Tuesday, May 16, 2017

Pulling Teeth

I am one of the Americans in the story below with one caveat, I have the money. 

When I was 16 and like all adolescents I had braces.  My Orthodontist was like all the rest of the medical professionals my family saw - a Quack.  My parents were not Americans and they had no idea about how to ask questions from Medical providers nor to inquire about second opinions or follow up care, that was just not done at the time.

So when my braces came off so did my teeth. They were utterly mobile and like all good practitioners he blamed me.  I had already had enough with the varying other quacks I was forced to go to when sick he was just another in a long line of quacks I would see throughout life only this one set the tone.

Dr. Nelson in Ballard was supposedly the best Orthodontist in the area and yet during 3 years of treatment failed to notice the gums bleeding, the teeth loosening and the other symptoms of what was Juvenile Periodontosis.  The reality is that I likely inherited this from my Mother who wore false teeth and claimed it was a hockey injury.   But again, not an American so having a full medical/dental history post war not possible.  And that she was a prodigious liar in her own right made it even more so.  My father did have solid teeth and he was not afraid of the Dentist and we had solid Union benefits that enabled treatment in those days.

So at age 16 I began the journey that finally brought me here to Nashville.  I did not specifically pick Nashville for this but I wanted a large Medical school within a city that focused on medical care and there are about three American Cities that truly have such a focus.   This was the cheapest and I thought the best, I still believe that despite my own issues with some of the care at Vanderbilt.

My Dentist at age 16 was the same Dentist I had until I left.  He, nor I, however are the same Doctor/Patient we were nearly 40 years ago. He saved my teeth and did what we have seen with regards to the All in 4 style bridge on both upper and lower jaws.  Finally about 6 years ago the anchor teeth were failing due to age, the final factor of disease and time so I began implant surgery.  I had and still do have Dentures. They are utter garbage. But my faith and confidence in my Dentist had waned and then the accident of 2012 which took resources and time away from completing the process occurred so I had to postpone.

During that time I consulted with others had the Dentures replaced 3 times and finally realized that I needed to move forward with my plan and it worked that leaving Seattle was also on my agenda. 

The surgery and the implants have changed.  I learned about Zygomatic and in turn found an amazing crew of surgeons and others who truly are revolutionary and talented.  It was time. Despite the one idiot who did not understand my own depression, anxiety was related to working in the schools while simultaneously feeling alone here she thought the Cops would fix the problem. Well at least I did not end up dead and got the second opinion I needed thanks to the one Cops referral of another Dentist.

This is why I hated the ACA, it did not address Dental issues nor vision.  It is a program that has a myriad of problems that appears will never be fixed.  Only Bernie Sanders had a proposal in his campaign with regards to the issue.  This is not something the policy wonks seem to care about.

In Washington State it is considered one of the most expensive with regards to Dental Care and I am fairly certain that what is costing me 15-18K would be double that if not more in Seattle.  Most dental work is considered cosmetic.  Yes cosmetic and the insurance regulations and industry have not changed their policies in decades.  There is no imperative to do so.  I have two policies here and they are still less than what I paid in Seattle for one. So instead of two cleanings a year I now have four and the extractions are partially covered.   Unlike Medical this is legal but to frank dental insurance is wasteful and useless on average.

There is a great book on this subject, Teeth, the Story of Beauty, Inequality and the Struggle for Oral Health in America, by Mary Otto was a compelling read.  The vanity and insecurity of those who struggle with what it means to be perceived as both healthy and beautiful comes from the very concept of having pearly whites.  When I watched Feud, the Story of  Bette Davis and Joan Crawford during the making of Whatever Happened to Baby Jane the ending discusses Joan's oral health and her lack of molars which were removed to give her sunken cheekbones.  The book starts with a story of a beauty contestant who was already beautiful then sent on a needless journey to perfect what was already perfect.

I miss having the ability to bite, to chew, to speak and to have endless shit in one's mouth. If I wanted to constantly have this feeling I should have become a professional whore and spent the day with varying cocks in my mouth as that is what it is like.  And hence when this work is done I will never put another dick in my mouth again.

We see endless commercials about Teeth, from brushing to whitening to straightening. The implant profession has set up more clinics than any other needless faux medical facility when in realty dental care starts early and can be like any medical situation - prevented. 

I don't think my problems were that easy, that my care and maintenance were not the issue, heredity and just being a freak of nature as my Dentist informed me on our last appointment were largely the reason.  For if it was the former then the work would not have lasted nor as been as successful as long as it was. So from age 17 to 50 I had a good ride but enough is enough and this merry go round is something I want off.  Fixing my teeth is vanity but it is health, I know the difference, I have felt and experienced it.  And others should.  But in Trump America this will not happen anytime soon.

