If the U.S. Federal Reserve is concerned about the state of dental care in this country, you know we have a problem.

In fact, according to the Fed, we have a very big problem.

The Federal Reserve Board of Governor’s Report on the Economic Well-Being of U.S. Households, released last month, contained some alarming statistics about the ability of Americans to find affordable health care — especially dental health care.

The report — which came almost 15 years to the day after U.S. Surgeon General David Satcher’s startling assessment of oral health in America — found that access to affordable dental care appears not to have improved much at all over the past decade and a half, especially among low-income families and people of color.

The report was the result of a survey the Fed conducted to get a handle on how many of us are experiencing economic hardships severe enough to make it difficult to make ends meet.

Thirty-two percent of those surveyed said they would have a hard time weathering a three-month period of “financial disruption” that might result from life-altering events such as the loss of a job or death of a primary breadwinner.

But job loss was not the main reason for a setback. Even with Obamacare, which enabled many of the previously uninsured to enroll in a health plan, the number one reason people cited for their financial hardship was a medical emergency.

Researchers found that dental care topped the list of the necessary medical care people said they didn’t get because of the cost.

When asked if there was a time during the past 12 months when they needed to see a doctor, specialist or mental health provider, get follow-up care or a prescription filled, or get dental care, 25 percent said dental care. Coming in a distant second at 15 percent was seeing a doctor.

Because of the close connection between oral health and overall health, skipping dental care can have serious consequences. Millions of Americans wind up in the hospital every year because they waited to long to get the dental care they needed.

As the report’s authors pointed out, the likelihood of foregoing care due to cost is strongly related to one’s income. Of survey respondents with a household income under $40,000, close to half said they had gone without some form of care during the previous year. Even if they had health insurance, it’s likely that few had dental benefits. Other researchers have estimated that as many as 140 million Americans have no dental coverage. And most people who do have dental benefits are in plans with high deductibles and low annual maximums. Most dental plans will only pay 50 percent of expensive procedures like root canals, and coverage typically is capped at $1,500 a year.

Sadly, in many respects, we as a nation have made little progress in addressing what Satcher referred to as a “silent epidemic.”

Here’s how Satcher summed it up in 2000:

 “The major message of this Surgeon General’s report is that oral health is essential to the general health and well-being of all Americans and can be achieved by all Americans. However, not all Americans are achieving the same degree of oral health. In spite of the safe and effective means of maintaining oral health that have benefited the majority of Americans over the past half century, many among us still experience needless pain and suffering, complications that devastate overall health and well-being, and financial and social costs that diminish the quality of life and burden American society. What amounts to ‘a silent epidemic’ of oral diseases is affecting our most vulnerable citizens–poor children, the elderly, and many members of racial and ethnic minority groups.”

There have been some positive developments over the past 15 years. The Affordable Care Act made dental benefits available to more children, and more people are getting sealants that help prevent decay.

But consider this:

• Since 2000, the number of people living in areas where they can’t easily see a dentist has climbed from 25 million to 47 million.

• The number of people seeking treatment for dental problems in hospital emergency rooms–one of the most expensive and least effective places to treat patients in pain because of bad teeth and diseased gums–nearly doubled from 1.1 million in 2000 to 2.1 million in 2010.

• Dental decay is still the number one chronic illness among children.

• More than a third of elementary school children have untreated tooth decay; the rate is twice as high for Hispanic and non-Hispanic black children and even worse for Native Americans.

• Even though more children have dental benefits, half of all kids on Medicaid did not get in to see a dentist in 2011, in large part because 80 percent of dentists nationally still do not accept Medicaid payment.

In a recent interview, Satcher noted, somewhat despairingly, that while “we have made progress, we still have some major challenges and disparities.”

“We still don’t have enough dentists,” he said, “and there are not enough states that are willing to look at alternatives (to make up for the shortage of dentists).”

Among the alternatives Satcher believes every state should be considering: allowing “dental therapists”–similar to nurse practitioners and physician assistants–to practice, as they can now in Alaska and Minnesota and will soon in Maine.

“I do think that dental therapists can fill that gap and that dental therapists ought to have partnerships with dentists no matter how far away dentists are,” he said, adding that similar arrangements have helped to expand mental health services through partnerships with primary care physicians.

“We need to find a way to make sure that everyone has access to quality oral health care,” and dental therapists can and should be a part of the solution, he said.

Author’s Note: This blog post is part of a series examining America’s oral healthcare crisis. Be sure to read the previous post, “ Why Growing Numbers of Americans Are Embarrassed to Smile.”

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