. Department of Health and Human Services reminding them that Medicaid savings can be achieved via adult dental cuts.
“While some benefits, such as hospital and physician services, are required to be provided by State Medicaid programs, many services, such as prescription drugs, dental services, and speech therapy, are optional,” the HHS letter said.
So, many states are scaling back on the adult programs. Others are already moving to restore certain dental services after struggling with some unintended consequences due to earlier cuts.
Heading To The ER Instead Of The Dentist
For example, some states that track dental-related emergency room visits are seeing much higher costs. And physicians unable to treat dental problems are generally handing out opiate painkillers and antibiotics, according to Centers for Disease Control data cited in The New York Times.
Dental problems are sometimes perceived as less important, or somehow distinct, from overall wellness and good health, studies show.
But the 2011 IOM report advised governments and universities to integrate oral health into overall health programs in order to improve access to services and remove disparities.
“The enduring separation of oral health care from overall health care has marginalized issues related to oral health,” the report said.
An elderly woman on MassHealth exhibits the results of poor, erratic dental care over the years.
An aside: I know this from personal experience. A close relative who is mentally ill and on MassHealth has black front teeth due to multiple, untreated cavities and old fillings that are falling out. After waiting two years for a dental appointment, she recently had the two most painful teeth pulled, though they could have been saved with fillings. (She also has 40-year old fillings that need replacing, but has no disposable income to pay for treatment.)
Another close relative, an elderly woman, also on MassHealth, has been trying to get dentures for several years because she only has five teeth left. She can’t afford care, though, and today I’m taking her to my own dentist for an emergency appointment, paying out of pocket, because her teeth became so jagged they were stabbing her in the tongue. Continue reading