Nothing to smile about: not everyone who needs dental care can get it.

• Author: Gordon, Dianna

There's a lot of pain. There's a lot of disfigurement. People can't even get jobs if they have bad teeth. No one is going to hire a person who has to hold a hand over their mouth when they talk because their teeth are so bad."

So speaks Marcia Brand of the federal Health Resources and Services Administration, Office of Rural Health Policy.

And West Virginia Delegate Barbara Evans Fleischauer concurs. "During our evaluation of welfare reform, we asked people who had difficulties getting jobs why they had problems. Twenty-one percent said it was because of their teeth."

The price of rotten teeth is troubling:

* Tooth decay and associated pain interfere with daily activities for 4 million to 5 million children and adolescents a year.

* Chronic oral infections can lead to heart and lung diseases, diabetes and stroke, as well as premature births and low birth-weights, according to the U.S. surgeon general's report, "Oral Health in America."

* The elderly lose their dental insurance when they retire, and Medicare does not pay for routine care. Hence, nearly a third of those over 65 have untreated cavities.

* About two-thirds of the states cover adult dental care to some extent through Medicaid. But 25 states are reducing or eliminating dental benefits; 27 are restricting eligibility; 17 are increasing co-pays; and 37 are freezing of reducing payments.

In rural areas, the lack is especially evident. Children, adults and the elderly with bad teeth face special challenges to better health--lack of dentists, an even lower number of dentists who accept Medicaid or other discounted fees, and reluctance by dentists to participate in managed care programs. Rural populations tend to be marked by poverty, limited education, cultural differences, lack of transportation, and the absence of any kind of coordinated screening and referral processes.

PREVENTION WORKS

Perhaps two of the easiest and most cost-effective solutions to today's dental crisis are preventive: fluoridation of community water supplies and sealant programs.

Researchers discovered as early as the 1930s that people living with naturally fluoridated water had fewer cavities. Today, water fluoridation costs less than $1 per person per year. And it's estimated that every dollar spent on supplementing drinking water with fluoride averts $38 in dental care, according to the Journal of Public Health Dentistry.

Despite proven benefits, more than 100 million Americans do not drink fluoridated water...