Good dental care is about more than brushing your teeth and keeping an attractive smile. Teenager Dominique Allen of Petaluma, Calif., was rushed to the hospital in 2010 with a life-threatening infection. The cause? Bacteria from four rotting molars that had caused crippling pain for months had spread into her jaw and neck, triggering so much swelling she could barely breathe.
Allen's case is not unique. Between 2000 and 2008, more than 60,000 Americans were hospitalized with abscessed teeth — a preventable problem — and 66 of them died. Researchers have also linked gum disease to heart disease and other serious illnesses. This guide will help you figure out how to get dental care for you and your family — and how you can keep your mouth healthier on your own. Plus, a special section on flouridation.
How to Find Affordable Dental Care Plans
Finding affordable dental care is a challenge for Americans in every income bracket, but especially for poor and middle-class adults on a tight budget. Even if they could afford dental insurance, they might have trouble finding a plan. Private insurers, Medicaid, Medicare and the Affordable Care Act Marketplace, for example, don't have to even offer dental care to adults. Employer health insurance policies may or may not include dental insurance. Here's where to look for it.
Your Affordable Care Act plan doesn't have to offer you dental insurance, but some ACA plans do. You can look for and buy a stand-alone dental plan, but you need to purchase your ACA medical coverage first.
This consumer website can help you find and compare medical costs - and help you understand an insurance policy. Visit the website or call for help at 1-855-566-5871. Be aware: navigating some of these subsidized options can be confusing and time consuming. Most have a phone number to call for help.
If your income is low or you have a disability, you may qualify for Medicaid, a state-run health plan that might include dental care. States are required to offer dental benefits to children covered by Medicaid, but fewer than half of the states provide comprehensive dental care for adults. Most states do provide at least emergency dental services, but options for preventive and basic care (such as cleaning and fillings) vary by state. Check your eligibility and state's benefits on the Medicaid website. Click on "Learn How to Apply for Coverage" or contact your state Medicaid program.
Even if you earn too much to qualify for Medicaid, you may be able to enroll your children in CHIP (the Children's Insurance Health Program), which covers dental care.
Employer Health Plans
If you're a full-time or even part-time employee, you may be eligible for dental insurance through your employer. According to the National Association of Dental Plans, 96 percent of large employers offer some sort of dental coverage (either through the company or the union). The larger the group insured, the better the benefits tend to be.
Because dental benefits vary so widely, it's important to read the information carefully, especially if you have a choice of provider. Take the time to balance the offered benefits against your needs. You may be able to adjust your choice during certain enrollment periods, usually once a year.
Private Dental Plans
These dental plans, which are also carried by some employers, include Delta Dental, Guardian, Humana, MetLife, Cigna Dental and Aetna. If you are planning to buy individual dental insurance, consider this:
Can you keep your dentist?
You probably won't be able to: most programs force you to select from a pool of their approved dentists.
Many major and expensive treatments, including root canals, are excluded from some policies. Implants, orthodontics, bridges, extractions and even porcelain crowns.
How soon can you be treated?
Many programs have a six month waiting period or exclude pre-existing conditions.
What is the annual limit on treatment?
Consider your needs.
If you don't want metal crowns, for example, put away some money for porcelain crowns.
12 WAYS YOU CAN PROTECT YOUR TEETH (and save on dental care)
You'll save big money on dental care if you don't put off seeing the dentist when you have swollen gums or a tiny cavity. Left unchecked, gum disease could cause you to lose a tooth. And if that cavity leads to an abscess down the road, it could be costly (not to mention dangerous). Besides getting routine dental exams, dental experts advise that you do the following:
- Brush your teeth at least twice a day with a soft-bristled brush.
- Floss your teeth once a day (before you brush).
- After brushing, use a mouthwash to rinse your mouth.
- Have your teeth cleaned every six months.
- Ask your dentist about dental sealants, which help protect your teeth against decay.
- Rinse your mouth after eating crackers or other food that sticks to your teeth.
- Eat a balanced diet with plenty of fruits, vegetables and protein.
