Map of life expectancy at birth from Global Education Project.

Monday, June 30, 2008

How do you know the toothbrush was invented in New Hampshire?

Otherwise it would be known as the teethbrush. (Before you start composing the hate mail, you should know that we have a tradition in Massachusetts and New Hampshire of insulting each other. It's okay, they're still Sox fans and we still go skiing.)

I'm planning to have big fun this afternoon getting endodontic therapy, popularly known as a root canal. This will be my third, which leads me to reflect that one of the particularly unintelligent aspects of our design is that the teeth just aren't built to last a lifetime. Here's some info from the CDC which might get your attention. Only one third of adults age 35-44 have all of their teeth. If you visit one of the poor countries, you will find teeth to be a scarce commodity. I have a friend who went on a medical mission to El Salvador and it turns out that the main thing the campesinos wanted was to have their teeth pulled. They were all rotten and painful, they knew they were never going to get reconstructive dentistry, so away with them, please. Francisco got on-the-job training as a dental assistant while his pediatrician wife wielded the pliers.

Now, I'm not sure why evolution has failed us in this regard. Maybe it's just that the choppers aren't built to last past reproductive age because by then, if we can't feed ourselves very well, the genome doesn't care. But a lot of people lose teeth earlier than that, and poor dental health is associated, not only with poor nutrition, but with chronic inflammation which increases the risk of heart disease, as well as overall debility. Remember this little kid who died from a tooth abscess because he couldn't get dental care?

So dental care really matters. Why is it, then, that as bad a job as we do extending other health care specialties to the population, we do much worse with dental care? According to the CDC report linked above, more than 44% of Americans who responded to the Behavioral Risk Factor Surveillance Survey didn't have dental insurance at the time of the interview. That's almost three times the percentage who lack health insurance. Employers just don't provide it, and in most states, Medicaid reimbursement is so low that few dentists can be found who will take it. Somehow we just don't think of it as having the same importance as "health" insurance, which seems entirely arbitrary.

So, when we get our universal, comprehensive, single payer national health care, let's not forget to include the dental plan.

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