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March 12, 2007
Dental health continues to be undervalued in our country. As the Bahamas Dental Association supported the improvement in public access to quality healthcare, amidst a national discussion about National Health Insurance, the association was informed that dentistry would no longer be incorporated in this "comprehensive health plan". It was left for the members of the local dental community to conclude that the government, in announcing this major health initiative, perhaps decided that dentistry was not important enough to be included as one of NHI's many benefits.
Perhaps the architects of the plan assumed that Bahamians don't value the importance of dental health, and would not be angry if the proposed national health plan did not include dentistry. However, our association is of the view that the elimination of dentistry from the proposed plan speaks to the difficulty recognized by the actuaries in meeting the costs of the proposed services, given the levels of contribution, which would only be compounded by including the costs of dental services in the equation. There is just no other way to explain why the government would seek to exclude essential dental services from the list of benefits, when they were initially included in the BRC's preliminary report of health services to be offered under NHI.
It is unfathomable that the reason behind the government's omission of dental services under NHI could be explained by a perceived lack of importance of dental care. Our association acknowledges that far too many within our community neglect their dental health, and suffer from unacceptably high levels of dental decay and periodontal disease. Dentists in The Bahamas have more disease to treat than cardiologists and cardiovascular surgeons! Fortunately, in most cases, having rotten teeth proves far less lethal than having a rotten heart. Deamonte Driver, a young, 12 year old boy from Maryland, U.S.A., had his life cut drastically short last week by a rotten maxillary (upper) tooth that had abscessed and remained untreated for so long, that the bacteria associated with the infected tooth, were able to travel through the blood vessels connecting the upper teeth with the brain, thereby creating a fatal infection at the base of his brain.
Deamonte's public health (Medicare) coverage had lapsed, and he was ineligible to access the public dental services until his mother could reapply and become re-registered under the states health welfare plan. He was forced to wait before he could receive the dental treatment he desperately needed. His illness became grave before he became re-eligible for coverage, and by the time treatment was administered, his health was severely compromised. According to the Washington Post: "Deamonte's death underscore(s) an often-overlooked concern in the debate over universal health coverage: dental care" It is saddening that so many adolescents have "bombed-out" molar teeth - teeth so badly decayed - that there is an open communication between the oral cavity, and the inner compartments of the tooth. This promotes a large opening for the passage of oral bacteria to gain easy access to the blood supply of the teeth, creating a nidus of infection in the teeth that spreads to the brain with lethal results, when maxillary teeth are involved, and the heart, when mandibular teeth are involved, leading to life-threatening stroke. Some lower tooth infections cause life-threatening airway obstruction that is so rapidly progressing that they can cause death in a matter of hours.
If more parents appreciated the dangers of abscessed teeth, there would be greater urgency to have children seen by dentists to routinely check for cavities and any other abnormalities within the oral cavity. The severity of these infections, the rapidity with which they spread, and the tendency for physicians to overlook the mouth as a cause for systemic illness, are a dangerous combination of factors that often result in a deadly outcome. The same article in The Washington Post states that "tooth decay is the single most common childhood disease nationwide (U.S.A.), five times as common as asthma". The prevalence of tooth decay in The Bahamas is even higher. The cost of Deamonte's medical care is estimated at $200,000 - 250,000, all because of an infection in a little tooth.
Countries leading the way in medical research and treatment have begun to appreciate the important role that oral health plays in the compromise of patients' systemic health. For example, protocols for the treatment of HIV/AIDS patients include the administration of regular dental prophylaxis to minimize the development of oral infection in these patients that could negatively affect them in their compromised immune states; while persons who are organ transplant recipients are required to have dental cleanings before they receive their organs to protect them from the proliferation of infection originating in the mouth, while being treated with immune suppression drugs to guard against the body's attack on the new organ.
It is the responsibility of the BDA and its members to continue to educate the Bahamian public about the critical role that oral health plays in one's overall health. We must not permit a grave disservice to be visited upon the Bahamian public, by allowing dental services to be denied to those in our community unable to afford this critically important public health service. The Bahamas Dental Association asserts that essential preventive dental health services, inclusive of dental cleanings and sealants, in addition to procedures to eradicate dental disease, such as basic fillings and dental extractions, must be included in a plan that purports to be a comprehensive health package. As is evidenced by the case of Deamonte Horn, the lack of access to dental care can produce medical emergencies with enormous costs to treat. This of course has implications for any nationally funded health care plan. Unfortunately, beyond the monetary costs, young Deamonte needlessly paid with his life.
Sincerely, S. Andre Rollins, D.M.D.
President, Bahamas Dental Association
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