8 ms·

America’s dental-health divide

67 points by endswapper 9y ago

droithomme 9y ago
The article seems to blame Trump for dental problems. This is strange since none of the described problems have anything to do with Trump. Adult dental coverage is not a required part of ACA plans so changes to ACA can't make it worse as the article implies.
- anigbrowl 9y ago
  You're skipping over the art where Trump promised voters like this an affordable and comprehensive solution to their healthcare needs. That's a matter of fact, and refuting it with legal technicalities is exactly the sort of thing that make his voters feel they've been had.
  - mjevans 9y ago
    They were (had / taken advantage of). Does anyone at all remember even an outline of a real plan for /HOW/ that campaign promise would be realized? All I remember is marketing puffery, pure factless, baseless, hot air. Come to think of it, I can't even remember what Hillary was running on. Bernie was someone I could believe in and wanted to vote for.
    - pnathan 9y ago
      Hillary would have expanded and improved Obamacare, basically. Relevant to this article, a goal was to add a public option; along with adding optional Medicare coverage down to age 55 and significantly enhancing the ideas of "community health centers", which are currently pretty effective. Of course, the goals of a product often conflict with implementation realities in the process of getting it done, so not all the features would have landed, I think. Er, I mean political candidate & campaign promises, not product & features. What was I thinking? That you don't remember Hillary's policy is an artifact of her marketing combined with the media's coverage, which was not on her policies.
      - droithomme 9y ago
        I would like to see a reference to Hillary promising to add dental coverage to Obamacare. Thanks in advance. I would also like to see a reference to Trump making the same promise as anigbrowl has claimed. Thanks in advance. It's interesting that several people in the thread are suggesting that adult dental coverage was going to be part of the ACA insurance overhaul proposals by both Hillary and Trump. I can find no reference to either candidate making such a proposal. Those claiming they did make these promises should provide references showing so.
        pnathan 9y ago
        > I would like to see a reference to Hillary promising to add dental coverage to Obamacare. Thanks in advance. Can't give that, sorry. I wanted to specifically provide the high-level claims Hillary was making, as GP couldn't recall her promises. My source is the campaign promise book, Stronger Together. Dental is not mentioned in the area I surveyed. A more policy oriented remark by HRC is found here: > We need to address the lack of access to primary health care, dental care, and mental health care by catalyzing partnerships between public health departments, health care systems, and community-based organizations. As we do, we must promote integrated mental health care, and enforce insurance coverage parity requirements to ensure that mental health care is not siloed. http://www.nejm.org/doi/full/10.1056/NEJMsb1612292 http://www.nejm.org/doi/full/10.1056/NEJMsb1612292 Clearly dental was not a headline coverage promise, unfortunately. I'm not sure it would have mattered.... With respect to Trump's promise: > DAVID MUIR: Let me ask you, Mr. President, about another promise involving Obamacare to repeal it. And you told The Washington Post that your plan to replace Obamacare will include insurance for everybody. That sounds an awful lot like universal coverage. > PRESIDENT TRUMP: It's going to be -- what my plan is is that I wanna take care of everybody. I'm not gonna leave the lower 20 percent that can't afford insurance. Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we'll go in and we'll do a new plan and -- and the Democrats will vote for it. Believe me. Source: http://abcnews.go.com/Politics/transcript-abc-news-anchor-david-muir-interviews-president/story?id=45047602 http://abcnews.go.com/Politics/transcript-abc-news-anchor-da...
- hexane360 9y ago
  I didn't read it that way. I read it more as "Obamacare gave America an opportunity to close the gap somewhat, and Trumpcare threatens to slam the door"
- brudgers 9y ago
  I don't think the article is blaming the president. To me, the article illustrates a reason that some people have decided that systems are broken/unfair/inaccessible.
jbuzbee 9y ago
Every time I hear about bad dental care, I think about these articles that were floating around ten years or so ago: http://www.nytimes.com/2006/05/07/world/europe/07teeth.html http://www.nytimes.com/2006/05/07/world/europe/07teeth.html Ouch!
firasd 9y ago
After I read in 2011 that funk musician Bootsy Collins' nephew died because he couldn't afford antibiotics for a tooth infection the fact really stuck with me. It really puts in perspective statements like “Nobody dies because they don’t have access to health care”, said by a politician just last week.
- quickben 9y ago
  What do you mean. Lots of people die because of lack of health care acess. Just look at the life expectancies in the undeveloped parts of the planet.
  - firasd 9y ago
    Well the politician was suggesting that if you lose health insurance in America you won't die because you can show up to the emergency room in hospitals. The statement was widely panned, and I especially find it absurd given the fact that you can die from a toothache. https://www.washingtonpost.com/news/powerpost/wp/2017/05/06/nobody-dies-because-they-dont-have-access-to-health-care-gop-lawmaker-says-he-got-booed/ https://www.washingtonpost.com/news/powerpost/wp/2017/05/06/...
- snappyTertle 9y ago
  That's so sad. Why should politicians decide health care access. The system is so messed up. Government regulation has caused price for health care to sky rocket. And now we have to beg them to be a 3rd party payer just so we can "afford" it.
- pkaye 9y ago