The painful truth about teeth

You can work full time but not have the money to fix your teeth – visible reminders of the divide between rich and poor

Story by Mary Jordan, Kevin Sullivan
The Washington Post
Published on May 13, 2017

SALISBURY, Md. — Two hours before sunrise, Dee Matello joined the line outside the Wicomico Civic Center, where hundreds of people in hoodies, heavy coats and wool blankets braced against a bitter wind.

Inside, reclining dental chairs were arrayed in neat rows across the arena’s vast floor. Days later, the venue would host Disney on Ice. On this Friday morning, dentists arriving from five states were getting ready to fix the teeth of the first 1,000 people in line.

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Matello was No. 503. The small-business owner who supports President Trump had a cracked molar, no dental insurance and a nagging soreness that had forced her to chew on the right side of her mouth for years.

“It’s always bothering me,” she said. And although her toothache wasn’t why she voted for Trump, it was a constant reminder of one reason she did: the feeling that she had been abandoned, left struggling to meet basic needs in a country full of fantastically rich people.

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 As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter.

Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left.

Over two days at the civic center, volunteer dentists would pull 795 teeth. A remarkable number of patients held steady jobs — a forklift operator, a librarian, a postal worker — but said they had no dental insurance and not enough cash to pay for a dentist.

1 in 5 Americans older than 65 do not have a single real tooth left.

Matello had both problems, adding to her frustration about being cut off from a world that many wealthier Americans take for granted.

“The country is way too divided between well-off people and people struggling for everything — even to see the dentist,” she said. “And the worst part is, I don’t see a bridge to cross over to be one of those rich people.”

SALISBURY, MD - MARCH 10: In sub-freezing temperatures, Dee Matello (R) age 46 waits in line with hundreds of others for a shot at free dental care from the Eastern Shore Mission of Mercy dental clinic in Salisbury, MD on March 10, 2017. Her family survives on money from this business run but they have no dental coverage. She hasn't seen a dentist in about eight years after her husband lost his job that provided dental benefits. Since then, the couple has put their children's dental needs first and say there hasn't been enough money for their own. Matello was among hundreds of people who waited in below-freezing temperatures for hours this morning to attend a free dental clinic in Salisbury, MD. Her tooth gets pulled tomorrow.

The line for the Eastern Shore Mission of Mercy clinic began at 4p the night before. Many patients at the free clinic are unemployed, retired, undocumented however, some are full-time workers whose employers do not offter dental coverage.

Matello voted for Barack Obama in 2008, thinking he offered the best option for working people, but she sat out the 2012 election. Last year, she rallied behind Trump after listening to him talk about “the forgotten men and women of our country, people who work hard but don’t have a voice.”

“I’m running to be their voice,” Trump said repeatedly.

What Matello heard was a promise “to restore pride to the working poor.”

A big part of that promise was Trump’s assurance that he would build a “beautiful” health-care system to serve every American, a system that would cost less and do more. But nearly four months into Trump's presidency, Matello sees Trump backing a Republican health care plan that appears to leave low-income people and the elderly worse off.

“I am hearing about a number of people who will lose their coverage under the new plan,” Matello said. “Is Trump the wolf in grandma's clothes? My husband and I are are now saying to each other: ‘Did we really vote for him?’ ”

Matello said she has no option but to keep hoping Trump will devise "a plan so we can all feel the benefits of a better economy." But since he took office, Trump has focused on so many other things — most recently, his decision to fire the FBI director — that Matello has begun to wonder about his promises to the working class:

“Was he just out to get our votes?”

‘What I’m seeing is . . . horrifying’

Straight, white teeth are associated with social success — just about everyone on TV or with a big job has them. People drop $2,000 per tooth on porcelain veneers to hide the smallest imperfections. Trump has unusually perfect, snow-white teeth, prompting numerous cosmetic dentists to publicly note that he seems to have had expensive work done.

“If I see someone with perfect teeth, I think, ‘Oh, man, they’re out of my league,’ ” Matello said. “Us poor people ‘status’ each other. We’re like, ‘Ah, dude, you don’t have any teeth!’ Or if you see someone with little jagged yellow stubs, you think, ‘Oh, man, you have lived here your whole life, haven’t you?’ ”

“Here” is Maryland’s Eastern Shore, the poorest part of one of the country’s richest states. It’s a region famous for chicken farms: Perdue’s national headquarters is here in Salisbury, a town of 30,000. Matello lives 20 miles north, in Laurel, Del., near fields that sprout corn, watermelons and soybeans.