- Avoid sodas and too many sugary foods.
- If you smoke, stop.
- If you have any tooth pain or a small crack or hole in a tooth, see your dentist right away. A filling can cost less than $50 in some places, while an untreated cavity can turn into an abscess costing hundreds of dollars or more.
- Never give your baby soda, and give your toddlers and children water rather than soda and sugary drinks.
- Don't let your baby go to sleep with a baby bottle in his mouth (this can cause serious tooth decay).
Warning: Despite the claims of some scam companies, discount dental cards are not insurance. The cards are marketed as a way to get lower prices for certain dental services -but not all dentists accept them. Here's what to do if you're considering a discount card:
- Call your state insurance commissioner to make sure the seller is legitimate.
- Check out the company on Yelp, the Better Business Bureau, RipOff Report and state attorney general's office.
- Ask for a list of providers that accept the card and check with three or four to see whether they do.
- Check the policy and make sure there's 30-day cancellation fee.
- See whether your provider will accept the card. If not, ask whether the company has a patient assistance program.
Why Is Good Dental Insurance So Important?
A healthy mouth is an important part of a healthy body. So why isn't everyone seeing the dentist?
One word: Money. Dental care is expensive. The 2014 ADA Health Policy Institute report Oral Health & Well-Being in the United States found that among all income and age groups surveyed, everyone — even people with the highest incomes — cited cost as a main reason for not seeking dental care.
That lack of care has consequences. The report found that:
- One in five low-income American adults say their mouth and teeth are in poor condition.
- Nearly 30% of young Americans say the condition of their mouth and teeth hampers their ability to interview for a job.
- One in four Americans are afraid to smile due to problems with their mouth and teeth.
- More than one in four Americans are plagued by tooth pain.
- 23% feel embarrassed about their mouth and teeth.
- One in five experience anxiety due to dental conditions.
One problem is that dental care "is excluded from most insurance plans for a bizarre and antiquated reason," according to an article in The Atlantic: As a profession, dentistry and surgery grew out of hairdressing — barbers used to pull teeth, drain abscesses and even take care of wounds. Surgery and medicine were considered two very different fields, a bias that some experts say drove policymakers planning Medicaid in the 1960s to pay little attention to dental problems.
As Columbia University professor of dental medicine Burton Edelstein told the magazine, the division between medicine and dentistry has long been a "medically, morally, and ethically inappropriate separation."
Indeed, when cost is taken care of, studies show dental care goes up dramatically. Researchers have seen improved dental health in children who are covered by Medicaid and the Children's Health Insurance Program (CHIP), which together cover 40 percent of children in the United States.
What about the Affordable Care Act?
Wasn't the Affordable Care Act supposed to guarantee our right to health care? Children have definitely benefited from its expansion of dental coverage. But according to some experts, dental insurance for adults fell through the cracks.
The Affordable Care Act of 2010 (ACA), sometimes called Obamacare, made dental care for children one of the ten essential health benefits. It's credited with major improvements in childhood dental health. (See "If You Have Children Who Need Dental insurance or Dental Care.") But it didn't do much for adult dental care.
Even though ACA marketplace plans don't have to offer dental coverage for adults, some do. If you decide you want dental coverage and your plan doesn't offer it, you can buy and enroll in a separate, stand-alone dental plan. There are many reputable sites out there that provide some good information about how the ACA works, who is eligible and how much subsidy support you may get.
The bottom line: Check whether dental coverage for adults through ACA programs are cost effective for you. The government Marketplace website has programs that allow you to check the costs and benefits, along with premiums and co-pays of stand-alone dental plans.
These vary state by state. Choose your state at Healthcare.gov to check plans available to you. Or call 800-318-2596 to speak to someone at the Marketplace. Note that many commercial organizations also have "marketplace" websites offering insurance. Be sure to check your options.
Dental Insurance: What Needs to Change?
The American Dental Association and the National Association of Dental Plans disagree on our current dental insurance's cost-effectiveness.
