Wednesday September 26, 2012

Citizen activism is alive and well in Vermont. Thanks to more than 1,000 people who contacted the Green Mountain Care Board, the recommendation to add dental benefits to exchange health plans is now on the table.

This does not mean that the board will finally vote for a comprehensive dental coverage package, but it does mean that they now know how important this issue is to Vermonters.

Legislators have told me that when they receive 10 or more correspondences from constituents they know that it is something that a lot of people are concerned about. They generally assume that for every letter there are many more people who feel the same way.

Relevant statistics about dental care and the lack of access to it are disturbing and revealing. According to an August 25, 2005 Medline Plus story, "A study by the Centers for Disease Control and Prevention found 42 percent of kids aged 6 to 19 had had a cavity or filling in their permanent teeth when examined between 1999 and 2002."

In 2005 a CDC report noted that, "Although dental caries (tooth decay) is largely preventable, it remains the most common chronic disease of children aged 5 to 17 years -- 5 times more common than asthma (59 percent versus 11 percent)." The report goes on to say that, "Poor children have nearly 12 times more restricted-activity days because of dental-related illness than children from higher-income families.


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Pain and suffering due to untreated tooth decay can lead to problems in eating, speaking, and attending to learning."

One of the more revealing pieces of information about dental care in this country is found in a 2011 report, "Health, United States, 2011" published by the CDC.

"Edentulism-the absence of any natural teeth-may occur for a variety of reasons but most commonly results from untreated dental caries or periodontal disease . Loss of teeth may also reflect poor dietary intake or limited access to oral health care. Edentulism is associated with morbidity, including heart disease and stroke."

"Over the past several decades, the prevalence of edentulism has declined, likely due to improved access to and use of oral health care services and fluoridated water, and lower prevalence of smoking among adults."

"Edentulism increases with decreasing relative family income. In 2010, among adults 45-64 years of age, edentulism was 5 times as high for those living below poverty, 4.8 times as high for those at 100 percent to 199 percent of the poverty level, and 2.7 times as high among those at 200%-399% of the poverty level, compared with those with income at 400 percent or more of the poverty level."

"In 2010, among adults 65 years of age and over, edentulism was 3 times as high for those living below poverty, 2.5 times as high for those at 100 percent to 199 percent of the poverty level, and 1.8 times as high among those at 200 percent to 399 percent of the poverty level, compared with those with income at 400 percent or more of the poverty level."

"For both age groups, the percentage with edentulism has declined from 2000 to 2010. However, there has been a more rapid decline among adults in higher relative family income groups, resulting in an increase in the percent difference in edentulism between the lowest and highest groups over the past decade."

The battle for dental care coverage is far from over. If the Green Mountain Care Board decides to include a comprehensive dental benefit they will also have to find a way to pay for it. We will hear sound bites about priorities and difficult decisions.

I hope that we hear concrete proposals rather than rhetorical posturing. There will have to be trade-offs and difficult decisions will have to be made initially. Not wishing to be just another gas-bag critic, I offer my trade-off to find money for dental care.

The Green Mountain Care Board could run some numbers and see how much savings there might be if all insurance plans, both public and private, only paid for pre-natal, maternity and post partum care for two children per household. 

It would be a tough sell from a lot of societal perspectives, but if we don't put ideas on the table we will not make any progress.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at rbdav@comcast.net.