  Walmart has Amoxicillin, a commonly prescribed antibiotic for tooth infection for $4 for a month supply. https://www.walmart.com/cp/4-dollar-presscriptions/1078664 https://www.walmart.com/cp/4-dollar-presscriptions/1078664 They have quite a few common generics all for the same low price. The generic medications are often times cheap but the catch is you need a doctor's prescription and that is where it costs.
  - 9y ago
bluedino 9y ago
You need two things for nice, straight teeth: Either good genetics, or parents with good dental insurance. Any kid who's parents had money in school had braces. I remember hearing parents complain/brag about spending $3,000, $5,000, and even $7,000 on their braces. The other kids? You better hope they came in straight. Mine came in fairly straight, but like others in my family one of the adult canine teeth never came through. It's still in my upper jaw. The baby tooth is still just barely there, and it's shifted my top row of teeth around a little bit. The other thing with teeth is you have to take care of them. You have to brush twice a day, you shouldn't eat things that get stuck in there, and avoid crunchy things that can break them. Even though I had dental insurance from work, I skipped out on going to the dentist after I wasn't living with my parents anymore. And like other hackers, I lived on sugary, acidic, and caffeinated drinks. Years later I succumbed to toothaches, finally went to see the dentist, and spent a couple thousand dollars (with insurance) getting fillings, crowns, root canals, and an extraction or two - all on the rear teeth that nobody can really see. Back to the top row of front teeth, I saw a orthodontist about having those fixed. When you're an adult, insurance doesn't cover braces. So I was looking at between $10,000 and $12,000 to get it fixed, which would all come out of pocket. Now, I don't think everyone has the right to perfect teeth, and you can't control everything about how they come in. But most people avoid the dentist until it's too late, they're in pain, need to get in right away, and the fix is expensive procedures like root canals and crowns. If you go every months (a regular visit doesn't cost much, even out of pocket) you can fix a lot of issues while they're cheap and easy to fix.
- FrozenVoid 9y ago
  >Either good genetics, or parents with good dental insurance. Not eating carbohydrate-rich food is the third option, as bacteria which destroy teeth need carbohydrates to feed. https://www.reddit.com/r/keto/comments/3q9pbz/the_effect_of_keto_on_my_teeth/ https://www.reddit.com/r/keto/comments/3q9pbz/the_effect_of_...
  - ItendToDisagree 9y ago
    He is talking about tooth alignment (braces) not decay as in cavities. Incorrect tooth alignment can have many health risks regardless of it being a class/beauty standard. The bacteria/decay thing is a whole other mostly preventable thing.
habosa 9y ago
The article is pretty poorly written and lacks focus, but the problem is real. Dental health is just health, it shouldn't be this separate part of our system. It's also one of the few parts of your health a stranger can judge from the outside. I can't see if you have arterial plaque but I can tell if you don't clean your teeth. I have two dentists in my family and when this topic comes up they focus on the Medicaid issues presented in the article. Medicaid reimbursement rates haven't budged in years and for whatever there's a much higher no-show rate among Medicaid patients. The end result is there's no incentive at all for dentists or orthodontists to help these people who need it most.
- rhizome 9y ago
  for whatever there's a much higher no-show rate among Medicaid patients A lot of people are afraid of the dentist, and I'll bet dollars to donuts that Medicaid isn't allowed to cover sedation dentistry and other enhancements that private insurance or cash patients have access to. Sure, "save your pennies," but think about the situation we're talking about here.
- blablabla123 9y ago
  > I can't see if you have arterial plaque but I can tell if you don't clean your teeth. Maybe if you are a dentist. Having not the best teeth myself, people sometimes think I don't clean my teeth. I think tooth health is actually similar to other parts of human health. If you maintain a healthy lifestyle from childhood on, do all recommended inspections, then everything is likely to be good. However most people don't know better or just don't do better. Politicians would do good in truly reforming a health system. I'm only aware of one example where efficiency got a 10x improvement, which is the Chinese one in the 50s. It's cool to complain about [insert politician] about cutting health cost but add the end of the day it's not how to solve the problem. Too sad Trump is intellectually too limited to make real cost savings.
  - blablabla123 9y ago
    Not sure why that's downvoted but I see that health care is a highly complex topic. On the one hand everybody knows (at least I hope so) that all the care systems are going to be more and more expensive every year. On the other hand people still want to maintain highly unhealthy lifestyles because those are more fun. But I think nobody is ready for a paradigm shift yet, that would allow for cheaper health, higher coverage and better health.
systemtest 9y ago
In the Netherlands, dental is outside of the national health care plan. And we are still doing fine. I pay all my dental bills out of pocket because its cheaper than insurance(#). So it is possible to have great national dental-health without having a national health care plan. (#) We have plans that compensate up to 75% of €500 per year, but it will cost you €250. Doesn't really make sense.
- konschubert 9y ago
  I'm down voting because you are saying: "This policy is good because it is good for me." You are saying "we are doing fine", but you provide no evidence and no explanation for it. Social policies should be evaluated by their impact on everybody in the society, not just on you.
eddieone 9y ago
