Demi Moore’s missing teeth, Trumpcare politics and America’s growing dental care divide

June 21--"Thank God for modern dentistry!"

So proclaimed actress Demi Moore in an interview with Jimmy Fallon last week. The still striking 54-year-old movie star was telling the "The Tonight Show" host about how a very skilled and no doubt pricey dentist saved her famous pearly white smile after she lost her two front teeth.

For Moore, the marvels of modern dentistry meant she wouldn't have to hide her face in shame or lose future job opportunities when she confronted a situation that's all too common and painful for many Americans, especially as they age: she had teeth that had become so bad they broke apart and fell out.

But what's not common for many Americans is having access to affordable dental care so that they can repair bad teeth.

We're not talking access to the kind of high-end cosmetic procedures that people increasingly rely on to have fashionably straight white smiles. We're talking about basic care to prevent tooth decay and gum disease so that they won't lose teeth or suffer other serious health consequences.

Experts say America is facing a massively under-reported health care crisis and it has to do with what's in our mouths. They add that the crisis could get worse if President Donald Trump and congressional Republicans repeal the Affordable Care Act, which increased dental coverage to poor children and several million low-income adults.

Yes, the idea that millions of Americans have poor oral health probably is surprising, given that Americans pour an estimated $1 billion annually into high-end procedures to make their teeth a few shades whiter.

But this crisis has been well documented in health care policy circles for years. It's also chronicled in "Teeth," an acclaimed new book by health care journalist Mary Otto. Her book opens with the story of a 12-year-old boy who died in 2007 from an infection that started from a simple toothache. According to Otto, the boy's parents were poor and, at one point, homeless, so they didn't have dental insurance and couldn't get him to a dentist before the infection spread to his brain.

This family's struggle to secure dental care for their son is startlingly common, especially in poor or in rural areas, these studies say. According to the National Association of Dental Plans, 114 million Americans don't have dental insurance, including 46.3 million people aged 65 or older.

Even for those with insurance, the costs of necessary dental work, including repairs to broken or missing teeth, sometimes must be paid out of pocket and are therefore out of reach for them. Implants go for an estimated $1,000 to $4,000 each.

"As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care," the Washington Post reported in a story in May.

The story focused on 1,000 people who came to a charity clinic for treatment for cracked molars and other routine problems. These people didn't have insurance, even those who held steady jobs. The story noted that millions of people rely on such clinics, as well as hospital emergency rooms, to treat painful and neglected teeth.

"Unable to afford expensive root canals and crowns, many simply have them pulled," the story read. "Nearly 1 in 5 Americans older than 65 do not have a single real tooth left."

Another complicating factor is America's historical divide between medical and dental care, with medical care being seen as a necessity while dental care has been privatized and regarded as a cosmetic luxury -- not something that people can routinely count on being part of any employer- or government-provided benefits package.

Straight white teeth -- of the kind glamorized by Moore and other movie stars -- are equated with social success. They've also become necessary for jobs in an economy that's increasingly service-based. In a review of "Teeth" for the New Republic, Adam Gaffney, a pulmonary and critical care physician who teaches at Harvard Medical School, writes that service workers are expected to perform what UC Berkeley sociologist Arlie Russell Hochschild has termed "emotional labor" in their jobs, transmitting happiness to the consumer.

"That's a task that demands a degree of oral health," Gaffney said. "At a time when service jobs are the predominant working-class occupation, missing teeth make it harder to get hired. Toothlessness spells joblessness, which means lack of access to dental care, which in turn leads to more suffering."

Former President Barack Obama's Affordable Care Act largely upheld the historical medical/dental care divide but it at least expanded some oral health care coverage requirements for children through private insurance and Medicaid and brought dental coverage to millions of adults under an expansion of Medicaid, according to the Children's Dental Health Project.

But those gains in oral health care could be lost if the GOP-led Senate approves an Affordable Health Care bill (aka Trumpcare) that's similar to the one passed by the House GOP in early May, the CDHP wrote.

It's evident that Demi Moore wasn't thinking about the politics of Trumpcare or of how oral health reflects U.S. income inequality when she praised modern dentistry on Jimmy Fallon's show. Of course, it makes sense that Moore's disclosure would generate headlines. In films like "Ghost," "Indecent Proposal" and "G.I. Jane," she crafted a career based on an almost ferocious dedication to maintaining a youthful, glamorous appearance.

But on Fallon's show, she explained how her good looks were compromised by chronic, long-term stress. That's the reason, she said, that her teeth broke apart and fell out.

Moore evidently had good intentions in sharing her story. She wanted to spotlight a dental-related health care problem affecting many Americans.

"I'd love to say it was skateboarding or something really cool, but I think it's really something that's important to share because I think it's literally, probably after heart disease, one of the biggest killers in America, which is stress," she said.

Dentists interviewed by several publications confirmed Moore's explanation for her tooth loss -- that chronic stress can trigger clenching and grinding, which Flossolution founder Tim Pruett told Self magazine can "definitely cause significant damage" to teeth and gums and become a contributing factor in tooth loss.

Unfortunately, Moore missed the bigger picture when she exclaimed, "Thank God for modern dentistry" -- such marvels are not available to many Americans these days.

Then again, it's hard to blame Moore for an ignorance shared by many Americans, including politicians, who view dental care as a luxury instead of a necessity.

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