Dentistry is “out of pocket health care”. Let’s say you have Multiple Sclerosis and you hit the dentist because you have some oral pain. You may have “health insurance” but you might not have “dental insurance”. So you get a bunch of dental X-rays (maybe a panorama as they say). Then you get a couple of cavities filled (MS patients in some studies have higher rates of cavities) and get booked for a deep cleaning. Bingo, you’re down a few grand but you know expensive dental work (even with “dental insurance”) is as inevitable as death and taxes.
Days go by with no oral pain relief. Hey guess what? It was your MS inducing the pain via a central demyelinating process that fed into the trigeminal nerve. The dentist doesn’t do MS. He’s a dentist, not some kind of “all purpose health care provider”. What do you want him to do next, sell used cars? (I’m not going to go there).
Hey you know what? With or without MS, if you have bad gum disease your risk for heart attack and stroke is increased. Cardiac and cerebrovascular diseases are the first and third leading causes of death in the US. Gum disease can trigger oral pain too. But get this- you think you can pop into your cardiologist for a discussion about your periodontitis? The cardio men and women have enough on their plates treating myocardial infarctions. Gum infection is for dentists. But bite down on this: You and boatloads of other Americans could save the US “health care” system millions of dollars (if not billions) by maximizing your gum care thereby decreasing the national rates of MI and CVA. However, gum care costs bucks- “non-covered health care” bucks. How’s the average Joe (plumber or not) supposed to afford that kind of meticulous intervention? What, one day when “that one”, some strep infested underinsured periodontal mess collapses on Main Street with a massive coronary thrombosis, we won’t have him rolled into an ER for a few hundred thousand smackers worth of the latest cardiac care? USA- the broke Techno Nation, remember?
These are cautionary tales, one specific to MS, and the other more general. They illustrate why the “health care system” needs major revision. Let’s bundle dentistry into “disease care” along with “preventive medicine” while we abolish the term “health care”.
Dental problems can kill you. Gum infections can seed the blood stream and feed into the deadly process of arteriosclerosis leading to blockages in and around the brain and heart. The GP, the cardiologist and the neurologist need to know this stuff. They can appreciate hot inflamed gums inside the mouth. This can lead to an important triage to the neighborhood dentist who can cool down such swollen bacteria laden tissue. In addition, the decision tree for a dentist treating a patient with oral pain often requires a top level ability to generate a differential diagnosis outside of the purely dental. This argues for a universal coverage program of dental conditions that don’t involve the purely cosmetic.
It would indeed be marvelous if a dentist were to say: “You know, I don’t see enough in your mouth to warrant a big time work-up or panoramic films. You’re a young person with atypical facial pain. See your neurologist.” And of course the story proceeds to a beautiful conclusion. The neurologist diagnoses MS and embarks on an appropriate immunomodulator and analgesic regimen. Even more astounding- in such a world of wonder, both the dental and the neurology visits were fully covered under universal health care. And you can get such care, should you be Joe Biden, Joe the Plumber, Joe Shmo, Jo Jo, Loretta, Say it ain’t so Joe, Joey Heatherton, JLo, Mr. Bojangles or somebody named Horatio who is down on his luck living in the streets.
Published On: December 02, 2008