I resell a lot of dental equipment. The tools are incredibly cheap now and the composites are becoming increasingly more advanced and easy to use. It's all coming from China where things have become deregulated. Also, aligners are now made using machine learning, so those are more affordable than ever. Basically, the tech is there but the regulation in US is lagging as always.
- petra 9y ago
  As someone from inside the field(and other replies are welcomed of course), let's say you had total regulatory freedom and could control everything - how would you write the rules, how would the businesses look like, what tech will be used, and maybe if it's possible to guess, how cheap can the common treatments(filling/root/crown) get ?
alistproducer2 9y ago
I used to have cavities every time I went to the dentist. Then I got a timer from the dollar store and use it to time 2 minutes. Use floss at night and the timer twice a day. No cavities in 3 years.
pnathan 9y ago
I'm sure part of the deeper issue is that preventative care is not really popular in the US among many, along with far too many sweets. Unfortunately, even if that changed overnight, tomorrow we'd still have the exact same problem. Systemically, we have to consider the costs of dentistry and why they are high; we have to consider the hand of the insurance company and their price regulation; the costs of materials; the costs of running a small office & regulatory compliance of same; the costs of dental school; and more. This is largely an exercise in system thinking and determining which lever is most effeciacious in improving public health outcomes. Insurance regulation is a narrow way to affect costs without disrupting the choices dentists and patients have made in their life regarding location, choice of careers, etc. Grew up poor, but we had floridated mouthwash to help cope with well water, and my parents made sure we hit the dentist 2x a year for cleaning & sealants. I wonder if the cost curves for dental care are different now, 20 years later. I'm very grateful to them for taking me to the dentist as diligently as they did. These days I have dental insurance, but still do the 2x/year clean.
- mancerayder 9y ago
  There's this seemingly unspoken assumption that fluoridated drinking water has dental properties worthy of whatever other risks it could have. I don't know either way, in fact I'm very curious for a trustworthy source, not of water but of evidence. Anecdotally, I always drank bottled water growing up in the US. I also never had a cavity. Is it genetic? Both of my parents have terrifying teeth issues. Is it diet? Partly - thanks to my mom, I was never obsessed about sweets. Anecdotes aside, why does fluoride belong in drinking water?
  - pnathan 9y ago
    http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf http://www.who.int/water_sanitation_health/publications/fluo... In summary: The beneficial and the detrimental effects of fluoride naturally present in water were well established by the early 1940s. High levels of fluoride present in concentrations up to 10 mg l–1 were associated with dental fluorosis (yellowish or brownish striations or mottling of the enamel) while low levels of fluoride, less than 0.1 mg l–1, were associated with high levels of dental decay (Edmunds and Smedley, 1996), although poor nutritional status is also an important contributory factor. Concentrations in drinking-water of about 1 mg l–1 are associated with a lower incidence of dental caries, particularly in children, whereas excess intake of fluoride can result in dental fluorosis. In severe cases this can result in erosion of enamel. The margin between the beneficial effects of fluoride and the occurrence of dental fluorosis is small and public health programmes seek to retain a suitable balance between the two (IPCS, 2002). The various in Basically: appropriate amounts of fluoride help your teeth to not decay.
andybak 9y ago
I'm British and yes - I have what you over the pond like to call "British teeth". I do wonder if it's fairly healthy from a social mobility standpoint that we haven't taken quite so passionately to US views on the value of cosmetic dental procedures. It's one less way to spot at a glance whether someone has a large disposable income.
ciconia 9y ago
> But since he took office, Trump has focused on so many other things... that Matello has begun to wonder about his promises to the working class: “Was he just out to get our votes?” This is truly sad. So many people put their faith in that con artist.
massysett 9y ago
Turns out this is another article about Trump. Now it seems so much press has to twist any possible story and make it about Trump or in this case "Trump's America." It seems WaPo is trying to make up for missing the possibility that Trump would actually win. But this article just underscores how they missed it in the first place: the issue of people not having dental care is not a standalone issue worthy of journalistic attention. Instead, the third paragraph has to say that someone voted for Trump, with a later paragraph saying someone voted for Obama. To WaPo these issues don't exist outside of the lens of presidential politics I guess. Unfortunately it seems WaPo has merely gone from ignoring some parts of America to simply taking a few safaris there to report on the exotics who voted for Trump and have rotten teeth. WaPo will tire of its safari soon enough and return to its usual class blinders, like reporting about "how hard it is to get into a good college" and then quoting the anxieties of a bunch of upper middle class kids from the Virginia and Maryland suburbs, and somehow it won't be worth mentioning that their parents voted for Clinton.
louithethrid 9y ago
One thing nobody taught me was that stressors and psychological problems can ruin your teeth. I spend years without nightguard- and bear the marks of that. If your dentitst mentions gnawing marks on your teeth- get a nightguard as soon as possible. Also get rid of the stressfull situation.

