In the year 2000, the U.S. Surgeon General published an important report, “Oral Health in America,” which focused on oral health not just as an individual concern but also as a public health issue, underscoring the fact that oral health is connected to overall health.

The main message of the report is that oral health means much more than beautiful teeth — although having a healthy smile can go a long way toward boosting self-esteem and creating a positive impression on prospective employers and others. The mouth reflects general health and well-being. According to the Centers for Disease Control and Prevention, oral diseases and conditions are often associated with other health problems. Oral health is therefore integral to the general health and well-being of all citizens.

And, yet, it has often been a low priority.

Fifteen years after the Surgeon General’s report came out, New Hampshire produced its own report, “New Hampshire Oral Health Data 2015,” which noted that the second most common reason for a hospital emergency room visit in New Hampshire at the time was tooth pain.

Although the data showed that while the state compared favorably with the rest of the nation when it came to oral hygiene — with 69 percent of its residents in 2014 visiting a dentist or dental clinic within the past year of the survey compared to 65 percent nationwide — disparities existed.

The study found that residents of rural northern New Hampshire received preventive dental services at a lower rate than the rest of the state, partly due to a shortage of dental health professionals at the time. Data also indicated that residents with lower income and/or lower educational attainment were less likely to access dental care.

Not for lack of needing it, though. Consider the overwhelming response to the annual “free dental care” days put on by Raynor Dental. Its Keene and Peterborough offices have each drawn upward of 100 patients on those days — almost all of them those who otherwise wouldn’t have access to dental care because of the cost.

Cost is often cited as a barrier to dental care. Even for those who have dental insurance, out-of-pocket costs to cover co-pays, deductibles and uncovered services can add up quickly, the New Hampshire report points out. It cites the Report on the Economic Well-Being of U.S. Households in 2014, published by the Board of Governors of the Federal Reserve System, which showed 25 percent of U.S. residents did not receive needed dental care during the 12 months prior to the survey because they were unable to afford it.

A bill now making its way through the state Legislature aims to change that for low-income individuals. Sponsored by state Rep. Joe Schapiro, D-Keene, and others, the bill would provide dental care, including regular checkups, to adults on Medicaid.

Last Thursday, the measure passed 225-127 in the state House of Representatives, although the coverage provided by the bill was scaled back to garner Republican support.

“The bill when hopefully passed by the Senate and signed into law by Gov. Sununu will bring increased dignity and decreased pain to tens of thousands of our neighbors and constituents,” Schapiro said in a prepared statement.

As many as 85,000 people could reportedly gain dental coverage under the measure, which would go into effect April 1, 2023.

Lawmakers who opposed the bill expressed concern about the cost and appeared to view it as an unnecessary entitlement program. Republican Matthew Santonastaso of Rindge told Sentinel reporter Rick Green, “I don’t believe government as an institution should be providing that.”

New Hampshire is in the minority of states where dental coverage for adults on Medicaid is limited to extractions or antibiotics for infection.

The expanded Medicaid benefit could cost the state $6.9 million yearly, according to an actuarial report, but this would be matched with $17.5 million in federal funds. And advocates say the bill might actually end up saving the state money because the Medicaid system incurs major expense when covering serious medical issues arising from untreated dental disease.

An ounce of prevention is worth a pound of cure, as the saying goes. A routine dental checkup with cleaning generally costs a lot less than a cavity filling or tooth extraction. Regular dental care is less expensive than emergency care. Further, as Schapiro argued, there’s no sound reason to separate dental care from other types of medical treatment when it comes to health insurance coverage.

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