American Dental Association Health Policy Institute
"For the vast majority of adults with private dental insurance, more is spent on premiums, copays and coinsurance than the actual cost of the procedures," said Marko Vujicic, PhD, chief economist and vice-president of the Health Policy Institute of the American Dental Association.
The Health Policy Institute just put out a comprehensive research brief on dental insurance, including employer supported plans. It examined more than 24 million dental claims across 5.9 million adults enrolled in a dental benefits plan for 365 continuous days.
First, the HPI found a third of people with private dental insurance didn't use the all benefits they paid for: More than one in three adults ages 19 through 64 with private dental benefits did not have a single dental claim within the year.
Second, the report found the fees paid to dentists were "significantly lower" than market rates for dental care.
The HPI also found that for 69 percent of adults with private dental insurance, their total spending including premiums was actually more than the "market" value of their dental care.
In many health insurance policies, the coverage kicks in to pay the costs after you've paid a certain amount — about $2,927 under the Affordable Care Act. Dental insurance is exactly the opposite: It cuts off when your costs hit the cap — usually $1,500 or less. "And for me to get a $1,500 benefit, I have to pay out almost that amount," Vujicic said.
And for adults without private or employer-sponsored insurance, the landscape is bleak. The Health Policy Institute has also released a comprehensive state-by-state report that "for the first time, shows how seriously oral health issues are impacting the lives of adults." At the national level, HPI reports, more than two out of five low-income adults have trouble biting and chewing due to the condition of their mouth and teeth. In addition, 29% of low-income Americans said the condition of their teeth interfered with their ability to look for a job.
The NADP reports that most employer-sponsored plans offering dental insurance pay for employees' premiums, but according to Vujicic, "Premiums are never free to beneficiaries. There is convincing empirical evidence by health economists that shows that employees pay for premiums either directly through contributions or indirectly through lower wages."
National Association of Dental Plans
The National Association of Dental Plans, which represents dental insurers, insists dental insurance is absolutely worth the consumer out-of-pocket cost.
The association charges that the ADA's study on dental claims used inflated dental costs and premiums and understated the cost of services funded by dental plans to reached "incorrect and misleading" conclusions.
The premium costs the ADA chose don't reflect the out-of-pocket costs of the majority of those insured, according to Evelyn Ireland, executive director of the NADP.
"In dental policies coverage kicks in after a deductible that averages only $50, unlike a medical policy where you spend almost $3000 out of pocket before getting coverage," says Ireland. "And consumers do not spend $1,500 to get $1,500 of coverage. Preventive services are usually covered at 100% and basic services like fillings are paid at 70% to 80% by the insurer. Only major procedures like crowns are covered at 50%."
Group plans, such as those offered through employers, cover 93 percent of those with [dental] insurance, and 77 percent of them have most or all of their premiums paid for by their employer, according to Ireland.
"If you adjust the premiums in the ADA study for group coverage, employer contributions and pre-tax payment of any premium the employer does not cover, the conclusion about the value of dental benefits is the polar opposite of that asserted by the ADA," said Ireland. "Only those consumers who don't go to the dentist will pay more for dental insurance than the market value of services used."
Just having dental insurance may be a benefit - it can prompt better preventive dental care, Ireland said. "There's clear research -cited by the surgeon general- that finds people with insurance coverage are two times more likely to go to the dentist than those without coverage," she said.
The insured "are also more likely to have the additional services needed to maintain dental health," Ireland said. "Without dental benefits, we would see a significant reduction in visits to the dentist and a surge in dental disease in the United States."
In terms of limits on coverage cited by the ADA, 95% of those with dental insurance stay within the limits on the amount of treatment paid by the insurer. "The dental industry offers higher limits but with only 5% of consumers reaching the limit, employers choose limits that keep dental premiums low and serve the needs of most of their employees," Ireland said.
Reza Koopah, DDS, says that about 80 percent of his San Francisco Bay area patients have some kind of dental insurance, but it's inadequate. "By the time patients come in for a procedure, their insurance is exhausted for the year," he said.