67 points by endswapper 9y ago

The article seems to blame Trump for dental problems. This is strange since none of the described problems have anything to do with Trump. Adult dental coverage is not a required part of ACA plans so changes to ACA can't make it worse as the article implies.

anigbrowl 9y ago
You're skipping over the art where Trump promised voters like this an affordable and comprehensive solution to their healthcare needs. That's a matter of fact, and refuting it with legal technicalities is exactly the sort of thing that make his voters feel they've been had.
- mjevans 9y ago
  They were (had / taken advantage of). Does anyone at all remember even an outline of a real plan for /HOW/ that campaign promise would be realized? All I remember is marketing puffery, pure factless, baseless, hot air. Come to think of it, I can't even remember what Hillary was running on. Bernie was someone I could believe in and wanted to vote for.
  - pnathan 9y ago
    Hillary would have expanded and improved Obamacare, basically. Relevant to this article, a goal was to add a public option; along with adding optional Medicare coverage down to age 55 and significantly enhancing the ideas of "community health centers", which are currently pretty effective. Of course, the goals of a product often conflict with implementation realities in the process of getting it done, so not all the features would have landed, I think. Er, I mean political candidate & campaign promises, not product & features. What was I thinking? That you don't remember Hillary's policy is an artifact of her marketing combined with the media's coverage, which was not on her policies.
    - droithomme 9y ago
      I would like to see a reference to Hillary promising to add dental coverage to Obamacare. Thanks in advance. I would also like to see a reference to Trump making the same promise as anigbrowl has claimed. Thanks in advance. It's interesting that several people in the thread are suggesting that adult dental coverage was going to be part of the ACA insurance overhaul proposals by both Hillary and Trump. I can find no reference to either candidate making such a proposal. Those claiming they did make these promises should provide references showing so.
      - pnathan 9y ago
        > I would like to see a reference to Hillary promising to add dental coverage to Obamacare. Thanks in advance. Can't give that, sorry. I wanted to specifically provide the high-level claims Hillary was making, as GP couldn't recall her promises. My source is the campaign promise book, Stronger Together. Dental is not mentioned in the area I surveyed. A more policy oriented remark by HRC is found here: > We need to address the lack of access to primary health care, dental care, and mental health care by catalyzing partnerships between public health departments, health care systems, and community-based organizations. As we do, we must promote integrated mental health care, and enforce insurance coverage parity requirements to ensure that mental health care is not siloed. http://www.nejm.org/doi/full/10.1056/NEJMsb1612292 http://www.nejm.org/doi/full/10.1056/NEJMsb1612292 Clearly dental was not a headline coverage promise, unfortunately. I'm not sure it would have mattered.... With respect to Trump's promise: > DAVID MUIR: Let me ask you, Mr. President, about another promise involving Obamacare to repeal it. And you told The Washington Post that your plan to replace Obamacare will include insurance for everybody. That sounds an awful lot like universal coverage. > PRESIDENT TRUMP: It's going to be -- what my plan is is that I wanna take care of everybody. I'm not gonna leave the lower 20 percent that can't afford insurance. Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we'll go in and we'll do a new plan and -- and the Democrats will vote for it. Believe me. Source: http://abcnews.go.com/Politics/transcript-abc-news-anchor-david-muir-interviews-president/story?id=45047602 http://abcnews.go.com/Politics/transcript-abc-news-anchor-da...
hexane360 9y ago
I didn't read it that way. I read it more as "Obamacare gave America an opportunity to close the gap somewhat, and Trumpcare threatens to slam the door"
brudgers 9y ago
I don't think the article is blaming the president. To me, the article illustrates a reason that some people have decided that systems are broken/unfair/inaccessible.

