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Tooth Decay On Rise Despite Boom Time For Dentists, CDC Data Show

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By ALEX BERENSON, The New York Times

Published: October 11, 2007

For American dentists, times have never been better.

The same cannot be said for Americans' teeth.

With dentists' fees rising far faster than inflation and more than 100 million people lacking dental insurance, the percentage of Americans with untreated cavities began rising this decade, reversing a half-century trend of improvement in dental health.

Previously unreleased figures from the Centers for Disease Control and Prevention show that in 2003 and 2004, the most recent years with data available, 27 percent of children and 29 percent of adults had cavities going untreated. The level of untreated decay was the highest since the late 1980s and significantly higher than that found in a survey from 1999 to 2002.

Despite the rise in dental problems, state boards of dentists and the American Dental Association, the main lobbying group for dentists, have fought efforts to have dental hygienists and other nondentists provide basic care to people who do not have access to dentists.

For middle-class and wealthy Americans, straight white teeth are still a virtual birthright. And dentists say that a majority of people in this country receive high-quality care.

But many poor and lower middle-class families do not receive adequate care, in part because most dentists want customers who can pay cash or have private insurance, and they do not accept Medicaid patients. As a result, publicly supported dental clinics have months-long waiting lists even for people who need major surgery for decayed teeth. At the pediatric clinic managed by the state-supported University of Florida dental school, for example, low-income children must wait six months for surgery.

The profession's critics - who include public health experts, some physicians and even some dental school professors - say too many dentists are focused more on money than medicine.

'Most dentists consider themselves to be in the business of dentistry rather than the practice of dentistry,' said David Nash, a professor of pediatric dentistry at the University of Kentucky. 'I'm a cynic about my profession, but the data are there. It's embarrassing.'

A defender of the profession is Terry Dickinson, a practicing dentist and executive director of the Virginia Dental Association. He said he thinks dentists are charitable and want to provide care to poor patients. But dentists are also in business; they must pay rent and employee salaries, and they deserve fair fees, he said.

'Charity is not a health care system,' Dickinson said.

Dentists, of course, are no more obligated to serve the poor than are lawyers or accountants. But the issue from a public health standpoint, the critics say, is that even as so many patients go untreated, business is booming for most dentists. They are making more money working shorter hours, on average, even as the nation's number of dentists, per person, has declined.

The lack of dental care is not restricted to the poor and their children, the data show. Experts on oral health say about 100 million Americans - including many adults who work and have incomes well above the poverty line - are without access to care.

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