A friend of mine I’ll call Tom is a Vietnam vet. His back is so wrecked he has to take a pain pill before he gets out of bed. He lies there in pain waiting for the drug to kick in. Then he stands in a hot shower until the muscles relax enough for him to walk. For years, he did this each morning before packing up his tools and heading out to work. Now he can’t work.
Jumping out of helicopters into the jungle with a heavy pack did this to Tom’s back. He was a skinny little kid to start with. But his back is not why Tom is in crisis now.
For years, Tom had bad teeth. He finally managed to save up enough to get them pulled but it took more months to save sufficient money to buy dentures. Tom’s down to skin and bones because he couldn’t bear the pain of chewing.
Two years ago, the Veterans Administration Hospital discovered Tom has COPD. Since then, he’s been on oxygen plus inhalers and struggles for each breath. The damage from a lifetime of work as a painting contractor can’t be undone, all those jobs of clearing away old asbestos insulation and sheetrock dust without wearing proper respiration masks. It wasn’t just a matter of not having money for a mask or not wanting the hindrance of something that restricts vision and mobility, although both those things applied. It was even more a matter of not realizing what atomized paint and volatile chemicals could do inside his body.
Now the VA has found that he has a faulty heart valve. Fixing it will be tricky because the vessel adjacent to the faulty valve has an ominous bulge, otherwise known as an aneurysm.
Inhaled particulate aside, how much of Tom’s predicament can be attributed to years of living with bad teeth? Plenty. As it turns out, respiratory disease can be a direct result of poor dental health:
Bacteria from periodontal disease can travel through the bloodstream to the lungs where it can aggravate respiratory systems, especially in patients who already have respiratory problems. A study published in the Journal of Periodontology uncovered a link between gum disease and an increased risk of pneumonia and acute bronchitis.
Or how about dementia, a condition increasingly suspect in Tom’s case?
Tooth loss due to poor dental health is also a risk factor for memory loss and early stage Alzheimer’s disease. One study, published in Behavioral and Brain Functions, found that infections in the gums release inflammatory substances which in turn increase brain inflammation that can cause neuronal (brain cell) death.
The U. S. Surgeon General in 2000 stated: “…oral health is intimately connected to general health and can be implicated in or exacerbate diabetes, heart disease and stroke, and complications during pregnancy.” And that’s the tip of an iceberg of ailments including erectile dysfunction and even cancer.
… a study published in Immunity earlier this year also hinted that a bacterium implicated in gum disease, Fusobacterium nucleatum, can reduce the ability of the immune system to recognize and destroy cancer cells.
Veterans theoretically get all their health care needs met. But there’s no veterans’ coverage for dental. Medicare and Medicaid also don’t cover oral health. It’s as if our mouths don’t matter.
In the seventeen years since the surgeon general issued his report clearly outlining the devastating systemic harm caused by poor dental health, nothing has been done to expand dental care to those who need it. Awful images jokingly posted on social media about “Walmartians” invariably include people with horribly decayed teeth. Or no teeth at all.
A 2016 Alternet article, “Why in Heaven’s Name Aren’t Teeth Considered Part of our Health?,” reveals that over 106 million Americans have no dental coverage and that one in four has untreated dental decay.
The social cost is as high or higher than the medical cost. We are immediately disgusted by those with visibly bad teeth. People with rotted teeth have a hard time finding employment and are shunned in social circles. Bad teeth are a marker of the lower classes. As noted by Susan Sered, author of the Alternet article,
The reality is that tooth decay signifies poverty in pernicious ways. Without expanding insurance to cover oral health, millions of Americans will continue to live with pain, stigma and the risks of systemic diseases that could be averted through an accessible and integrated system of dental care.
Even before the surgeon general issued his report, common sense told us that decaying teeth sent infection into our bloodstream and compromised our immune system. A steady drip of pus into the body’s blood and lymph systems overwhelms not only the body’s ability to resist infection but also damages otherwise healthy tissue in vital organs.
No wonder Tom has a diseased heart, diseased lungs, and a poor prognosis. He lived with rotten teeth for years. Nobody in the VA stepped up and advised him about this problem. It’s not in their job description.
Likewise, as noted in the Alternet article, the lack of dental coverage in Medicare and Medicaid leaves out large segments of the population most in need of care. It’s estimated that 70% of seniors lack dental care precisely at a time in life when dental problems are most likely to appear.
Except for the random ‘free’ clinic for those qualified (and those lucky enough to live near one and who find their way through the tedious process of discovering where and how such clinics function), those without expensive dental insurance are on their own in addressing this vital and overlooked medical need. Many, like Tom, go without attention to their dental health until they can literally pluck teeth out of their inflamed gums like so many ripe plums.
There’s no excuse for this country to continue to ignore dental health. As one of the fundamental causes underlying so many severe medical conditions, dental disease should rank near the top of conditions covered fully by all insurance programs. In addressing oral health, insurance companies could help prevent or reduce many long-term ailments that cost untold millions and generate incalculable pain and suffering.
There’s no help for Tom. Even after saving enough of his meager pension to purchase dentures, he has continued to decline. It takes all his effort to simply walk across the room. While the VA gropes with surgical options for his heart and keeps him supplied with pain meds and oxygen, Tom lives at home alone without access to Meals on Wheels or other resources that could bring him at least one hot meal a day. He lies in bed watching television, dependent on liquid nutrition drinks and microwaved meals for food. His family chips in when they can, but that’s not a daily meal.
Tom insists he’s not interested in assisted living in the veterans’ home because he’s heard bad things about how people there are treated. He’s also not close enough to death to qualify for hospice. He’s stubborn and proud and thinks he might be able to work again.
This travesty stems largely from the failure of our nation to recognize the insidious creeping harm of poor dental health or the true preventative nature of proper dental care. It’s hardly news that there’s little to no respect for prevention—the lack of understanding about nutrition and poor food preparation skills are a big part of the nation’s mushrooming health care costs, driven in part by the rise of fast food and the barrage of advertisements for unhealthy foods.
“We are what we eat” has never been a more important thought. Especially when we consume bacteria from rotting teeth.