jbuzbee 9y ago

Every time I hear about bad dental care, I think about these articles that were floating around ten years or so ago: http://www.nytimes.com/2006/05/07/world/europe/07teeth.html http://www.nytimes.com/2006/05/07/world/europe/07teeth.html Ouch!

firasd 9y ago

After I read in 2011 that funk musician Bootsy Collins' nephew died because he couldn't afford antibiotics for a tooth infection the fact really stuck with me. It really puts in perspective statements like “Nobody dies because they don’t have access to health care”, said by a politician just last week.

quickben 9y ago
What do you mean. Lots of people die because of lack of health care acess. Just look at the life expectancies in the undeveloped parts of the planet.
- firasd 9y ago
  Well the politician was suggesting that if you lose health insurance in America you won't die because you can show up to the emergency room in hospitals. The statement was widely panned, and I especially find it absurd given the fact that you can die from a toothache. https://www.washingtonpost.com/news/powerpost/wp/2017/05/06/nobody-dies-because-they-dont-have-access-to-health-care-gop-lawmaker-says-he-got-booed/ https://www.washingtonpost.com/news/powerpost/wp/2017/05/06/...
snappyTertle 9y ago
That's so sad. Why should politicians decide health care access. The system is so messed up. Government regulation has caused price for health care to sky rocket. And now we have to beg them to be a 3rd party payer just so we can "afford" it.
pkaye 9y ago
Walmart has Amoxicillin, a commonly prescribed antibiotic for tooth infection for $4 for a month supply. https://www.walmart.com/cp/4-dollar-presscriptions/1078664 https://www.walmart.com/cp/4-dollar-presscriptions/1078664 They have quite a few common generics all for the same low price. The generic medications are often times cheap but the catch is you need a doctor's prescription and that is where it costs.
- 9y ago

bluedino 9y ago

You need two things for nice, straight teeth: Either good genetics, or parents with good dental insurance. Any kid who's parents had money in school had braces. I remember hearing parents complain/brag about spending $3,000, $5,000, and even $7,000 on their braces. The other kids? You better hope they came in straight. Mine came in fairly straight, but like others in my family one of the adult canine teeth never came through. It's still in my upper jaw. The baby tooth is still just barely there, and it's shifted my top row of teeth around a little bit. The other thing with teeth is you have to take care of them. You have to brush twice a day, you shouldn't eat things that get stuck in there, and avoid crunchy things that can break them. Even though I had dental insurance from work, I skipped out on going to the dentist after I wasn't living with my parents anymore. And like other hackers, I lived on sugary, acidic, and caffeinated drinks. Years later I succumbed to toothaches, finally went to see the dentist, and spent a couple thousand dollars (with insurance) getting fillings, crowns, root canals, and an extraction or two - all on the rear teeth that nobody can really see. Back to the top row of front teeth, I saw a orthodontist about having those fixed. When you're an adult, insurance doesn't cover braces. So I was looking at between $10,000 and $12,000 to get it fixed, which would all come out of pocket. Now, I don't think everyone has the right to perfect teeth, and you can't control everything about how they come in. But most people avoid the dentist until it's too late, they're in pain, need to get in right away, and the fix is expensive procedures like root canals and crowns. If you go every months (a regular visit doesn't cost much, even out of pocket) you can fix a lot of issues while they're cheap and easy to fix.