2 million Emergency room visits because of dental issues in 2016 1.6 billion Costs of those ER visits

In these rural areas, even the water can work against people. Many homes, including Matello’s, rely on well water. Unlike water from public systems, well water is not fluoridated. Nationwide, 25 percent of Americans are not connected to a fluoridated water system, and therefore, are missing out on what the Centers for Disease Control and Prevention called one of the 10 great health advances of the 20th century.

“It’s all well water, no fluoride,” said Patricia Higgins, one of the dentists volunteering at the Salisbury clinic. “In these places, we see people with a different level of dental problems.”

George Acs, director of the dental department at Chesapeake Health Care, a clinic near Salisbury, said people with oral pain and infections are inundating hospitals. Last year, more than 2 million U.S. emergency room visits were attributed to neglected teeth.

“What I am seeing is absolutely horrifying,” said Acs, who recently testified about the problem before the Maryland state

Although those hospital visits cost an estimated $1.6 billion a year, the ER is generally not equipped to fix dental problems, Acs told lawmakers. So ER doctors just medicate people with “a perpetual cycle of antibiotics and opioids.”

That cycle is feeding a nationwide epidemic of opioid addiction. Meanwhile, Higgins said, Americans’ increasing reliance on all kinds of drugs is further ruining their teeth. Many drugs cause dry mouth, which leads to more cavities. When she started her practice 35 years ago, she said, people took far fewer prescription drugs. Now patients hand her computer printouts with long lists of them.

Matello’s problem wasn’t complicated: A molar shattered years ago. The 46-year-old mother of three had not seen a dentist in nine years. When parts of her tooth broke off, she knew fixing it could cost hundreds of dollars, and other bills were always more urgent.

Then she heard on TV that the nonprofit Mission of Mercy was coming to the Eastern Shore to host one of the free dental clinics that had drawn overnight crowds in Nebraska, North Carolina and other parts of the country. So she decided to take Friday off.

Matello and her husband own a small vending-machine business called DeeLicious, spending their days restocking 69 machines installed in factories, schools and office buildings. They offer granola bars and other healthful snacks, but Snickers sell best.

Life was easier before the recession hit in 2007. Her husband managed a furniture warehouse, making more than $70,000 a year, and she sold fishing boats, adding to their income. But then people stopped buying big-ticket sofas and boats, and they both lost their jobs.

So they started buying vending machines and earn about $47,000 a year. Matello said she doesn’t know if the country’s rich-poor divide is worse now, but it sure feels more “in your face.”

“I am just fed up with it,” she said. “I don’t do Facebook. It’s ‘I went on this trip’ or ‘I got this new thing.’ You know, I really don’t need to see how great you are doing. It puts me in a state of depression.”She said people judge success based on what people wear or where they live, and she even catches herself doing it. Washington, for example, is just 150 miles west, but to Matello it feels a planet away, totally out of reach.

“It’s a beautiful city to drive through. But I could never live there. I wouldn’t fit in,” she said. “I don’t have the toys, the education, the money to live there. We have nothing in common. That divide is why you see lower income people rising up, being mad at affluent people.”

And teeth, she said, “are the telltale, visible sign of wealth.”

Fewest dentists where need is greatest

The Washington region has one of the greatest concentrations of dentists in the world, with many offering high-end services in offices that resemble luxury spas. More than 50 million Americans, by contrast, live in areas officially designated by the federal government as Dental Health Professional Shortage Areas. A great many of them are working poor.

“It’s completely skewed. You have the fewest dentists where the need is greatest,” Acs said. He recently sent a patient here with impacted wisdom teeth 120 miles to find a dental specialist who accepts Medicaid.

Louis Sullivan, a physician who was secretary of health and human services under President George H.W. Bush, said “broad systemic problems” block access to dentists.

25 percent of Americans – 80.7 million people – don’t have access to fluoridated water.

First, new dentists often start out with significant debt, and they gravitate toward wealthy areas where they have a better shot at making money. The typical graduate from a four-year, post-collegiate dental school owes $260,000 — more than the average medical student.

Then they set up solo practices, shouldering pricey overhead — equipment, office space, a receptionist — that accounts for much of a patient’s bill. While younger dentists are more likely to join groups that share costs, the century-old model of the solo practice has resisted change.

Then there’s the matter of payment. Teeth generally are treated separately from the rest of the body, a tradition that dates to dentistry’s origins as a specialty of barbers, who performed oral surgery and pulled teeth. Today, many public health officials view that division as a mistake. Poor oral health can lead to heart disease and other serious medical problems, and tooth loss can lead to depression and difficulty eating and speaking.

