Why 30% of Americans haven't been to the dentist since before the pandemic

Nearly 1 in 3 Americans haven’t been to the dentist since before the COVID-19 pandemic began, according to a new survey from invisible aligners company Byte.com.

The sample size of that survey was small, but several dentists USA TODAY spoke with said that figure wouldn’t surprise them.

Even before the pandemic provided people with a reason to avoid the dentist, some Americans delayed care for years.

“A lot of the patients that come to Aspen Dental haven’t been to the dentist in about 10 years or more,” said Dr. Arwinder Judge, chief clinical officer for the nationwide dental chain.

The top reasons for delaying dental visits, according to the Byte survey are:

• Cost: Respondents said it’s too expensive - 59%

• Fear: Being too anxious or afraid of the dentist - 44%

• Avoidance: Just don’t want to go - 39%

• Procedure: Worried about needing a procedure. 34%

• Coverage: Not having dental insurance. 33%

As families have been hit this year with rising costs for groceries and other necessities due to high inflation, many have let dental visits slide further down the do-to list because of the out-of-pocket costs incurred with or without insurance.

But the further out people push that first return visit, the scarier the procedures and total bill could become, said Dr. Sodabeh Etminan, dental director at the University of Illinois’ Mile Square Health Center, a network of health centers in the Chicago area.

“We're seeing a lot of bigger cavities because patients weren't coming in to get them treated when they were smaller,” Etminan said.

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Why is dental work so expensive?

Cost is the No. 1 deterrent for going to the dentist because even those with dental insurance end up paying for much of their care out-of-pocket.

The Urban Institute surveyed average annual dental spending from 2015 to 2018 and found the annual cost for adults slowly increases with age from $198 for those ages 20 to 29 to $532 for those ages 70 to 75.

And costs have only gone up since the start of the pandemic due to the labor shortages and inflation that has impacted every other industry, said Adam Powell, a health care economist and president of consulting firm Payer+Provider Syndicate.

“In general, there's been tremendous medical inflation that's been seen over the past year,” he said.

In fact, the price of dental services had the largest monthly change “ever recorded” when the cost went up 1.9% in June, according to the U.S. Bureau of Labor Statistics which began tracking such numbers in 1995. And those prices rose 9.1% from a year earlier, making it the largest 12-month increase since 1981, according to the consumer price index.

Powell said that dental offices have also suffered a reduction in labor supply post-pandemic as more people chose to stay home and care for children instead of paying for child care. They have to pay people more to compensate, he said.

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What are the health risks of delaying dental visits?

Just like with medical conditions, dentists stress that preventative care and early detection are key to good oral health.

Dentists not only clean teeth during a regular visit, but they also check for things like oral cancer, which is easier to treat when caught early, said Etminan.

The bacteria present when someone has periodontal, or gum, disease can lead to health issues in other parts of the body, and some research suggests could even lead to the onset of Alzheimer’s.

If you’re scared of dental procedures, catching the problem early is better than waiting.

“Something that might have been a simple filling could turn into a root canal, could turn into a tooth that might need to be taken out or extracted,” said Judge of Aspen Dental.

Waiting to address tooth issues can even lead to expensive emergency room visits. Dental pain accounts for millions of emergency room visits each year, according to the American Dental Association.

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Beyond the medical risks, having bad teeth can impact people emotionally and even financially, Judge said. Interviewing for a job with missing front teeth, for example, may not make the best impression.

Why do so few people have dental insurance?

In 2019, the University of Illinois Chicago’s College of Dentistry reported about 74 million Americans had no dental coverage. That's about 23% of the population or more than double the percentage that lacks health insurance.

Two-thirds of those who do have dental insurance get it through their employer, the college reported.

“Dental insurance just often looks like a better deal for people if their employer's partially subsidizing it,” Powell said.

This means the unemployed and under-employed are more likely to not have dental insurance.

“There's a huge equity issue and low-income people are much more likely to have gone without dental care,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation.

Medicaid, the government program that provides health insurance to lower-income Americans and those with disabilities, generally covers dental care for kids. But it offers very limited dental benefits for adults, Hempstead said.

And despite a push last year to add dental benefits to Medicare, seniors currently must purchase supplemental insurance or enroll in Medicare Advantage to get any dental benefit.

“Which is an omission that disproportionately affects lower income, particularly African American older adults who don’t have access to dental care,” Hempstead said.

After the proposal to add dental, hearing and vision benefits to Medicare was stripped from the Build Back Better Act, lawmakers urged the Centers for Medicare and Medicaid Services to expand the definition of “medically necessary” dental care so that more services would be covered.

The Biden administration has since put forth a proposal that could allow for reimbursement of some dental services for those with Medicare-covered diseases or injuries.

Is dental insurance worth it?

Dental insurance operates differently from medical insurance because the potential financial losses are so much smaller, according to Powell. The most expensive dental procedures will never add up to as much as medical treatments like chemotherapy or brain surgery.

So dental insurance tends to work like more of a discount program than true insurance, Powell said.

“Really what you're doing is you are pre-paying for some services, like preventive care. And then you're getting some coverage,” he said. “It is not really true insurance that covers catastrophic risk.”

Many people find that if they need to have anything more than a routine filling done, their dental insurance doesn’t cover much, and they end up paying for more expensive surgeries out of pocket.

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“I think there's a common view that dental insurance ... isn't very good coverage,” Hempstead said. “If anything really serious happens, it's not going to cover it anyway. So if I'm on my own, why am I paying the premiums?”

Powell said each person needs to look at their own dental health and needs individually and crunch the numbers to find out if it’s worth getting insurance.

For those in good oral health who anticipate just needing a cleaning twice a year, it may not be worth the premium, he said.

“But then the benefit of dental insurance is if something more serious is caught if you chew on a popcorn kernel and your tooth cracks, you know you have insurance to help offset the cost of those additional services," said Etminan of Mile Square Health Center.

She said those without insurance or those worried about costs should look into federally qualified health centers because they operate on a sliding fee schedule based on income and family size.

Dental colleges also often offer services at discounted rates.

Etminan said anyone who hasn’t been to the dentist since before the pandemic needs to make it a priority.

“I know it's easier said than done," she said. "Go in and get it done. If there is something going on, you're going to get the news one way or the other.”

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This article originally appeared on USA TODAY: Cost of dental insurance a top reason Americans avoid the dentist