Dental gap

I recently warned a class of students that I was not going to be in the best condition to lecture because I had just had a root canal.  I survived the lecture but after the class, a student came up to me and timidly asked what a root canal was.

This was a middle-class student but he had never heard of a root canal.  That encounter reminded me that there is a terrible gap in the Philippines when it comes to accessing dental care.

On one hand, we have the many Filipinos who live in places with no dentist at all or, even where there are dentists, are unable to afford regular dental care.

I once caught a segment of some American reality show where they showed a man from a rural area tying one end of a string to a tooth and the other to a rock, which he then dropped, in an unsuccessful bid to extract the presumably decaying tooth.  I have not met any Filipino who had to resort to such desperate measures, but I would not be surprised to hear DIY (do-it-yourself) extractions. If they do go to a dentist, it will still be for a tooth extraction even if it might be possible to fill up the tooth’s cavity, a choice that’s considered too expensive and time-consuming.

That extraction may not always be followed by dentures, again because of the high costs. I talked once to a family driver who had two front teeth missing—something so common we have a term for it: “bungal.”  When I asked him why he hadn’t gotten dentures, he flashed a wide smile and answered, or rather, rationalized, that it was “suwerte” (good luck), and sheepishly added that his wife thought he looked sexier without the front teeth.  I held myself back from joking that his wife probably wanted him to remain bungal so he wouldn’t attract other women.

There are dentures and there are dentures, meaning the quality will vary, greatly. Low-cost dentures are available even from nondentists, usually former dental assistants who have started their own home operations with supplies that are readily available from Rizal Avenue’s medical stores.  But the products don’t last long and, again, I hear another set of horror stories about what low-income people do when their dentures break, including using Mighty Bond to try to mend it, oblivious to the toxicity of the adhesive.

Kids who love dentists

Contrast that situation with the upper classes, who now have an amazing range of options starting at a very young age.  We now have pediatric dentists, who offer all kinds of procedures from fluoride treatments to very delicate ways of filling cavities, plus amazing child-friendly tactics that endear them to the kids, including little treats after a dental procedure.  Kids, like my own, actually beg me to see their “doktora dentist.” But among the poor, kids are terrified by dentists, their phobia worsened by parents who threaten them with a fate worse than death, that of getting a dentist to pull out every last tooth, when they misbehave. It sounds so much more horrifying in Filipino: “Sige, sige, dalhin kita sa dentista at bubunutin ang lahat nang ngipin mo.”

As upper- and middle-class kids grow older, dental braces come in, although I have been told by some dentist-friends it’s better to wait until adulthood—welcome news because the braces can be as expensive as private-school tuition.  Now I can tell the kids they’ll have to fund their own braces after they start working.

Which, paradoxically, is something that even lower-income young adults will spend on, when they can find more affordable dentists.  The dental braces are worn not just for a desired aesthetic result but also because they signify social mobility, much like bleached or glutathione-induced fair skin.

Let’s get back to upper-class dental options.  An extraction is considered a very extreme option, with dentists arguing that keeping the original tooth, even if only parts of it, is still better than a denture.  It used to be just having cavities filled, but now you have the root canal, involving the surgical removal of damaged tissue or pulp from inside the tooth, followed by disinfection of the area and then filling up the cavity.  The procedure is usually followed by porcelain jackets or caps.

Dentists are very careful, using dental X-rays to plan out a procedure. There are even panoramic X-rays now, which “shoot” all the teeth.  And before using local anesthetics for extractions, fillings and root canals, dentists will check the patient’s blood pressure first because the anesthetic can aggravate high blood pressure.  During my last root canal, I had some problems with my blood pressure and my dentist patiently waited for it to drop before we proceeded to the root canal.  After we finally got the root canal done, I asked for the bill and the dentist laughed, saying: “Settle the bill when you come back.  I don’t want your blood pressure shooting up again.”

Root canals and other dental procedures are expensive.  Good dentures, crafted so well no one can tell they’re false teeth, are expensive, too.  And the latest developments are dental implants, each one costing about twice the monthly salary of a UP assistant professor.

It used to be, too, that you had an annual propylaxis, or tooth cleaning.  These days, you’re offered all kinds of dental cleaning and whitening procedures and other forms of cosmetic dentistry, all the way up to gum sculpting.

Sparkling teeth and more

One reason Filipinos are unwilling to invest in dental procedures is that the teeth’s value are seen mainly as aesthetic.  Even brushing the teeth is done mainly to keep them kukuti-kutitap, sparkling, white, and to keep a fresh breath.

Public awareness is low about how dental health affects the rest of the body, with growing evidence that periodontitis, inflammation of the gums, can mean increased plaque that clog the arteries and can cause heart attacks.

In the Department of Health’s calendar, February is the month to promote a healthy heart.  Maybe we should promote it as dental month as well to get information to the public on a “healthy heart, happy smile” connection (it’s a phrase I’m borrowing from a British Medical Journal editorial three years ago, which noted the link between coronary heart disease and periodontitis).

There is much that needs to be done concerning dental health education, including going beyond toothbrushing and flossing.  We also have to talk about diets, with our penchant for sweets and for processed foods contributing to the decline of Filipinos’ dental health.

PhilHealth only covers dental procedures done in hospitals, and health maintenance organizations (HMOs) usually require extra premiums to include dental services. It’s high time the government recognized the dental gap between the rich and the poor as unacceptable, because of its implications for public health.  If we are to have universal coverage by health financing, it must include dental services.