The separation extends to insurance. Even Medicare, the federal health program that covers 55 million seniors and disabled people, does not cover dental problems. For that, people must buy dental insurance, which typically limits annual benefits to about $1,500 per person — an amount that has barely budged in decades, even as costs have risen.

The price of employer-provided plans varies greatly, and can cost a family $500 a year or more, industry experts said. For those whose jobs don’t offer dental benefits, it can be even more expensive. So tens of millions go without: More than a third of American adults have no dental coverage, according to the ADA’s Health Policy Institute.

Children’s coverage has been improving. All states are required to provide dental benefits to children on Medicaid and the Children’s Health Insurance Program. Obama’s Affordable Care Act currently requires medical plans to offer dental care to those younger than 19. But that requirement – and the dental benefits of 5 million adults newly covered under the ACA – are jeopardized by the Trump-backed health overhaul now being debated in Congress.

Adults who are poor enough, and live in certain states, can get coverage through Medicaid, the state-federal health program for low-income Americans. But only about 38 percent of dentists accept Medicaid — about half the rate of physicians — in part because of low reimbursement rates. On average, Medicaid covers about 37 percent of the bill, according to a recent ADA analysis. Dentists who don’t accept Medicaid also complain of bureaucratic hassle and high rates of canceled appointments.

In a handful of states, Medicaid offers no dental coverage for adults. Delaware, where Matello lives, is one of them. Which is why, on a damp Friday morning, she found herself lining up with hundreds of other people with aching teeth.

More than 1,000 people received treatment on a first come, first served basis during the two-day clinic in Salisbury.

116 dentists, 1,165 patients

At 9:44 a.m., five hours after arriving in Salisbury, Matello finally made it inside the civic center and began to warm up.

“What do you need done?” she asked an older veteran in a wheelchair.

“Need nine teeth pulled,” he said. “My wife works at Rite Aid, and we don’t have any insurance.”

A little after noon, Matello’s number was called. A volunteer took her temperature; she was running a slight fever but not high enough to stop treatment.

Two more hours. Finally, she was waved over to an X-ray machine under a basketball hoop.

Just as Matello expected to be called for her turn in the dentist’s chair, a volunteer announced in a loud voice: “Those up to number 500 will be seen today. The rest will have to come back tomorrow.”

“You have to be kidding!” yelled a frustrated woman behind Matello. “I have to do this all over again?”

Matello’s eyes filled with tears. She had been waiting 10 hours.

A volunteer gave her a wristband that would put her at the head of the line the next day. So she drove home in her 18-year-old Jeep, ate dinner chewing only on the right side yet again, and set her alarm.

By 7 a.m. the next day, she was finally in one of the reclining chairs, with a dentist pointing a bright light into her mouth.

She stared up at the arena’s high industrial black ceiling. The whir of drills across the open room competed with Billy Joel’s “New York State of Mind” playing over a loudspeaker.

Robert Testani, a volunteer dentist from Catonsville, Md., examined Matello and checked her X-ray before easing a syringe of novocaine into her mouth. He prepared to pull her broken molar.

“Don’t worry. This is routine,” he said. He paused and looked around. “Except for the setting.”

LAUREL, DE - MARCH 10: At home, Dee Matello tries to privately floss a problem tooth she needs pulled in Laurel, DE on March 10, 2017. Her family survives on money from this business run but they have no dental coverage. She hasn't seen a dentist in about eight years after her husband lost his job that provided dental benefits. Since then, the couple has put their children's dental needs first and say there hasn't been enough money for their own. Matello was among hundreds of people who waited in below-freezing temperatures for hours this morning to attend a free dental clinic in Salisbury, MD. Her tooth gets pulled tomorrow. Many patients at the free clinic are unemployed, retired, undocumented and some are full-time workers whose employers do not offer dental coverage. However, like Matello, there is class of workers who live above the defined poverty level but do not make enough to afford dental care for themselves or their family.

Over two days, 116 dentists treated 1,165 patients, providing $1 million worth of fillings and other care, according to the Mission of Mercy. Matello was grateful. She was told her panoramic X-ray and extraction would have cost $600 to $800 in a regular office.

She looked at some of the others who had come here, despite working for a living cutting down trees, building homes, minding a town library, running small businesses.

“We are not staying home, not sleeping and living off the government,” she said.

She wondered why there wasn’t a better system for people like her. She tried not to look at the 51-year-old truck driver lying next to her who had three teeth pulled, his mouth stuffed with bloody gauze.

“I am trying to think that this is not demeaning,” she said as she cleared the chair for the next person in line. “But it is. It’s like a Third World country.

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