Another problem — for patients and dentists - is that coverage hasn't kept up with the times and improvements in care. The limits have not changed in decades. Newer sophisticated procedures that can save teeth — such as inlays rather than crowns - are not covered, for example.
These limits affect the way some patients make care decisions. "A lot of patients have become insurance dependent, and tend to think that's all the care they should get," Koopah said. For this reason, they don't pay more out of pocket for needed treatment "and they end up suffering."
Alternatives to Dental Insurance: Going Outside Coverage
If You're Low to Moderate Income
No mistake about it: Finding affordable dental care if you're strapped for cash can be a tough, exhausting search. Perhaps you've already sat all day at a public health clinic only to find it doesn't cover dental problems. You may have had to travel 100 miles or more to find a dentist that accepts Medicaid. And the waiting list for your local dental school clinic may be months long. Still, if you don't have dental insurance, some of these options may help you find dental care you can afford.
Working out a payment plan with your dentist
Most dental offices understand patients may have difficulty paying for their services. Billing is usually handled by the office personnel, not the dentist directly. Be sure to tell the office personnel about your situation. They may be able to offer you advice or even a payment plan.
If you can pay on the spot with cash or a credit card, you may be able to get a discount of about 5 percent on services from some dental offices. It's good to ask.
If you don't have the money to pay up front, ask about a payment plan. Some dental offices will offer a payment plan through their office. Almost all will direct you to a loan installment program such as such as CareCredit, which will pay the dentist and give you a year or more to pay back the money at zero interest (see below).
CareCredit: A no-interest loan for dental care
It may hurt less to pay for that $2,500 root canal and crown combo if you can pay it off over time - say six, eight or even 24 months - with no interest. The companies that allow you to do so include CareCredit health financing.
The catch: if you don't pay it off within the time your contract specifies, you'll pay walloping interest rates — almost 27 percent — on the total amount, retroactively from the date of service.
Many dentists work with one or more of these companies. Ask your dental office personnel which they prefer, and they can help you set it up.
Clinics at dental and dental hygiene schools
Many dental schools and oral health teaching facilities have clinics that can be a good source of quality, reduced-cost dental care and treatment. These clinics provide students with experience in treating patients while offering care at a reduced cost. Students are closely supervised by experienced, licensed dentists or dental hygienists, and many schools also have clinics where faculty members and graduate students also offer low-cost care.
The costs vary, but will be less than private care—sometimes considerably less. At the University of North Carolina School of Dentistry, for example, fees are about one-third of those in private practices. And if you can't afford that, the school may direct you to free clinics.
The drawback: So many people apply for treatment at these clinics that there may be a long waiting period before you get treatment, which can be a problem if you have a dental crisis that can't wait. At this point, a no-interest loan from CareCredit, working out a payment plan with your dentist or visiting a dental fair in which thousands of patients are treated at once may be a better option.
To find a clinic at a dental or hygienist school, look on the list of dental and hygienist schools searchable by zip codes, which is offered by the Commission on Dental Accreditation on its website. Some schools have information about clinics on their website, or you may need to contact the schools directly.
Community health centers
Thousands of federally funded Community Health Centers around the country offer low cost and even free health care, including some dental and oral health care, to those who can't afford to pay. Approximately 1 in 13 people in the U.S. relies on a one of these health center for medical care, with more than 24 million Americans treated through these programs last year.
Fees are most often on a sliding scale - you pay what you can afford, based on your income. And no patient will be denied health care services if you can't afford to pay, says Martin Kramer of the Health Resources and Services Administration (HRSA).
Many, but not all, offer oral health services. Find a center near you by entering your zip code on its website.
Oral Health America
This national nonprofit supports an informative website called Tooth Wisdom that can direct you to some affordable resources in your state.
The United Way is a non-profit organization that offers a range of health services referrals to people from all communities and of all ages and may be able to direct you to free or reduced-cost dental services in your community. To find the United Way in your area, visit the site and type your zip code in the box provided. You can also call 211, or access www.211.org to find programs in your area.
