By Dr. Evan, Levine, MD

In the words of the American Dental Association:

Taking care of your teeth and gums isn’t just about preventing cavities or bad breath. The mouth is a gateway into your body’s overall health. And since gum disease and other health problems may be linked, brushing and flossing are more important than ever. See your dentist regularly to keep your smile, and yourself, healthy.

So why didn’t the ADA fight to be part of the Affordable Care Act? Some say that ADA lobbyists fought hard to keep most dentists out of the government program, with only children ending up with some dental coverage through Obamacare. Some plans include pediatric dental care (18 and younger), other plans may offer it as an option, and all plans include an oral health risk assessment for children 10 years and younger.

But what about adults?

For the middle-class the cost of dental care has become so prohibitive that many are forgoing routine care while others are in debt to their dentists for recurrent costly procedures like root canal treatment, the placement of crowns, or periodontal work. Some of my own patients report to me that they borrowed money or are late paying other bills because they were charged several thousand dollars for treatment of their teeth.

My colleagues and I are now seeing patients with rotting teeth, with infectious endocarditis (a bacterial infection of a heart valve) caused by poor dentition, and people in chronic pain from old caries. When one considers how commonplace these conditions are, one can understand how chronically poor dental care contributes to locking many into chronic poverty. Heart surgeons are doing careful dental exams because they are concerned that patients have smoldering gum and tooth infections that could result in an infection of their newly inserted valve. Therefore, many patients having heart surgery are first having a number of teeth urgently removed. But under Obamacare the patient’s surgery will be covered, the heart surgeon will be paid about $2,300 (CPT code 33403) for his work, that includes all his postoperative care and visits, and the patient will likely be billed thousands of dollars, by the dentist. Under ACA, patients having life-saving heart surgery will have more out of pocket expense for that dental bill than for the heart surgery!

Without affordable dental care many will forgo seeing a dentist because they just cannot afford to. Others will lose their savings to pay-off their dentist. But dentists remain immune to government control, immune to being paid whatever government feels is reasonable to pay them. Why would a dentist, including an oral surgeon, wish to be part of a program that could reimburse them a few hundred dollars for a procedure for which they now charge a thousand dollars or more, like root canal? And while physicians are now asked to contact insurers to get approval for a test or procedure (I must say that this is necessary because too many doctors would perform every test and procedure possible if they could) dentists just need the approval of their patient, something that I suspect is an invitation for the most duplicitous types to perform unnecessary and costly dental work.

So if the American Dental Association tells us that “The mouth is a gateway into your body’s overall health,” then why isn’t that gateway to our overall health part of Obamacare? Did the lobbyists for the ADA convince the Obama administration to exclude affordable dental care? Is the Obama administration willing to allow millions to become sick because of diseases of the mouth and carries?

Once again those running this country have really screwed up. If President Obama believes we all deserve affordable health care then why isn’t dental care part of the Affordable Care Act? I just can’t imagine how government can provide care for the feet, eyes, and skin but neglect dental care.

About the author: Evan S. Levine, MD FACC, is Director of the Cardiovascular Center at Saint Joseph’s Hospital and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.