Going to the dentist has always made me nervous. But since I left my last full-time job five years ago, nerves haven’t kept me away from the dentist. The lack of dental insurance has. However, my mother taught me to properly brush and floss regularly, so my teeth are in pretty good shape considering it’s been years since I’ve had my teeth professionally cleaned. I’m just grateful I got my wisdom teeth pulled when I had insurance.

If you’re currently uninsured or underinsured, do you remember when was the last time you saw a dentist? Have you ever seen one at all in your life? Have your children? In California, one in four kids have never gone to a dentist, according to a just-published study in the journal Health Affairs. The problem is particularly prevalent among African-American and Latino children, whether they have dental insurance or not. And according to the Kaiser Family Foundation, 100 million Americans in 2006 lacked dental coverage for a full year.

Dental care, like vision care and mental health, is often overlooked in discussions about health reform, but having healthy teeth is a very important precursor to having a healthy body. If not properly addressed, poor oral hygiene can lead to health problems, such as heart disease, low birth weight, diabetes, and stroke. It’s simply unconscionable that so many children in our state go without good oral health. An unhealthy mouth can also lead to poor self-esteem, and tragically, even death.

Uninsured Americans end up paying hundreds and thousands of dollars in out of pocket costs for dental care. But even those with dental insurance have difficulty getting affordable treatment. The online magazine Slate published a seven-part series last year called The American Way of Dentistry, a well-researched and comprehensive look at how and why dental care in America is in crisis – something many citizens are probably unaware of.

Dental care has become extremely costly, with more patients paying for dental bills themselves than they do medical bills. According to the Slate article, in the United States, the population is almost evenly divided between the dental care haves and have-nots, with a mouth full of rotting teeth a clear predictor of class. And the country will soon face a shortage in dentists as baby boomer practitioners retire, the series said.

The Slate series presents some solutions to the American dental crisis, such as mandating all dentists in training to work a year in public health, providing more loan forgiveness plans for dental students, opening up more dental schools, allowing more foreign dentists to practice in the U.S., and allowing dental hygienists to be trained to perform basic dental procedures. These solutions would certainly address the practitioner shortage problem, but I’m not sure they would adequately fix systemic-wide problems of cost and access.

The series mentions that much of our dental healthcare dollars are spent on cosmetic procedures for the affluent and not enough on caring for the oral health of the poor. What we need to do is equalize access for everyone. Requiring dental school graduates to train for a year in poor and rural areas sounds great, but shouldn’t the poor (and financially-strapped middle-class for that matter) also have access to more experienced practitioners if they wish? Shouldn’t everyone be able to count on having their dentist stick around in the community?

Fortunately, California’s single-payer healthcare legislation, SB 810, would cover dental care for all state residents. Not even Canada’s much touted single-payer healthcare system provides dental coverage for all its citizens, relying mostly on supplemental private insurance or fee for service. Rather, when it comes to dental care, SB 810 would be similar to countries in Scandinavia, where many dentists work in private practice, but services are funded through taxes. No Californian should ever have to suffer through a toothache just because he or she has no money to get it fixed.

Sylvia@californiaonecare.org