This morning’s New York Times contained a piece about the lack of dental care in Kentucky (and some surrounding states). While we may be aware of the statistics about the lack of health care in the US, I think we often sort of subsume that awareness while we’re worrying about our own co-pays, premiums and plans. Some of the anecdotes and statistics in this article are a bit jarring:

About 1 in 10 state residents are missing all their teeth, according to 2004 federal data.

At his private practice, Dr. Smith said that at least once a month he sees a patient who has used Krazy Glue to reattach a broken tooth to the root or to an adjacent tooth… patients who have tried to avoid the cost of a dentist by swishing with rubbing alcohol to deal with a tooth infection or by rubbing crushed aspirin pills on gums to numb pain. Both tactics worsen the situation by burning the gums and creating ulcers, he said.

[...] His teeth crooked and blackened, Justin Baker is the face of another reason for Kentucky’s oral hygiene problems: methamphetamine use. “They just rotted,” Mr. Baker, 16, said about the damage done in less than a year of drug use.

Yes, meth use and lack of knowledge are separate problems, but they’re only perpetuated by the health care system. Medicaid reimbursement to dentists in the state is so low that less than a quarter of them accept it, and the only option available to someone with a severely infected tooth is to have it pulled. Medicaid doesn’t pay for a root canal or dentures. Medicare doesn’t cover dental at all. Why would you go see a dentist if you know he won’t be able to help you because you don’t have the money or insurance, or if your only option even with insurance will be to get your teeth pulled?

“Try finding work when you’re in your 30s or 40s and you’re missing front teeth,” said Jane Stephenson, founder of the New Opportunity School in Berea, Ky., which provides job training to low-income Appalachian women.

I once had a co-worker who was missing several of her front teeth (don’t know how/why). She was going to night classes, etc. trying to improve her skills and get beyond answering phones for the company we worked for. She was quite aware that her appearance was holding her back and wanted to have her teeth fixed. The company had insurance (however crappy, it was better than nothing), but the fear of seeing a dentist after so many years of not caring for her teeth - and the fear that she would not have money to cover her portion of the procedures - was paralyzing. Lots of people have fear of the dentist, but this was something different - there was shame for having ignored that aspect of her own health.

I’d like to think we all do what we can for people who might need our help - whether it’s holding the door open for someone struggling with a stroller or carrying many bags, cooking dinner for a busy friend, donating blood (because it’s always needed), participating in food or clothing drives, simply sending money to an organization that needs it, babysitting for friends/family when they need a night off, or volunteering your time (if that’s what you’ve got more of than money) to help other people in some way.

But what do you do when something like this is the problem? How do we help when the government systems that are supposed to help people who aren’t in the right area to get cushy jobs with full benefits, or who are self-employed and can’t afford the high cost of insurance, are a huge part of the problem? Or when we’re looking at generations of people who have been going about it their own way, however detrimental that is to their health - a legacy of ignorance? Yes, you can provide more money for people working to fix it - like Dr. Smith in the article - but that’s a Band-Aid, isn’t it?