Why doesn't health insurance include dentistry?

Dental hygienist Diane Stigler prepares to X-ray Kaitlyn Rodriguez's teeth during a free Christina's Smile clinic earlier this year in Tampa. KATHLEEN FLYNN   l   Times
Dental hygienist Diane Stigler prepares to X-ray Kaitlyn Rodriguez's teeth during a free Christina's Smile clinic earlier this year in Tampa.KATHLEEN FLYNN l Times
Published October 5 2012

Every year around this time, millions of us confront a bunch of confusing documents, charts, websites, emails — and perhaps fight back the urge to set fire to them all.

Yes, it's the fall health insurance open enrollment season.

In a way, the chaos is reassuring, since it means that one has access to insurance, which far too many of us still do not.

So although I wouldn't dream of complaining, I do think it's fair to point out some of the more mystifying aspects of the annual ritual. One that has bugged me for my entire working life is this: Why doesn't health insurance include dentistry? (Vision coverage is a similar mystery.)

Some say it's because the need for dental care is predictable and its cost won't destroy your life as a medical crisis can. (Do they know what root canals go for?)

Others say it has something to do with the 19th century and barber shops and how the medical and dental professions evolved. Others blame the American Dental Association for not wanting to be included in Medicare.

Maybe cultural attitudes about teeth play a role here, too. Am I the only one who has noticed a lot more advertising for teeth whitening than for dental floss, as if teeth were fashion accessories?

And do all those denture adhesive ads send a subtle message that losing your teeth is normal and inevitable?

It's also interesting that fluoride is the one additive in the public water supply that has acquired political overtones. Nobody ever seems to want to ban chlorine, which protects our bodies from foreign invaders much as fluoride protects teeth.

Whatever the reason, it's time to reconsider this strange divide we have placed between medicine and dentistry.

• Research is showing that infections starting in the mouth can spread throughout the body and have been linked to heart disease, stroke and oral cancers.

• Tooth decay affects American kids more than any other chronic infectious disease, according to the U.S. Centers for Disease Control, and toothaches are a leading reason for missing school.

• For the first time in 50 years, visits to dental offices in the United States have declined year over year, apparently due to the recession, the ADA reports.

• But dental-related visits to hospital emergency rooms are up, even though most ERs can do little more than administer antibiotics, painkillers and advice to visit a dentist (as if you wouldn't have already done that if you had access to a dentist).

• In Florida, dental-related ER visits cost more than $88 million in 2010, according to the Florida Public Health Institute — and you can bet not all patients paid cash.

So, you might be thinking, why not just buy dental insurance? Perhaps you haven't looked at a policy lately — they tend to be expensive and/or limited.

And that's no answer for people living paycheck to paycheck.

The ADA estimates that two exams and cleanings and a set of X-rays in 2011 would have cost an average of $370. Cheaper than the ER, but out of reach to many.

In a country where some people can't afford cancer treatment, it might be tough to get worked up over dental care — especially if your teeth are fine.

But the choice shouldn't be one or the other. Despite the message that our curious insurance traditions send, it all matters.

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