Clinical trials for dental and oral conditions
Researchers sometimes look for volunteers with specific dental, oral and craniofacial conditions to participate in studies, also known as clinical trials. Study participants may get free or low-cost dental treatment for the particular condition under study. One study, for example, looks at people with face, head, and neck abnormalities; others are examining people who have had facial traumas. Another looked at gum disease in people with Type 2 diabetes. To find an oral health clinical trial that may fit your needs, visit the National Institutes of Health.
Other state and local resources
Your state or local health department may know of programs in your area that offer free or reduced-cost dental care. To find out, call your county or state health department and ask about their financial assistance programs or check their websites. You can find your state public health department contact information on the CDC site.
The National Institute of Dental and Craniofacial Research
Veterans services (see "If You're a Veteran")
Children, Veterans and Other Special Groups: Where to Find Insurance
WHERE TO GET LOW-COST DENTAL CARE FOR YOUR CHILDREN
In a 2015 report, the Pew Charitable Trust called dental care "the greatest unmet health need among U.S. children." in 2015 approximately a quarter of U.S. children did not have dental insurance, either private or public, the report said. Left untreated, dental disease can lead to emergency room visits, hospitalizations and even death: In 2008, children went to the emergency room more than 215,000 times for preventable dental issues, at a cost of more than $104 million.
Here are some resources to help you find affordable dental care for your children.
The Affordable Care Act Marketplace
The ACA has done more for children's oral health than adults. By helping lower dental insurance costs and encouraging use with subsidies, it's credited with major improvement in childhood dental health.
Despite the passage of the ACA, buying dental insurance and/or paying for care is a struggle for many families, according to the CDC. See what's available in your state.
The good news: States are required to provide dental benefits to children covered by Medicaid and/or the Children's Health Insurance Program (CHIP). Together, these programs cover benefits for 40 percent of children in the United States, including — in some states — medically necessary orthodontia.
Medicaid dental care for children covers regular screenings and treatment for any discoverable dental condition, whether or not the services are included in that state's Medicaid plan. Dental services include pain and infection relief, restoration (or fillings) and basic dental health.
These benefits are based on family income and size, and the two programs complement each other: All children enrolled Medicaid are eligible for dental care; and families who earn too much to qualify for Medicaid but can't afford private insurance can find free dental care through CHIP.
Much of this assistance goes unused. In 2013, however, more than 16 million children who were enrolled in Medicaid and eligible — almost 50 percent — got no dental care.
CHIP (Children's Health Insurance Program)
For eligibility in CHIP, some 46 States and the District of Columbia cover children up to or above 200 percent of the federal poverty level, which is $51,500 for a family of four in 2019. Some states allow 250- 300 percent of the federal poverty level. You can check the levels here on the website. States are required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages. To find children's dental care programs in your state, visit Insure Kids Now or call 877-543-7669.
Employer's coverage and private plans
If your work-related health policy has dental coverage, it may cover your dependent children — perhaps up to age 26. There may be an extra premium or copay, however. Check your policy and contact your company's human resources office for more information.
Credit: GKAS Facebook page
Give Kids a Smile (American Dental Association)
This program has helped 5 million underserved children receive free dental services, which are provided by about 10,000 dentists and 30,000 dental team members. Visit the program's Facebook page to find out about upcoming events. The ADA also has a resource page for parents to help them find the closest clinic offering free or low-cost dental care.
School-sponsored dental clinics
The clinics tend to appear in schools with a higher percentage of children eligible for federal free or reduced-cost lunch programs. Funding comes from a variety of sources, including Medicaid.
One initiative is the school-based sealant program, which has been successful in reducing cavities by more than 70 percent, according to a Surgeon General's Report.
Dental sealants are special tooth coatings that prevent tooth decay and also stop cavities from growing. These are typically run by dental hygienists using portable equipment, a mobile dental van or clinic. Depending on the state and how a particular program works, students are checked for early signs of tooth decay. Some programs also provide cleanings, topical fluoride, oral health education, and screenings, according to Pew Charitable Trust.
