The Dental Crisis in America

While many in the United States receive some of the best oral health care in the world, the reality is that millions of Americans are unable to get even the most basic dental services. In fact, more than 40 million people live in areas around the country that have a shortage of dental providers. An even larger number of Americans do not have dental insurance coverage and are unable to afford the care they need. While there is no easy fix for the dental crisis in America today, Sen. Bernie Sanders' Comprehensive Dental Reform Act of 2012, introduced in the Senate in June, would remove many of the barriers that prevent people from achieving good oral health.

Erica Solway, a fellow in Sanders' office who has worked on dental legislation, recently saw firsthand the need for improved access to care when she traveled to Wise, Va., in rural Appalachia, where an organization called Remote Area Medical (RAM) offers a free health care clinic which provides medical, dental, and vision services. More than 26,000 people have received free care at the events held at the Wise County Fairgrounds over the past 13 years. Just last month, 2,500 patients from 19 states were treated by 1,400 volunteers.

A majority of those attending the clinic had experienced long-term unemployment or disability and earned less than $10,000/year. While some patients were uninsured, many had health insurance through Medicaid. Dental and vision services, which are optional benefits to the states in their Medicaid programs, were in the greatest demand.

The long lines and the wait times at the event in Wise provide a rare glimpse into the incredible need for health services, and for dental care in particular. Many people arrived by midday on Thursday, July 19th to secure the number that determined the order in which they would be seen beginning the following day. Many individuals and families drove for hours to get to Wise, so countless people spent one or more nights sleeping in car or in tents they pitched in the parking lot to get the care they so desperately needed.

The dental facilities included mobile units and a large tent under which dental chairs were arranged. Patients were examined and were given a wristband that identified the service they were to receive. They were then guided to rows of folding chairs in which they patiently waited their turn, shuffling from seat to seat in the rain and heat, one step closer to being seen by a volunteer provider as the day wore on. Over the course of the 2.5 day event, the volunteer dentists and hygienists treated over 1,450 patients, completing nearly 2,000 fillings and 3,500 extractions. Dr. Terry Dickinson, the executive director of the Virginia Dental Society, leads the dental portion of the event called Missions of Mercy, or MOM. He estimated that they have extracted over 80,000 teeth in total through MOM events and that the value of the pro bono care provided in Wise to 16,400 dental patients over 13 years totals $12.5 million.

Many of those attending the event had gone years and sometimes decades without seeing a dentist because they could not find one in their community that they could afford. Some described becoming accustomed to living in pain each and every day; pain so severe that it interfered with their ability to eat and to work. A young woman who was 20 weeks pregnant and experiencing severe dental pain anxiously awaited the news of whether she would receive a full mouth extraction or would be required to wait until her baby arrived to be relieved of her discomfort. A 50-year-old from Kentucky, who had lived without any teeth (or dentures) for 18 years, became one of fewer than 100 "lucky" people chosen by lottery to be fitted with free dentures at the event. He had also gone six years without eye glasses and received a free pair on that same day.

As the volunteer dentists and hygienists worked tirelessly to meet the demand starting in the early morning darkness on Friday, July 20th, by just after noon, those requesting dental services were told that they would be required to return early the next morning to get dental care. Even those who were in significant need and overcame considerable obstacles to get to Wise (such as arranging and paying for transportation and child care) were not guaranteed an opportunity to be seen. In fact, there was so much demand for dental care that many people who arrived in the later part of the weekend were sent away or were redirected to the medical and vision services which had more reasonable wait times.

Remote Area Medical/Missions of Mercy serve as a stark reminder of the incredible and extensive need for dental care in rural communities all over our country, including in Vermont. These events serve as the final safety net for dental care within a "system" in which enormous gaps and disparities exist.

Sanders' bill not only extends dental coverage to millions of Americans to make care more affordable, but it also authorizes funding to expand access points like federally qualified health centers (FQHCs) and school-based health centers, increases the size of the oral health workforce, addresses the education of providers to better meet the needs of underserved populations, and authorizes increased funding for oral health research.

Until we make strides to address the crisis, those people with the patience and resources to attend free clinics like the one offered yearly in Wise will continue to wait for days for care. Others will continue to be turned away or will go without any care at all. In our great country we must do better. To ensure access to affordable dental care, Congress must pass the Comprehensive Dental Reform Act of 2012 today.