Moving Ahead for Progress in the 21st Century Act--Resumed

Floor Speech

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Mr. SANDERS. Madam President, I am here for Senator Boxer, in terms of the Transportation bill, but before I get into transportation, I wanted to say a word on another issue that does not get the attention it deserves, and that is why, as chairman of the Subcommittee on Primary Health Care, I will be holding a hearing on the dental crisis in America.

As I think many Americans know--although they do not hear a whole lot about it--we as a Nation are in the midst of a very severe dental crisis. More than 47 million Americans live in places where it is difficult to get dental care. About 17 million low-income children received no dental care in 2009. One quarter of adults in the United States ages 65 or older have lost all of their teeth. Low-income adults are almost twice as likely as higher income adults to have gone without a dental checkup in the previous year.

I should tell you that bad dental health impacts overall health care. When you talk about dental care, you are talking about health care in general. If people have bad teeth or no teeth, they are unable to digest their food, which causes digestive problems. People who have poor teeth can get infections leading to very serious health problems. And, in fact, there are instances where people have actually died because of poor teeth and infections. Furthermore, the risk for diabetes, heart disease, and poor birth outcomes are also significant if people are not having their teeth well maintained.

Since 2006, there were over 830,000 visits to emergency rooms across the country because we have a lot of low-income people who are in severe pain and they can't find a dentist. So they go into an emergency room, and I suspect maybe they get their tooth extracted or get some pain killer. But that is certainly not an adequate substitute for providing the dental care that all Americans need.

Almost 60 percent of children ages 5 to 17 have cavities, making tooth decay 5 times more common than asthma among children of this age. In fact, as I understand it, the single most prevalent reason for children being absent from school is, in fact, dental problems.

In the midst of the severe need for more dentists, what is happening is our dentists in our dental communities are becoming older and many of them are retiring. In fact, we need a lot more new dentists to replace those who are retiring. The sad truth is that more dentists retire each year than there are dental school graduates to replace them.

One of the other problems we are facing is that only 20 percent of the Nation's practicing dentists provide care to people with Medicaid. So that is a serious problem. We need more dentists but, equally important, we need to make sure that dentists are providing service to the people who need it the most. And one of the sad realities of contemporary dental life is that only 20 percent of the Nation's practicing dentists provide care to people who are on Medicaid, and only an extremely small percentage devote a substantial part of their practice to caring for those who are underserved.

The current access problem is exacerbated by the fact that private practices are often located in middle-class and wealthy suburbs. What we need is to bring dentists into those areas where people need dental care the most. That is certainly something we need to do.

Further, we need to expand Medicaid and other dental insurance coverage. One-third of Americans do not have dental coverage. Traditional Medicare for seniors does not cover dental services. States can choose whether their Medicaid Programs provide coverage for dental care for adults, and the truth is many of them do not.

Let me give some good news, though, in terms of where we are making some progress. Recently--and I have been active in this effort--there has been an expansion of federally qualified community health centers. Community health centers provide health and dental care to anybody in the area regardless of their ability to pay. We now have a situation where community health centers are providing dental services to over 3 1/2 million people across the country.

I am happy to say in the State of Vermont, in recent years, we have seen a very significant increase not only in community health centers in general but in community health centers that are providing state-of-the-art dental care. We have beautiful new facilities located in Richford, in the northern part of our State; in Plainfield, VT, in the central part of our State; and in Rutland. Burlington is just developing a beautiful new dental facility.

Furthermore, one of the areas where I think we are seeing some progress not only in Vermont but around the country--and which I think has huge potential--is putting dental offices right in schools. I know in Burlington, VT, we helped bring that about some years ago, and we have kids from all over the city of Burlington getting their dental care at one particular school. It is working phenomenally well, and we have similar programs in Bennington and Richford.

I did want to mention that I think the time is now for the Congress to begin addressing this issue. One of the things I have done recently on my Web site--which is sanders.senate.gov--I have asked people in Vermont and all over the country to tell us their stories in terms of what happens if they do not or if members of their family don't have access to dental care. We have received more than 1,200 stories from Vermont and all over this country.

Those stories are heartbreaking because they tell the tales of people who are suffering every day because they simply don't have the money to go to a dentist to take care of their dental needs. These are parents who are worried about their kids and pointing out how hard it is to find affordable dental care in their communities. So if people want to write my office, they can go to my Web site, sanders.senate.gov, and we would love to hear from them. Because I think there are a lot of stories out there that are not being told.

What I wish to do now is to read from a publication that we have just produced called ``Dental Crisis in America: The Need to Expand Access.'' This will be distributed and released tomorrow at our hearing, but I did want to read a few stories which I think speak to the experience that a whole lot of people from one end of this country to the other are having regarding lack of access to dental care.