Check with your school and state public health department about these other school-based programs and edibility requirements.
Other resources for children's dental care
For information on CareCredit no-interest loans for your children's dental care, working out a payment plan with your dentist and checking into resources offered by United Way, community health centers, dental fairs and other programs, please see "How to Find Low-Cost Dental Care Outside Insurance."
WHERE TO GET DENTAL INSURANCE AND LOW-COST DENTAL CARE
Older adults are one of the fastest growing segments of the American population — and can be most at risk when it comes to dental and oral issues.
Aging brings a series of special dental needs. Seniors are often more susceptible to dry mouth, gum disease, tooth loss, jaw issues due to tooth loss, mouth fungus (thrush) and oral cancers. Yet only 2 percent of retirees have dental coverage through a prior employer, according to Oral Health America, a Chicago-based nonprofit.
Certain Medicare Advantage plans
Medicare is a federal health insurance program for people 65 and older and for people under 65 with specific disabilities.
Although most seniors 65 or older have Medicare, it doesn't cover dental care except in situations where the dental problem is related to certain other medical issues. It doesn't cover any routine care. Medigap — a private insurance plan that supplements Medicare — also fails to offer dental coverage. Some private Medigap Medicare Advantage managed care plans such as Kaiser's Senior Advantage do offer dental benefits, for a fee. (See Medicare Advantage Plans, next).
For more information about Medicare coverage, visit Medicare Dental Services or call 1-800-MEDICARE (1-800-633-4227). Have your Medicare number handy when you call.
Medicare Advantage Plans
These Medicare health plans are offered by private companies that contract with Medicare to provide Part A and Part B benefits. Several different kinds of organizations offer Medicare Advantage plans, including Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans and Medicare Medical Savings Account Plans.
These organizations offer prescription drug coverage, and for another fee may be able to supplement your basic coverage with dental care. However, these plans often have co-pays, do not allow preexisting conditions (such as lost teeth) and may be capped at a certain amount
Medicaid is a state-run program that offers subsidized health coverage, which can include dental care, for those who qualify. Most states do provide at least emergency dental services, but check your state's benefits: Coverage for preventive and basic care (such as cleaning and fillings) vary by state.
The Affordable Care Act Marketplace
If the Marketplace in your state is run by the federal government, there's a Catch-22: You won't be able buy a stand-alone dental plan unless you're also buying a health plan - and if you have Medicare, you already have a health plan.
If your state is running its own Marketplace, you may be able to purchase a stand-alone dental plan.
Oral Health America
This national nonprofit supports an informative website called Tooth Wisdom that can direct you to some affordable resources in your state.
An online reference tool of the nonprofit Medicare Rights Center, this website lists some options for finding affordable dental care for seniors.
Veterans Health Administration
If you're a vet, you have health benefits through the federal Veterans Administration, but dental care is limited. To be eligible for VA dental benefits, a veteran must have a service-related dental disability, be a former prisoner of war or be totally disabled from a service-related injury. Check with the VA to see what benefits there are for you or your dependents.
Under the national VA Dental Insurance Program (VADIP), some veterans and dependents can buy private dental insurance at a reduced cost. But the benefits have the same drawbacks as other private dental insurance: payments are limited to $1,500 a year, with a copay of 50 percent for most procedures such as fillings and crowns, and some procedures aren't covered at all. (see "Buying Private Dental Insurance").
Free services for veterans
Volunteer dental professionals and organizations are proving some free services for veterans. Dental groups, individuals and organizations across the country volunteer to offer free dental care to veterans under programs such as "Veterans' Smile Day" or "Give Vets A Smile." In 2015, more than 300 dentists from nearly all the 50 states provided more than $300,000 in free dental services to an estimated 2,000 veterans, according to the ADA. This year, dental teams from Aspen Dental, a national chain of dental offices, treated more than 4,000 veterans in mobile units across the country to $2.1 million in free dentistry on its annual "Day of Service" June 25.
