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Author Topic: DIY Dentistry *shudder*
ClaudiaTherese
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quote:
Originally posted by fugu13:
CT: there probably is a shortage. However, I suspect the shortage is not as bad as in the UK, notably because we see neither an incredible rise in the price of dentistry or a huge number of people waiting in lines to see dentists (the latter is the primary manifestation in the UK, but the former is more likely how it would manifest here).

I am not sure that the relative shortage is not just as bad -- at least for kids -- in the US.

(And I don't think I would have come to that realization if I hadn't worked in a couple of ERs. People with poor teeth tend to hide it, and they tend to be less visible people anyway. I remember one mother telling me her son "had chocolate stuck on his tooth" when I my attention was arrested by his tooth rather than a possible ear infection. It was clearly a tooth turned brown by decay, not chocolate -- and, as it turned out, both he and his mother were exceedingly ashamed by this.)

There are price controls in the sense that Medicaid pays a fixed sum. Most dentists have dealt with this by refusing to see patients who pay through Medicaid -- and, as I understand it, they can do this if it is a blanket policy (i.e., they cannot pick and chose which patients on Medicaid to see, but they can chose to see no Medicaid patients, which most do, I think).

As Javert Hugo notes above, this has indeed created disastrous waiting lines for kids.

As for adults, I honestly don't know how widespread the problem is. I will try to find some solid numbers. I do know that we would at least try to find dentists for kids that came into the ER in bad shape without non-Medicaid coverage, but as for adults, the ER physicians said it was useless to even try. Nobody, absolutely nobody, would take them.

I think those people are pretty invisible in day-to-day middle class life, but I bet somebody has pulled numbers on them. I wonder if there we will find the same conditions as Kettricken describes in the UK: no waiting lines if you have the money to pay separately, but a lot of people without access to care because they cannot come up with the money themselves (above what is provided by a government program such as the NHS or Medicaid).

[ October 17, 2007, 04:32 PM: Message edited by: ClaudiaTherese ]

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ketchupqueen
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My kids were both on Medicaid until their first birthday. Even though the guidelines recommended they each see a dentist by then, my pediatricians both told me not to even try unless they chipped a tooth or had another emergency, there just was no way they would get in for routine dental care with Medicaid coverage.

Luckily I spoke to some dentists who said that unless a tooth is growing abnormally or there is an emergency they don't really need to see patients until 2.5 or 3 anyway because as long as we are cleaning their teeth at home, all they will need to do is count teeth, etc. They don't really need their first cleaning until around age 3 IF they are following an appropriate dental care routine at home. I felt better, but still worried that something would happen and I wouldn't be able to get them in to see anyone (even for emergencies, there was a 7 to 14 day wait in both areas I lived for emergency dental care at dentists that accepted Medicaid coverage.)

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King of Men
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Ye gods, how can it be important to have a dentist clean milk teeth, anyway? No wonder there's a dentist shortage when people get useless services like that one. I am moderately convinced that dentists in Norway do not clean anyone's teeth for them, at least not without it being specifically requested - I know I never had my teeth cleaned by a dentist until coming to the US, in spite of going to the dentist once a year for routine checkup - and we have a lower rate of cavities than the US, according to the WHO.
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ClaudiaTherese
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quote:
Originally posted by King of Men:
Ye gods, how can it be important to have a dentist clean milk teeth, anyway? No wonder there's a dentist shortage when people get useless services like that one.

Seriously? Cavities and/or abscesses in the primary teeth can infect the secondary teeth below. "Bottle caries" is a major problem in some segments of the US -- putting a baby to bed with a bottle of juice (or milk, or even formula -- and astonishingly, soda pop) is closely associated with dental problems longterm.

I suspect standard practices differ enough between the US and Norway (e.g., what is your breastfeeding rate?) that the direct comparability of early dental rates may not be as straightforward as it initially appears.

Regardless, problems with "milk teeth" are a serious and widespread issue in the States.

---

Edited to add: information on and pictures of "bottle caries" on a pediatric dental site

And from a US military site (lots of kids in military families on public health medical/dental assistance):
quote:
This means an infant under the age of 1 can start having tooth decay. Tooth decay that happens in infants is called Early Childhood Caries. ECC is a severe problem that causes debilitating tooth destruction in infants and young children.

