The Tragedy of (No) Access to Care
One year ago this month, Inside Dentistry presented a full-coverage feature story on the state of the union in terms of access to oral healthcare in this country.1 We began our story with this statement: “Living in the most industrialized nation on the planet perhaps gives us all a false sense of security when it comes to our healthcare—we have the best medical schools, the best hospitals, the best specialists, and the best medical technology in the world. But the best medicine will not work when it cannot be accessed.”
In a most tragic example of the truth of this statement, as we went to press with this issue The Washington Post broke the story of 12-year-old Deamonte Driver, an underprivileged seventh-grader from Prince George’s County, Maryland.2 When he first complained of a headache in January, his mother Alyce was focused on trying to find a dentist to treat Deamonte’s younger brother DaShawn, who himself was suffering from six rotted teeth. Alyce’s problem then was trying to find a dentist who would accept her Medicaid insurance, the only coverage that the single mother—working several low-paying jobs with no employer-provided healthcare benefits—had. When she did find a dentist, she discovered that her Medicaid coverage had lapsed due to a paperwork glitch; her family was in between homeless shelters at the time. Forced to cancel DaShawn’s appointment, she could not have foreseen what was about to happen to her older son.
Unaware that an abscessed tooth was the cause of Deamonte’s headache, Alyce took her ailing son to the local hospital where he was treated for the abscess and sinusitis. But a couple of days later his condition worsened and he was rushed to Children’s Hospital in Washington, DC, where surgeons tried twice to try to stop the bacteria that had invaded his brain from the abscess. After more than 6 weeks of invasive treatment that could ultimately cost an estimated $250,000, young Deamonte died on February 25.
The Post aptly conveyed the heinousness of his death with one simple, grim line: “A routine, $80 tooth extraction might have saved him.”
We all must take careful note of this.
On the same day that Deamonte’s story was published in The Post, the local newspaper in Charlottesville, Virginia, The Daily Progress,3 reported the creation of the Charlottesville Free Clinic, an initiative begun by three nonprofit organizations that “will offer acute dental care and restorative care to adults with incomes up to twice the region’s poverty level.” Perhaps Alyce Driver would have qualified under this program had she and her sons not lived one state away.
But “perhaps” is a useless word when it comes to access to healthcare. Last year, we reported on a bill that had been introduced in the House of Representatives, H.R. 4624[109th]: Special Care Dentistry Act of 2005.1 The intention of the bill is “to require States to provide oral health services to children and aged, blind, or disabled persons under the Medicaid Program.” Three days after Deamonte’s death, a visit to GovTrack.us, an independent organization that tracks the progress of introduced legislation through the US Congress, found that the last action on this bill was taken on January 3, 2006, when it was referred to the House Energy and Commerce Subcommittee on Health.4 GovTrack’s disclaimer on its site states that “because the government takes a day or two to post legislative information online, GovTrack is usually current as of the start of the previous day.” This means that this bill, with all of its potential to make a positive impact for the millions of uninsured and underinsured Americans relying on Medicaid to receive the most basic of oral healthcare services—including emergency care—has been stalled for well over a year. This bill, with its primary definition of oral healthcare services being the “relief of pain and infections,” is at this moment nothing more than words on paper stuck in a Congressional subcommittee, having done little—or nothing at all—to help save the life of a young boy or to relieve the pain and suffering of countless others like him. Perhaps if this legislation had made some progress over the last year it would have made some difference, no matter how slight; maybe it would have at least enabled Deamonte to receive the simple $80 tooth extraction that may have saved his life.
Last year we also reported on the American Dental Association’s (ADA) “Give Kids A Smile®” program (GKAS),1 which has two basic yet critical missions: To help children get the dental care that they desperately need and to raise awareness that our children deserve a better dental healthcare system that can address their specific dental needs.5 Last year on National Children’s Dental Access Day, more than 512,000 children in over 2,000 locations across the country were screened and treated by 12,000 participating dentists and 27,000 auxiliary dental team members. This year those numbers hold even more promise: as of March 1, the ADA had reported that more than 750,000 kids in over 2,200 locations had been screened and treated by more than 14,000 dentists and 38,000 auxiliary dental team members, with more communities yet to submit their participation figures.5
Perhaps if Deamonte had been able to participate in this program, which was held on February 1, just shortly after he began complaining about the headaches, a volunteer dentist would have been able to identify the cause of his pain and performed the simple procedure that would have relieved his suffering, and certainly would have prevented his death.
While the good news of GKAS' success this year comes too late for Deamonte and his grieving mother and brother, perhaps in these numbers lives some real hope for other underprivileged children and their families. But even the ADA refuses to be satisfied with its obvious progress. On its GKAS Web page, one year later, it still says: “A one-day event...isn’t a cure all; it’s a wake-up call. People shouldn’t have to depend on charity for basic dental care. It’s time for politicians, parents and others who care to work together toward a solution.”5
The publishers and staff of Inside Dentistry fully embrace this philosophy. How many more children will suffer needlessly because preventive care is not available to them through circumstances beyond their control? How many more children will suffer long-term, life-altering consequences—such as pain and parafunction so severe it interferes with their ability to sleep and eat and even contributes to a sense of social stigma—as a result of not receiving the most basic preventive oral healthcare? How many more children will die of tooth abscesses before stronger, more sustaining action is taken to prevent such incomprehensible tragedies? How do the public and private sectors of the dental profession come together and strive to solve the access-to-care crisis in this country?
These are the questions we are asking, and we are prepared to do what needs to be done to find the answers. We are inviting you to join us in this mission. We have already partnered with many excellent organizations, such as Oral Health America and the National Children’s Oral Health Foundation, as well as dental corporations whose mission is aligned with ours, and who are all working tirelessly to bring about positive change. But we do believe that it takes a village, and we want your thoughts, opinions, reactions and ideas about how we can all work together to make the needed improvements to this critical aspect of dental healthcare. Please send your letters to firstname.lastname@example.org.
References1. Neuman L, Ranft L. Access to Care: Who Gets it...and Who Doesn’t. Inside Dentistry. 2006;2(3):42-54.
2. Otto M. Md boy dies from toothache. The Washington Post. February 28, 2007. Available at: www.washingtonpost.com_Highlights. Accessed February 28, 2007.
3. McNeill B. Dental program to help area needy. The Daily Progress. February 28, 2007. Available at: www.dailyprogress.com. Accessed March 1, 2007.
4. H.R. 4624[109th]: Special Care Dentistry Act of 2005. Available at: www.GovTrack.us. Accessed March 1, 2007.
5. The American Dental Association. Give Kids A Smile®. Available at: www.ada.org/prof/events/featured/gkas. Accessed March 1, 2007.