— Four-year-old Emily Bratcher is having a cavity filled.
And as uncomfortable as getting a tooth drilled might be, she’s lucky to be sitting in Rhonda Switzer's dentist chair at all.
Last year, the U.S. Centers for Disease Control and Prevention ranked Tennessee 47th among the 50 states for dental care. The CDC says the number of Tennessee residents visiting a dentist routinely is on the decline.
Working but poor families like Emily’s have the hardest time accessing dental care. They make too much money to qualify for government aid, but too little to pay for the care at market rates.
So Emily and her sister are being treated at the Interfaith Dental Clinic
, a medical charity operated by a faith-based ministry. It can be especially important for people struggling to find or keep a job to have good oral health.
“Unfortunately, our society looks at people’s weight, their dialect, and their teeth in making decisions like, is that person educated or employable,” Executive Director Rhonda Switzer said.
And just as unfortunately, the problem is only getting worse. The Pew Research Center released a study earlier this year that indicates the U.S. has a severe shortage of dentists.
More than half of those currently in practice are nearing retirement. Even more alarming, a growing number of Americans are showing up at hospital emergency rooms looking for dental care.
“This is the 'canary in the coal mine.' This is the symptom that tells you we have a broken dental delivery system,” said Shelly Gehshan, director of the Pew Children’s Dental Campaign. “We don’t have enough dentists. We don’t have enough clinics. We don’t have enough dental insurance. We don’t have enough financing in the system. We don’t have enough prevention. It’s a neglected area.”
Gehshan says the Affordable Care Act, President Barack Obama’s signature healthcare reform initiative, will, in theory, extend dental coverage to every child in the nation, but she says the poorest of those children may still have trouble accessing care.
“They need help with transportation, or translation, or child care, and most dental care is provided by private dentists and they’re not set up to provide those extra services,” she said.
Gehshan says non-profit clinics like Switzer’s facility are better equipped to address those needs, but charitable operations are rare. She says one possible solution some states are exploring is introducing what she calls “mid-level” dental practitioners. Currently, only fully accredited doctors are allowed to practice dentistry in the U.S.
“In other countries there are other more different types of providers. So they have dental hygienists with extra training, or dental therapists, or people with both types of training," Gehshan said.
Little Emily Bratcher’s mother, Deborah, is not really interested in the politics of health care. She just wants her daughters to see a dentist regularly, and she’s a little angry it is not happening now.
“It’s just upsetting, because I don’t want my children to go through life having bad teeth, because I can’t afford $3,000 for dental work every other month or something,” Deborah Bratcher said.
The Pew Center’s Shelly Gehshan notes that the Affordable Care Act does not mandate dental coverage for adults, meaning millions of Americans will continue to struggle to maintain good oral health.