A News Reporter Looks at the Dental Profession in a New Book – “Teeth”

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A News Reporter Looks at the Dental Profession in a New Book – “Teeth”

Mary Otto1Otto M. Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America. The New Press, New York. 2017. was a reporter for the Washington Post who in 2007 wrote about the death of Deamonte Driver, a seventh-grade student in Maryland. Deamonte’s death was attributable to spread of an infection from an abscessed tooth.

Otto has written a book, titled “Teeth,” with the subtitle “The Story of Beauty, Inequality and the Struggle for Oral Health in America.” This subtitle foretells the focus of the book.

Otto’s reporting generated a great deal of interest about the lack of access to dental care in the United States for many people of limited means, and the suffering associated with the ravages of dental disease. She further develops this theme in “Teeth.”

The book opens with a less than complimentary discussion of esthetic dentistry, how creation of an ideal smile enhances one’s appearance and the importance of an ideal smile in a stereotypical setting such as a beauty pageant. This is in the context of society’s increased focus on a youthful appearance, and how that can be achieved with cosmetic procedures.

The book quickly turns to another side of the narrative, which is the problem of access to dental care and the development of abscessed teeth when oral health care services are not generally available. The personal testimonies of affected individuals are difficult to read, although multiple research studies have reported the challenge of meeting the needs of persons with dental emergencies. In the absence of other services, hospital emergency departments often serve as the safety net. Otto discuses utilization of hospital emergency rooms for dental problems. This wasteful use of health care services is another, much more common example of the impact of poor access to dental services in the United States. Definitive treatment is often not provided in that setting.

A study of avoidable visits to hospital emergency departments identified “toothache” as the most common chief complaint.2Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point. Int J Qual Health Care 2017;29(5):642-5. Reports from a number of states have identified characteristics of individuals visiting a hospital emergency department for a dental problem, including adults between the ages of 25 and 44, with low income. Some studies were able to examine racial/ethnic differences and observed that Blacks have relatively higher utilization and Hispanics lower utilization.3Rampa S, Wilson FA, Wani R, Allareddy V. 1. Emergency Department Utilization related to dental conditions and distribution of Dentists, Nebraska 2011-2013. J Evid Based Dent Pract 2013;17(2):83-91.,4Chalmers NI. Racial disparities in emergency department utilization for dental/oral health-related conditions in Maryland. Front Public Health 2017;5:164.,5Serna CA, Arevalo O, Tomar SL. Dental-related use of hospital emergency departments by Hispanics and non-Hispanics in Florida. Am J Public Health 2017;107(Suppl 1):S88-93. Of particular concern is the increased utilization of hospital emergency for dental problems over time.6Singhal S, McLaren L, Quiñonez C. Trends in emergency department visits for non-traumatic dental conditions in Ontario from 2006 to 2014. Can J Public Health 2017;108(3):e246-50.,7Tomar SL, Carden DL, Dodd VJ, Catalanotto FA, Herndon JB. Trends in dental-related use of hospital emergency departments in Florida. J Public Health Dent 2016;76(3):249-57. This crisis has even led to the call for primary care physicians, or those serving in hospital emergency departments to be trained in primary dental care, including tooth extraction.8Simon L, Martin S. Like pulling teeth: Expanding the oral health workforce by training physicians in dental extractions. J Health Care Poor Underserved 2017;28(3):881-6.

The book also includes a history of the development of the dental profession and dental education, with an emphasis on the separation of the dental and medical professions. Otto devotes a considerable part of the book to a solution to the access issue that involves training a cadre of mid-level providers who can provide care where none is available, and the barriers to implementation of such a plan. The inclusion of mid-level dental providers remains controversial in the United States. There is a growing belief that the more widespread utilization of such providers could help address the unmet need for dental services.9Rodriguez TE, Galka AL, Lacy ES, Pellegrini AD, Sweier DG, Romito LM. Can midlevel dental provides be a benefit to the American public? J Health Care Poor Underserved 2013;24(2):892-906.,10Koppelman J, Vitzthum K, Simon L. Expanding where dental therapists can practice could increase Americans’ access to cost-efficient care. Health Aff (Millwood) 2016;35(12):2200-6. The book concludes with a detailed review of the Deamonte Driver story, observing that his case is not the only one that resulted in death caused by a dental infection.

“Teeth” is a book that will engender strong feelings from those on either side of the discussion. Therefore, it is a book that all members of the dental profession should read, both for the historical context and to understand the real impact of lack of dental services for many minority populations in the United States. Intended for a lay audience, “Teeth” will find its way into the discussion on improving access to care, and what changes may occur to the current system of delivering dental care to achieve that end.

Lack of access to dental care for a substantial portion of the U.S. population is inexcusable. The reasons for this lack of access are complex, and a solution will require changes on the part of the dental profession, as well as mechanisms to pay for the expansion of care. Many members of the dental profession have shown a great willingness to provide care as part of programs such as those organized by Remote Area Medical Volunteer Corps, which is mentioned in the book. There is a need for stakeholders to work together towards a solution, and Mary Otto’s book may be the impetus for real change.

References

  • 1.Otto M. Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America. The New Press, New York. 2017.
  • 2.Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point. Int J Qual Health Care 2017;29(5):642-5.
  • 3.Rampa S, Wilson FA, Wani R, Allareddy V. 1. Emergency Department Utilization related to dental conditions and distribution of Dentists, Nebraska 2011-2013. J Evid Based Dent Pract 2013;17(2):83-91.
  • 4.Chalmers NI. Racial disparities in emergency department utilization for dental/oral health-related conditions in Maryland. Front Public Health 2017;5:164.
  • 5.Serna CA, Arevalo O, Tomar SL. Dental-related use of hospital emergency departments by Hispanics and non-Hispanics in Florida. Am J Public Health 2017;107(Suppl 1):S88-93.
  • 6.Singhal S, McLaren L, Quiñonez C. Trends in emergency department visits for non-traumatic dental conditions in Ontario from 2006 to 2014. Can J Public Health 2017;108(3):e246-50.
  • 7.Tomar SL, Carden DL, Dodd VJ, Catalanotto FA, Herndon JB. Trends in dental-related use of hospital emergency departments in Florida. J Public Health Dent 2016;76(3):249-57.
  • 8.Simon L, Martin S. Like pulling teeth: Expanding the oral health workforce by training physicians in dental extractions. J Health Care Poor Underserved 2017;28(3):881-6.
  • 9.Rodriguez TE, Galka AL, Lacy ES, Pellegrini AD, Sweier DG, Romito LM. Can midlevel dental provides be a benefit to the American public? J Health Care Poor Underserved 2013;24(2):892-906.
  • 10.Koppelman J, Vitzthum K, Simon L. Expanding where dental therapists can practice could increase Americans’ access to cost-efficient care. Health Aff (Millwood) 2016;35(12):2200-6.