This is from a woman named Heather Getty, who lives in

East Fairfield, VT, in the northern part of our State. This is what she says:

My husband and I and our four kids are the working poor. We have to think about rent and electricity before we think about dental care. My wisdom teeth have been a problem for over a decade now. I take ibuprofen and just keep on going. My husband has not seen a dentist since he was a teenager. He's afraid of the costs if they find something. So it's been 20 years. Because of Vermont's Dr. Dynasaur program, at least my children have been lucky enough to have regular cleanings, but I have to comb through the Yellow Pages to find an office who will accept their coverage. One time I missed an appointment because my car broke down, and when I called to reschedule, they told me that we had been blacklisted and that no one from my family could be seen by that office again. We've learned over the years how important dental care is. If you get preventive care early, you are less likely to have problems later on.

That is from Heather Getty in East Fairfield, VT.

Let me read a statement from Shawn Jones in Brattleboro, VT.

Last year, I had a toothache that was so painful, I had trouble eating and sleeping. My girlfriend is also covered by Medicaid so I called her dentist, but they wouldn't see me. So I called 12 more dentists in the area, but they all said the same thing: They weren't taking new Medicaid patients. A few said to call back in three months, which seems like a long time to live with a bad toothache. Finally, someone from Office of Vermont Health Access helped me get an emergency voucher to get my tooth pulled. I'm just grateful that my girlfriend had a car to get me there.

That is just a couple of the statements that came from Vermont, and in fact from all over the country. But let me read a statement from Dr. David Nash, who is the William R. Willard Professor of Dental Education, Professor of Pediatric Dentistry, College of Dentistry, University of Kentucky in Lexington. Dr. Nash writes:

Society has granted the profession of dentistry the exclusive right and privilege of caring for the oral health of the nation's children. Unfortunately, the dental delivery system in place today does not provide adequate access to care for our children. In many instances it is because few dentists will accept Medicaid payments. In other countries of the world, children's oral health is cared for by dental therapists, primarily in school-based programs. This results in an overwhelming majority of children being able to receive care. Dental therapists as utilized internationally do not create a two-tiered system of care. They have extensive training in caring for children, significantly more than the typical graduate of our nation's dental schools. International research supports the high quality of care dental therapists provide. The time has arrived for the United States to develop a new workforce model to care for our children's oral health.

What Dr. Nash is talking about is another issue we will be discussing tomorrow in the hearing; that is, it is clear from international studies and, in fact, from some States in the United States that there are well-trained people who can take care of certain types of dental problems who are not dentists. I think that is an area we need to explore--how can we expand the dental profession to include people who do not graduate dental school but who have the qualifications to take care of a variety of dental problems?

Let me read another story that comes from Vermont regarding what happens if you don't have dental care. It is from Kiah Morris from Bennington, VT.

When I was pregnant, I had a tooth infection that had gotten into my lymph nodes and I needed a root canal, but adult Medicaid has a $495 cap, which wasn't enough. Dental care shouldn't be a luxury.

What she is saying is that in Vermont and in many other States where you do have Medicaid helping out for dental care for low-income people, there is often a cap, and that cap is much too low to provide the services many folks need.

So the bottom line is that we have a crisis in terms of access to dental care in this country. We lag behind many other countries around the world in that regard. We have many people who have no dental insurance at all. Some who do have dental insurance, such as my family, have very limited coverage--I think it is about $1,000 a year. Meanwhile, the cost of dental care is sky-high, and we are also going to explore why that is so. I am not sure I understand or many people understand why dental care is as expensive as it is. What I do know is that there is a city in northern Mexico whose function in life is to provide dental care for Americans who go down below the border because they can't afford dental care in this country.

There is a serious problem. People don't have dental insurance. Low-income people don't have access to dental care. We have many dentists out there who are not accepting Medicaid patients or, if they are accepting Medicaid patients, they are accepting very few of them.

The population of our dentists in general is getting older, and we are losing more of them to retirement than we are seeing graduates of dental school. Even the dentists who are graduating are often not migrating to the areas where we need them the most. Many dentists are involved in making our teeth white and shiny and our smiles very beautiful, but meanwhile in those communities there are people who are seeing the teeth in their mouth rot away, there are kids who have dental problems, and they are not getting the treatment they need.

I hope that tomorrow at the hearing we are going to bring forth some great panelists. We will be talking about the issue. I intend, as soon as we can, to introduce comprehensive legislation to make sure every person in this country has access to affordable and decent-quality dental care.

Mr. President, I suggest the absence of a quorum.

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