ASK Musings

No matter where you go, there you are.



November 2018



“As Bad As a Root Canal” Isn’t That Bad … If You Have Insurance or Money

Written by , Posted in Adventures

My first memory of dental work was when I was five or six. I even recall my dentist’s name, although I’m not going to share it here. My teeth were starting to come in, and he could tell my bite would need some correction, so he pulled five baby teeth in an effort to get things moving. The numbing agent started wear off by the end of the fourth extraction, and he didn’t offer to top me up, so I had one tooth pulled with essentially no pain killers.

You can see why I wasn’t such a fan of dental work after that.

Unfortunately, I had five years of orthodontics ahead of me. Braces, neck gear, rubber bands, and finally retainers. On the plus side, I was free from all but the retainer before I hit junior high, so while I looked awkward in middle school, it wasn’t because I had a mouth full of metal (just some bad haircuts and poor fashion choices).

I’ve also always liked sweets, so I knew I had to take care of my teeth. I flossed — and still do floss — every single night. I brushed twice a day. And yet the cavities came. And then the crowns. And the root canals. We tried prescription toothpaste. I got sealants on my teeth. And yet for many years, I feared each visit to the dentist (which I dutifully scheduled every six months) because of the newest filling I would need.

When I moved back to Seattle, I found a new dentist. He fixed some crappy fillings I’d gotten in New York, and did his best to keep fillings from turning into crowns. It didn’t always work, but he tried. In fact, the only reason my most recent root canal happened yesterday and not a year ago is because my Seattle dentist worked hard to make some adjustments.

Every molar in my mouth has some sort of restoration. When I visited my new dentist in the UK and got some x-rays, I was reminded of how lucky I’ve been to have access to dental care my whole life.

And when I was referred for a root canal last week, I was reminded of how screwed up it is that dental care isn’t covered for adults in the US. Even when people over 21 or under 65 qualify for public health benefits, dental care isn’t covered. And I’ve seen first-hand what that means.

For the past five years, Seattle has hosted a public health clinic in the fall. Individuals can, at no cost, receive medical, dental, and vision care. People line up at midnight to be let into a holding area, where numbers are then distributed. Because dental and vision coverage are hard to get in the US without private coverage, individuals are limited to medical + dental or medical + vision for each visit. The floor of Key Arena is converted to a giant dental office, filled with chairs.

Photo by KUOW

I was able to work at two of the clinics, one time as a runner, and one time managing the waiting area for the dental floor. People who had been up all night waited hours longer to be seen by a dentist, then sent over for x-rays and referred to come back the next day for a cleaning, flippers (removable partial dentures), fillings, or extractions. People who have had infections, even abscesses, for who knows how long, grateful that someone is taking their dental health seriously.

It was heartening to see all the volunteer dentists and hygienists, but it was infuriating that it was necessary at all.

I’ve had root canals in New York, Seattle, and London. I can vividly recall the walk into the New York endodontist’s office; there was scaffolding up around the building. My union dental insurance covered the full cost, I believe. The second one, in London, was performed at the dental office associated with LSE, and I don’t believe I had to pay anything for it. And I had great dental insurance in Seattle, so if I had anything to pay then, it was maybe 10%. In each of those three cases, I either had dental insurance (US) or didn’t have income and so qualified for my costs to be covered (UK).

As I sat in the dentist’s chair last week, she talked through my options. I could pay a whole lot of money to go to a private endodontist who has excellent new equipment, a private endodontist with good equipment, or I could pay £60 and go to an NHS specialist. The wait would probably be awhile, and the equipment might not be as good. I chose one of the private options, but the fact that, if I didn’t have money, I could still have secured the care I needed, is a reminder of how the UK is light years ahead of the US in so many ways.

People in the US like to make fun of British teeth. The reality is, they aren’t obsessed with the appearance of teeth; they just want to make sure their residents get to keep their teeth. In the US, people get care if they have insurance, but if they don’t? Oh well. Never mind the concerns about impacts of things like gum disease on overall health. I find it absurd that dental and vision care aren’t automatically included in all health care in the US. Those are vital parts of our overall health.

Monday afternoon I arrived at the posh dental office. After a consultation, I signed some forms and they got down to work. Even in the 15 years between my first and most recent root canal, the technology has improved. I had almost no pain during the procedure, and some of the techniques she used kept my jaw from aching and kept over spill from the various drilling and equipment out of the rest of my mouth. Near the very end, the numbing agent did start to wear off, but even then it didn’t really hurt. After about 75 minutes she wrapped things up, I popped some ibuprofen, and headed home. I haven’t needed any painkillers since.

I know I’m lucky that I had the money to get the procedure done quickly. But even if I hadn’t, I still would have been able to get care thanks to the NHS dental system.

I’m sure that there are plenty of people in the UK who have had horrible NHS dental experiences, but at least they had access to some care. It’s literally the least a country can offer its residents.

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