To learn about free programs for veterans in your area, contact your state's Dental Society. You can find a link to dental societies by state on the ADA site.
For more on free or low-cost options, see "Alternatives to Dental Insurance," above.
People with Diabetes
PEOPLE WITH DIABETES: WHAT ORAL CARE MEANS FOR YOUR MONEY - AND HEALTH
More than 29 million people in the U.S. have diabetes — either Type 1 or Type 2, with almost 2 million new cases diagnosed each year, according to the American Diabetes Association. This disease can cause special dental problems. People with diabetes are more vulnerable to gum disease and mouth infections, dry mouth, changes in the taste of foods and slower healing. Periodontal (gum) disease is the most common dental problem, and it can exacerbate symptoms of diabetes.
The potential savings from preventive dental care, however, is enormous. One research paper found that treating gum disease in 60 percent of Americans with diabetes could save $39 billion in health care costs.
Another study, led by dental scientist Majorie Jeffcoat, DMD, professor and dean emeritus of the University of Pennsylvania, found that that treating people with diabetes for gum disease resulted in "an average of $2,840 savings per patient per year, with drug costs decreasing by $1,477." Looking at a different sample in the same study, researchers also found that hospitalizations dropped by 39.4 percent among those who were treated for gum disease.
Ways to prevent dental problems if you have diabetes
The American Dental Association recommends a five-point action plan to help lower the risk of dental problems for people with diabetes.
Control blood sugar levels with medication and a healthy diet to help your body fight any bacterial or fungal infections in your mouth and help relieve the dry mouth caused by diabetes. Avoid smoking. If you wear any type of denture or removal bridge, clean it each day. Make sure to brush twice a day with a soft brush and floss correctly daily. See your dentist for regular checkups.
The American Diabetes Association also has some good advice for taking care of your teeth.
A Word About Fluoridation
The benefits and safety of fluoride for dental health have been debated and documented for nearly 70 years. Back in the 1940s and 50s, conspiracy theories about fluoride in community drinking water flourished. While science was heralding it as a public health boom, others were calling it a communist plot and public health hazard.
Over time, scientists triumphed, with community water fluoridation recommended by nearly all public health, medical and dental organizations because of its contribution to the dramatic decline in tooth decay in the United States since the 1960s. Numerous scientific studies from organizations around the world, including the World Health Organization, have found it safe and effective.
Researchers say drinking fluoridated water has reduced tooth decay by approximately 25 percent in children and adults, saving money and teeth. In fact, the Centers for Disease Control and Prevention (CDC) named community water fluoridation one of 10 great public health achievements of the 20th century. Fluoride is also available in toothpaste and mouthwashes.
"It's a very good practice," says Alice Boghosian, DDS, a spokesperson for the American Dental Association and a clinical instructor in restorative dentistry at the University of Illinois College of Dentistry. "Think back about why dentures were so prevalent in the past. People lost teeth at a relatively early age due to extensive decay, and in fact expected to lose teeth as they aged. Today, that has dramatically changed, with those who grew up with fluoridation keeping most of their teeth life long."
"Fluoridation helps prevents cavities, making teeth and the protective enamel harder," she added.
There's still some controversy, with organizations such as the Fluoride Action Network opposing adding fluoride to community water sources. If you are wondering about the benefits and purported risks of the practice, check out the FAQ on the CDC website.
An Expert's Advice: Good Oral Health: How Do We Get There?
Marko Vujicic , PhD, is the chief economist & vice president of the Health Policy Institute, part of the American Dental Association.
Why is dental health so important?
It's interesting people even ask that question, which shows there is a lack of understanding about how seriously oral health issues impact us all - medically, physically and emotionally. The medical connection of oral health to disease has been documented in many studies. Our recent state by state report on oral health and wellbeing found a significant emotional impact as well: 29 percent of low-income adults said their ability to interview for a job was affected by the condition of their mouth and teeth - and nearly one in four reported they participate less in social activities because of oral health issues.
Why don't more people get care?