The prevalence of ECC is estimated to be as high as 90 percent in some Head Start populations.*** [emphasis added] However, by following the guidelines developed by the American Academy of Pediatric Dentistry and by visiting a dentist for the first check-up by the child's first birthday, ECC can easily be prevented.

ECC is a specific form of severe decay found in the teeth of infants and toddlers who fall asleep with bottles of milk, juice or any sweetened liquid in their mouths. ECC is also known as baby-bottle tooth decay, nursing-bottle caries and milk-bottle syndrome. It is the only severe dental disease common in children under 3 years of age.

...

Baby teeth are important to a child for chewing and biting food, making a good smile, and speaking. However, the most important function of baby teeth is that they are holding space in the mouth for upcoming permanent teeth.

The first baby tooth erupts around 6 to 8 months of age, and usually all 20 baby teeth are erupted by the age of 2 or 2-and-a-half. Early loss of baby teeth can cause blocked eruption, drifting, crooking and crowding of the permanent teeth.

A child who prematurely loses baby teeth will have a very high chance of needing braces in the future. If an abscess or infection occurs around baby teeth with ECC, it may affect the development of the underlying permanent teeth.

***[Head Start is a comprehensive program to meet the development needs of preschool children in families whose income is below the federal poverty line]

For whatever reason, problematic bottle use is pretty widespread in segments of the US population. Intervention by public health nurses is not at all as effective as intervention by dentists. It shouldn't be a problem, but it is -- although I would not be surprised to find it is not nearly as much of a problem in Norway.

Dental problems are also highly influenced by genetics. Some families seem extra-prone to cavities and some seem extra-prone to gingivitis. (see posts earlier in this thread) I also would not be surprised to find out that Norway has a more homogeneous population than the US and that, quite possibly, that there are not as many different family lineages with this particular problem (at least, not yet).

[ October 17, 2007, 04:17 PM: Message edited by: ClaudiaTherese ]

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King of Men
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According to this random website,

quote:
approximately 97% of women breastfeed when leaving hospital, 80 per cent are breastfeeding at 3 months and 20 per cent beyond 12 months.
So, ok, you're saying that the need for dentist cleaning is a response to difficulties caused in another part of your healthcare system. Some nations just can't win for losing.
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ClaudiaTherese
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quote:
Originally posted by King of Men:
According to this random website,

quote:
approximately 97% of women breastfeed when leaving hospital, 80 per cent are breastfeeding at 3 months and 20 per cent beyond 12 months.
So, ok, you're saying that the need for dentist cleaning is a response to difficulties caused in another part of your healthcare system. Some nations just can't win for losing.
And possibly genetics (see above edits to prior post).

The thing about having a highly fragmented (and fractured) health care delivery system is that there are just so many different cracks to fall through. Our society is in general not very homogenous, there is a wide disparity in income levels and in formalized education status, and there is not good access to a standardized source for medical information and advice.

It's a setup for heartbreak. Literally.

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ketchupqueen
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I am convinced that the only reason my kids (and kids in some other families I know) who are on or have been on Medicaid have managed to make it this far this healthy is medical professionals in the family and/or high intelligence and willingness to research. I know how to care for my kids because my mom is a nurse/OT, my dad is a family practitioner, and I research anything going on with my kids to see what I should be doing to care for them properly. If I have a question, I call my parents. They sure weren't going to be taken care of properly on Medicaid.

I've known some great doctors that accept Medicaid. Unfortunately many of them are specialists who only see kids if they manage to make it through the referral system, and many more have completely full practices. There is one doctor in our area who accepts Medicaid, and he was so awful that after one visit I took Bridey to the public health clinic for her shots and had my mom and dad do her routine checkups. I shudder for people who don't have that option.

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HollowEarth
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It strikes me as the bulk of the problem here is medicare rather than a supply issue? Obviously that's the place to start fixing things. Shame doing that is similar to draining the oceans.

edit: this comes off much more flippant than I intended. Its a real problem, that I don't foresee being fixed.

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