Academic journal article Fordham Urban Law Journal

Who's Smiling Now? Disparities in American Dental Health

Academic journal article Fordham Urban Law Journal

Who's Smiling Now? Disparities in American Dental Health

Article excerpt

6. Comprehensive Dental Reform Act of 2012

The Comprehensive Dental Reform Act, (199) introduced in the 112th Congress by Senator Sanders (I-Vt.) in the Senate and Representative Elijah Cummings (D-Md.) in the House, proposes doing what the ACA does not do: ensuring comprehensive dental coverage to a wide group of people, including the elderly and those with low incomes. (200) Title I of the bill details the need for dental coverage: 47 million people have difficulty accessing dental care; 17 million low-income children do not get coverage for dental care; and the Medicaid program is not required to provide dental coverage for adults. (201) The bill described those most likely not to get adequate dental care to include "individuals with low incomes, racial and ethnic minorities, pregnant women, older adults, individuals with special needs, and individuals living in rural communities." (202)

The bill, if passed, would provide dental care for Medicare recipients as well as for adults receiving care through Medicaid, (203) and for those covered by the Veterans Administration. (204) In addition, the bill would create mobile units providing dental care in places where access to dental providers is thin, and it would help fund the training of dental care professionals, including "dental therapists." (206) It would also provide funding to educate emergency room physicians in emergency dental care. (206) The bill provides for funding by imposing a tax of 0.025% on securities transactions. (207) The bill would significantly minimize disparities in dental health in the United States. The bill provides a good model for what needs to be done. However, it has virtually no chance of becoming law--at least not at this time--as it died in committee. (208)

II. TEETH EVEN THE "TOOTH FAIRY" MIGHT ENVY

For people with financial resources, dental care in the United States provides not only for patients' health needs, but also, often, for their aesthetic yearnings. The latter is significant in promoting a culture where people may assess each other's teeth to determine socioeconomic status. Such assessments cross class boundaries. (209) A person's dental condition can signal poverty and low socioeconomic status. For those without teeth or with visibly mangled teeth, social and economic opportunities can be significantly limited. (210) At the other end of the nation's socioeconomic hierarchy, however, teeth can signal wealth. (211) For middle- and upper-class Americans, contemporary dentistry has diverged from its counterpart of a half century ago. (212) The fluoridation of water and routine dental care for middle- and upper-class children have significantly limited the types of problems that once brought many Americans to dentists. But dentistry--once considered a has-been profession--has flourished as Americans with means have become hooked by cosmetic dentistry. (213)

"Americans," reported June Thomas, have become "obsessed with teeth" (214)--a reference not to dental health, but rather to the presumptive importance of dental aesthetics. "A beaming smile," Thomas adds, "is the ultimate testament to American prosperity and self-confidence." (215) The dental profession itself has supported the presumption that one's teeth reflect one's values. This is evident, for instance, in the profession's support for the proposition that dental health is a product of individual responsibility and choice. (216) The condition of a person's teeth allows others to place that person on the nation's socioeconomic hierarchy (217) and to assess his or her moral grit. (218) In short, teeth have become a barometer of class status.

Unsurprisingly, as middle- and upper-class Americans have focused more and more on the aesthetics of teeth, they have become less satisfied with the appearance of their teeth. At the start of the 1990s, 57% of people in the United States were "very satisfied" with the way their teeth looked. …

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