FrozenVoid 9y ago
>Either good genetics, or parents with good dental insurance. Not eating carbohydrate-rich food is the third option, as bacteria which destroy teeth need carbohydrates to feed. https://www.reddit.com/r/keto/comments/3q9pbz/the_effect_of_keto_on_my_teeth/ https://www.reddit.com/r/keto/comments/3q9pbz/the_effect_of_...
- ItendToDisagree 9y ago
  He is talking about tooth alignment (braces) not decay as in cavities. Incorrect tooth alignment can have many health risks regardless of it being a class/beauty standard. The bacteria/decay thing is a whole other mostly preventable thing.

habosa 9y ago

The article is pretty poorly written and lacks focus, but the problem is real. Dental health is just health, it shouldn't be this separate part of our system. It's also one of the few parts of your health a stranger can judge from the outside. I can't see if you have arterial plaque but I can tell if you don't clean your teeth. I have two dentists in my family and when this topic comes up they focus on the Medicaid issues presented in the article. Medicaid reimbursement rates haven't budged in years and for whatever there's a much higher no-show rate among Medicaid patients. The end result is there's no incentive at all for dentists or orthodontists to help these people who need it most.

rhizome 9y ago
for whatever there's a much higher no-show rate among Medicaid patients A lot of people are afraid of the dentist, and I'll bet dollars to donuts that Medicaid isn't allowed to cover sedation dentistry and other enhancements that private insurance or cash patients have access to. Sure, "save your pennies," but think about the situation we're talking about here.
blablabla123 9y ago
> I can't see if you have arterial plaque but I can tell if you don't clean your teeth. Maybe if you are a dentist. Having not the best teeth myself, people sometimes think I don't clean my teeth. I think tooth health is actually similar to other parts of human health. If you maintain a healthy lifestyle from childhood on, do all recommended inspections, then everything is likely to be good. However most people don't know better or just don't do better. Politicians would do good in truly reforming a health system. I'm only aware of one example where efficiency got a 10x improvement, which is the Chinese one in the 50s. It's cool to complain about [insert politician] about cutting health cost but add the end of the day it's not how to solve the problem. Too sad Trump is intellectually too limited to make real cost savings.
- blablabla123 9y ago
  Not sure why that's downvoted but I see that health care is a highly complex topic. On the one hand everybody knows (at least I hope so) that all the care systems are going to be more and more expensive every year. On the other hand people still want to maintain highly unhealthy lifestyles because those are more fun. But I think nobody is ready for a paradigm shift yet, that would allow for cheaper health, higher coverage and better health.

systemtest 9y ago

In the Netherlands, dental is outside of the national health care plan. And we are still doing fine. I pay all my dental bills out of pocket because its cheaper than insurance(#). So it is possible to have great national dental-health without having a national health care plan. (#) We have plans that compensate up to 75% of €500 per year, but it will cost you €250. Doesn't really make sense.

konschubert 9y ago
I'm down voting because you are saying: "This policy is good because it is good for me." You are saying "we are doing fine", but you provide no evidence and no explanation for it. Social policies should be evaluated by their impact on everybody in the society, not just on you.

eddieone 9y ago

I resell a lot of dental equipment. The tools are incredibly cheap now and the composites are becoming increasingly more advanced and easy to use. It's all coming from China where things have become deregulated. Also, aligners are now made using machine learning, so those are more affordable than ever. Basically, the tech is there but the regulation in US is lagging as always.

petra 9y ago
As someone from inside the field(and other replies are welcomed of course), let's say you had total regulatory freedom and could control everything - how would you write the rules, how would the businesses look like, what tech will be used, and maybe if it's possible to guess, how cheap can the common treatments(filling/root/crown) get ?

