In a Dentist Shortage, British (Ouch) Do It Themselves

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“Britain’s state-financed dental service, …stretched beyond its limit, no longer serves everyone and no longer even pretends to try.” (New York Times )

And neither, for that matter, does the United States’! None of my MassHealth (the version of Medicaid here) patients have any dental benefits, and it is getting more and more difficult to find even emergency services for them. From time to time, the underlying reason why someone presents to me with a mental health problem such as despondency or suicidality, alcohol or drug abuse (which MassHealth still pays for) is agonizing dental disease. When I can arrange to treat the ‘root cause’ [pun intended], it is only because I have begged and pleaded, calling in a favor from a dentist or dental surgeon colleague. More often, regrettably, the patient leaves the psychiatric service in as much mouth pain as when they came in, my efforts to go beyond merely patching them up to no avail. But I guess that is no different from many of the insoluble socioeconomic problems that are the real foundations of some of the mental illnesses I try to treat.

Addendum: Walker pointed me toward a particularly apt quote from Malcolm Gladwell’s <a href=”http://www.gladwell.com/2005/2005_08_29_a_hazard.html
” title=””>”The Moral Hazard Myth”:

“… People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn’t, of course. The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes. The pain of tooth decay leads many people to use alcohol as a salve. And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier. If your teeth are bad, you’re not going to get a job as a receptionist, say, or a cashier. You’re going to be put in the back somewhere, far from the public eye. What Loretta, Gina, and Daniel understand, the two authors tell us, is that bad teeth have come to be seen as a marker of “poor parenting, low educational achievement and slow or faulty intellectual development.” They are an outward marker of caste. “Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ “

The U. S. health-care system, according to “Uninsured in America,” has created a group of people who increasingly look different from others and suffer in ways that others do not…”