Cost is the number one reason cited across the income spectrum - even from those with higher incomes and dental insurance. Dental care is treated separately from other health care and often not included in health insurance.
Why does dental insurance have so many restrictions?
Good question. Stand-alone dental insurance really should be called a benefit, not insurance. Most insurance is meant to shield the beneficiary from catastrophic costs. But dental insurance is exactly the opposite: it shields the insurer, not the patient, from catastrophic costs. In my view, this model is outdated and quite Byzantine.
Is anything being done about this?
The ADA put out a comprehensive report on Oral Health and Wellbeing in the U.S. that looked at insurance, among other aspects of access to dental care. It's been clear that the better access to dental care for children under Medicaid and under the Affordable Care Act has resulted in significantly increased access to dental care and improvement in oral health. The next logical step is to explore policies to improve access to dental care for adults, particularly low-income adults.
What do you recommend?
First, we need to revisit the separation of mouth and body in federal and state health care policy. Given the significant impact of oral health on the body as a whole, and vice versa, the current official views make no sense.
Second, it's time for dental "insurance" to be restructured so it actually pays for oral health - that was made clear when our survey found cost was a major reason for foregoing needed dental care even among those with insurance. Obviously, the insurance system now isn't working for better oral health.
Finally, we need to switch the focus when measuring oral health from just cavities and gum disease to the importance of overall oral health to everyone's physical, social and emotional well-being. We need to change our health care system so it includes -and actually delivers - oral health care.
To quote the report again: We need to put more effort (and perhaps money) where our mouth is.
About Judith Horstman
- The New York Times. "State Lags in Dental Health Care for Children." Accessed October 23, 2023.
- JOE. " Andrea C. Shah, DMD Kelly K. Leong, BA Min Kyeong Lee, DMD Veerasathpurush Allareddy, BDS, PhD Published:July 15, 2013DOI:https://doi.org/10.1016/j.joen.2013.04.042 PlumX Metrics." Accessed October 23, 2023.
- U.S. Department of Health and Human Services. "About the Affordable Care Act." Accessed October 23, 2023.
- FAIRHealth Consumer. "Consumers Estimate your healthcare expenses." Accessed October 23, 2023.
- Medicaid.gov. "MEDICAID & CHIP HOW-TO Information." Accessed October 23, 2023.
- Medicaid.gov. "Renew Your Coverage." Accessed October 23, 2023.
- Medicaid.gov. "State Overviews." Accessed October 23, 2023.
- The Atlantic. "Why Don't We Treat Teeth Like the Rest of Our Bodies?." Accessed October 23, 2023.
- HealthCare.gov. "Get Coverage." Accessed October 23, 2023.
- CareCredit. "CareCredit FAQs." Accessed October 23, 2023.
- UNC School of Medicine. "Dental Clinic." Accessed October 23, 2023.
- CODA. "Search for Dental Programs." Accessed October 23, 2023.
- The Pew Charitable Trusts. "States Stalled on Dental Sealant Programs." Accessed October 23, 2023.
- Medicaid.gov. "Dental Care." Accessed October 23, 2023.
- ASPE. "HHS Poverty Guidelines for 2023." Accessed October 23, 2023.
- CDC. "Dental Sealants." Accessed October 23, 2023.
- Medicare.gov. "Dental services." Accessed October 23, 2023.
- Medicare Interactive. "Resources if you need dental coverage." Accessed October 23, 2023.
- U.S. Department of Veteran Affairs. "Providing Health Care for Veterans." Accessed October 23, 2023.
- U.S. Department of Veteran Affairs. "VA Dental Insurance Program (VADIP)." Accessed October 23, 2023.
- Aspen Dental. "Healthy Mouth Movement." Accessed October 23, 2023.
- Medscape. "Does Treatment of Oral Disease Reduce the Costs of Medical Care?." Accessed October 23, 2023.
- CDC. "Ten Great Public Health Achievements -- United States, 1900-1999." Accessed October 23, 2023.
- CDC. "Community Water Fluoridation FAQs." Accessed October 23, 2023.