alistproducer2 9y ago

I used to have cavities every time I went to the dentist. Then I got a timer from the dollar store and use it to time 2 minutes. Use floss at night and the timer twice a day. No cavities in 3 years.

pnathan 9y ago

I'm sure part of the deeper issue is that preventative care is not really popular in the US among many, along with far too many sweets. Unfortunately, even if that changed overnight, tomorrow we'd still have the exact same problem. Systemically, we have to consider the costs of dentistry and why they are high; we have to consider the hand of the insurance company and their price regulation; the costs of materials; the costs of running a small office & regulatory compliance of same; the costs of dental school; and more. This is largely an exercise in system thinking and determining which lever is most effeciacious in improving public health outcomes. Insurance regulation is a narrow way to affect costs without disrupting the choices dentists and patients have made in their life regarding location, choice of careers, etc. Grew up poor, but we had floridated mouthwash to help cope with well water, and my parents made sure we hit the dentist 2x a year for cleaning & sealants. I wonder if the cost curves for dental care are different now, 20 years later. I'm very grateful to them for taking me to the dentist as diligently as they did. These days I have dental insurance, but still do the 2x/year clean.

mancerayder 9y ago
There's this seemingly unspoken assumption that fluoridated drinking water has dental properties worthy of whatever other risks it could have. I don't know either way, in fact I'm very curious for a trustworthy source, not of water but of evidence. Anecdotally, I always drank bottled water growing up in the US. I also never had a cavity. Is it genetic? Both of my parents have terrifying teeth issues. Is it diet? Partly - thanks to my mom, I was never obsessed about sweets. Anecdotes aside, why does fluoride belong in drinking water?
- pnathan 9y ago
  http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf http://www.who.int/water_sanitation_health/publications/fluo... In summary: The beneficial and the detrimental effects of fluoride naturally present in water were well established by the early 1940s. High levels of fluoride present in concentrations up to 10 mg l–1 were associated with dental fluorosis (yellowish or brownish striations or mottling of the enamel) while low levels of fluoride, less than 0.1 mg l–1, were associated with high levels of dental decay (Edmunds and Smedley, 1996), although poor nutritional status is also an important contributory factor. Concentrations in drinking-water of about 1 mg l–1 are associated with a lower incidence of dental caries, particularly in children, whereas excess intake of fluoride can result in dental fluorosis. In severe cases this can result in erosion of enamel. The margin between the beneficial effects of fluoride and the occurrence of dental fluorosis is small and public health programmes seek to retain a suitable balance between the two (IPCS, 2002). The various in Basically: appropriate amounts of fluoride help your teeth to not decay.

andybak 9y ago

I'm British and yes - I have what you over the pond like to call "British teeth". I do wonder if it's fairly healthy from a social mobility standpoint that we haven't taken quite so passionately to US views on the value of cosmetic dental procedures. It's one less way to spot at a glance whether someone has a large disposable income.

ciconia 9y ago

> But since he took office, Trump has focused on so many other things... that Matello has begun to wonder about his promises to the working class: “Was he just out to get our votes?” This is truly sad. So many people put their faith in that con artist.

massysett 9y ago

Turns out this is another article about Trump. Now it seems so much press has to twist any possible story and make it about Trump or in this case "Trump's America." It seems WaPo is trying to make up for missing the possibility that Trump would actually win. But this article just underscores how they missed it in the first place: the issue of people not having dental care is not a standalone issue worthy of journalistic attention. Instead, the third paragraph has to say that someone voted for Trump, with a later paragraph saying someone voted for Obama. To WaPo these issues don't exist outside of the lens of presidential politics I guess. Unfortunately it seems WaPo has merely gone from ignoring some parts of America to simply taking a few safaris there to report on the exotics who voted for Trump and have rotten teeth. WaPo will tire of its safari soon enough and return to its usual class blinders, like reporting about "how hard it is to get into a good college" and then quoting the anxieties of a bunch of upper middle class kids from the Virginia and Maryland suburbs, and somehow it won't be worth mentioning that their parents voted for Clinton.

louithethrid 9y ago

One thing nobody taught me was that stressors and psychological problems can ruin your teeth. I spend years without nightguard- and bear the marks of that. If your dentitst mentions gnawing marks on your teeth- get a nightguard as soon as possible. Also get rid of the stressfull situation.