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Dentistry with
Social Work Impressions

Natalia J. Garland

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No matter what my circumstances in life, I have always managed to take care of my teeth. Personally, I would rather have good teeth than diamonds. Consequently, I have visited many dentists over the years. Moving to different locations, changes in my insurance coverage, and recommendations of friends have all played a part in my voluntary or involuntary switch from one dentist to another. Fortunately, I have had pretty good luck with dentists, and most of them have helped me preserve my prized possessions.

Lately, however, I came across some circumstances which prompted me to re-think the doctor/patient relationship. You see, access to any kind of medical care is based on an ability to pay. You must have insurance coverage. If you are poor, or rather poor enough, you might qualify for state assistance. But assistance programs only cover basic repair and extractions. Assistance usually does not include preventive care or cosmetic work.

I do not believe in the concept of cosmetic dentistry. Let me clarify that statement. I think that any dental work is essential if it protects or repairs your teeth, corrects structural problems, or makes you look and feel better. I have paid thousands of dollars cash for so-called cosmetic work which was essential to correct a very painful T.M.J. condition. My insurance had deemed such work unnecessary.

Perhaps the following might serve as a better illustration. Have you ever had a toothless therapy patient? I have. Yes, I understand that if they had not spent outrageous sums of money on cocaine, they might not have ended up in a toothless state. But here is the twist of fate that therapy poses to such a person: he or she might be expected to get a job. Now, can you imagine going on a job interview if you have no teeth? Or if you are missing a front tooth? Can you imagine any employer hiring such a person? If there is any reality to the concept of rehabilitation, then reconstructive dental care needs to be added as a component.

What about the toothless people who never abused alcohol or drugs? What about the truly poor, or that category of people known as the working poor? They must face the sad truth about what really lies beneath the doctor/patient relationship. They know that without an insurance I.D. card, there is no such relationship. As I was writing this essay, by coincidence, I found some applicable statistics in the June, 2002, issue of Wired magazine:

  • New cavaties reported annually in Americans 18 to 65: 184 million.
  • Percent of U.S. population without regular dental care: 30
  • Percent of U.S. adults without dental insurance: 44.3
  • Americans without access to fluoridated water: 120 million.
  • Average number of teeth Americans lose (mostly to decay) by age 50: 12

Getting dental care, therefore, is all about being a consumer of goods and services. This is not quite the case with social work. It is not generally the goal of the medical professions to tend to the poor, the needy, the victims. Your dentist, who might be a talented professional and seem like a nice person, probably would not look at you if you did not possess an insurance I.D. card or have cash in hand. Then where would you go? To whom would you turn? Maybe your dentist would allow you to make cash payments, probably in advance of the work to be done.

Maybe you would search out an alternative clinic of some sort. However, when you pay cash to a no-frills dentist, you may not have a legal case if the dentist commits errors on you: because he might not have followed proper procedure with the added expense of x-rays, and he might not have taken the time to get a good medical history on you. And all the while, you were trusting in his credentials and his seemingly humanitarian intentions.

My point is that social work serves as a good model for treating all people with equality and respect. It is possible to access good psychotherapy with insurance, assistance programs, a sliding scale cash fee, and even for free. Moreover, it would be considered professional abandonment to abruptly discontinue treatment because of a person's inability to pay.

It is not a crime to be truly poor, or unemployed, or uninsured, or any combination thereof. There are unexpected things that happen in life beyond our control. Some people may at some point in their life need services which are not affordable. Not having access to such services at the time of need, will only result in more complicated and costly conditions later on.

I would like to present a challenge to dentists. If all the dentists in America would do free dental work one day or even one afternoon per week, the benefit to society would be far-reaching. I feel certain that most dentists could easily absorb the financial loss of one afternoon's work. This would re-define the dental profession as foremost a caring profession. This would place the dentist in the role of a community caretaker and friend. A dentist's legitimacy would be measured not only by his credentials, but also by his willingness to accept responsibility for the care of those who can give nothing in return. (Written 06/03/02 - Revised 12/01/03: bibliography available.)

Until we meet again..............stay sane.

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Copyright 2002, 2003 Natalia J. Garland