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If your income is low or you are uninsured, chances are you're getting little or no dental care

An appointment with a dentist can be intimidating enough, but for those who don't have insurance or can't afford the appointment, the visit might be impossible. As a result, tens of thousands of Tucsonans just have to ignore their dental health and hope for the best.

"It's a mixed bag," says Todd Haft, a Tucson dentist and current president of the Southern Arizona Dental Society. "People who can afford it receive good care, but the underprivileged don't receive what they need. The federal and state governments need to say that oral health is something we need to take care of, maybe to the point of offering assistance."

A survey conducted in Arizona three years ago revealed that visiting a dentist was directly related to income. Only 42 percent of adults earning less than $15,000 a year reported seeing a dentist within the past 12 months, while almost 80 percent of those earning more than $50,000 annually did.

Calling the issue "a 'silent epidemic' of dental and oral diseases," a 2000 report from U.S. Surgeon General David Satcher concluded that those living in poverty and members of minority groups "experience a disproportionate level of oral health problems."

Then in 2003, Surgeon General Richard Carmona issued a "National Call to Action to Promote Oral Health."

"The great and enduring strength of American democracy," Carmona wrote hopefully at that time, "lies in its commitment to the care and well-being of its citizens."

Although there have been some signs of dental-care improvement since then, there are also signs that things have gotten worse. According to a recent New York Times article, statistics from the Centers for Disease Control and Prevention show that the percentage of people in the United States with untreated cavities has risen substantially in the past few years, to 27 percent of children and 29 percent of adults.

The number of Americans without dental insurance is now estimated to be greater than 100 million--one third of the total population and more than twice the number who lack medical coverage. A 2004 survey also indicates than only about one in four adults without insurance saw a dentist that year.

"That so many Americans still lack access to basic oral care," wrote Mark Feldman, president of the American Dental Association, a few weeks ago, "is a disgrace. ... Federal, local and state governments and society at large must stop shortchanging oral health and find the political will to get better dental care to the millions of Americans who don't receive it."

Not only can oral health be of importance to people's teeth and gums, but also their job performance, personal attitude and general well-being. "Some researchers have found," reports the ADA, "that periodontitis (the advanced form of gum disease that can cause tooth loss) is associated with cardiovascular disease, stroke and bacterial pneumonia."

In Tucson, poor and uninsured people have several options for dental service, one of which is the El Rio Health Center. Another is St. Elizabeth of Hungary outpatient clinic.

Rosemary Leon is the program director for dental services at St. Elizabeth's, and she says they provide 400 appointments each month, but can't see everyone who needs assistance.

"We don't turn people away if they're in pain," Leon says, "but can only take new patients twice a year. The need is greater than we can meet."

Haft says his local dental group does a lot to help the poor and uninsured. He points out there are programs in schools as well as a new effort called the Community Dental Health Coordinator.

"This program will serve underserved areas," Haft says, "by getting people trained to provide basic dental care under the supervision of a dentist. Residents of these communities will go through one to two years of training at a community college."

Another effort which many local dentists have pushed for years is to add fluoride to Tucson's water. Years ago, the City Council authorized the program, but the discontinuation of the Central Arizona Project water-treatment plant doomed that attempt.

"It's a huge problem," Haft says, "but we're told there's no money to add fluoride to all the wells. If we could, it would help reduce tooth decay significantly."

Rick Murray, executive director of the Arizona Dental Association, stresses that adults enrolled in Arizona's low-income health-care program, the Arizona Health Care Cost Containment System, have never been covered for preventative dental care. According to AHCCCS officials, they don't have financial projections regarding how much such coverage would cost.

While oral emergencies are addressed by AHCCCS--and a new program will include some long-term care patients for dental services--Murray concludes: "There is a tremendous burden placed on private practitioners to cover (the poor and uninsured)."

Ann Sierra, a human services specialist with AHCCCS in Tucson, says: "Kids are covered, but after that, you're sort of on your own. It really amazes me that dental care is not considered a part of health."

Murray says his organization has lobbied to include adult dental care as part of AHCCCS, but hasn't succeeded. "The political climate in Arizona is not inclined to include adults," he says. "More and more states are reducing their dental services (because of tight budgets), but we never had the benefit in Arizona.

"The question is," Murray asks, "are citizens of the state willing to pay to cover adults?"

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