Your Health

The Politics of Tooth Decay

  • Playlist
  • Download
  • Embed
    <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

Tooth decay is the most common disease among children and it is epidemic among the poor and under-insured. Larry Caplin is a dentist and advocate, and he talks to Tony Cox about the Oral Health Impact Project, an attempt to increase access to affordable dental care for children.

TONY COX, host:

It may not get the same headlines that diabetes or AIDS do, but tooth decay is still a problem, and a big problem. Earlier this year, a 12-year-old Baltimore boy actually died of a tooth infection after it spread to his brain. The boy's mother reportedly didn't have access to dental care. In fact, tooth decay is the single most prevalent childhood disease in the United States, and underprivileged kids suffer the most. That's partly because more and more dentists are refusing to accept Medicaid.

Dr. Larry Caplin is a dentist. He's made his mission to get more poor kids into the dentist's chair for less. He is the CEO of the Oral Health Impact Project. Dr. Caplin, welcome to the program.

Dr. LARRY CAPLIN (CEO, Oral Health Impact Project): Thank you, Tony. I appreciate you having me on.

COX: Let's talk about Deamonte Driver first, the 12-year-old boy from Baltimore. For you, his story is a classic example of the system failing to meet the needs of the underprivileged, isn't it?

Dr. CAPLIN: Absolutely. It failed at all levels. The failure started prior to Deamonte even being born, and that was with his parents not having any education into oral health care and what should be available or should be expected for him. So when he was being raised, he wasn't being taught any of what he needed to know. From there, the problems went into actually being able to have access to care for people that are disadvantaged, and that is just an ongoing problem nationally that is starting to finally get some attention and starting to get some legislative movement.

COX: Let's talk about this problem from the standpoint of the dentist, because we mentioned in the introduction that some are reluctant, perhaps, to deal with patients who are not able to pay or to demonstrate their ability to pay, and that sometimes a dentist has a predisposition toward these kinds of underprivileged patients.

Dr. CAPLIN: Well, statistically, the Center for Disease Control did a study of over about 30 states. And what they found were that about 16 percent of the dentists nationally are invested in treating this population. So that means 84 percent clearly are not going to see these patients at all. Part of that problem is the predisposition of the dentists not just based on what they're assuming that the patients want, but they're also regarding the system as a whole.

The Medicaid system, historically, has paid so poorly and with such administrative challenges that it wasn't worth the dentist's involvement. So they chose to just not be involved in it, and have separated themselves from the system. At the same time, though, many of those dentists have chosen to provide care for free for the population, as opposed to dealing with the administrative burden and for what they considered to be just completely inadequate compensation.

COX: So this is a conundrum of sorts, I suppose. The dentist - the dental community, the professionals have issues with dealing with people who are unable to pay. And the people who are unable to pay are often not a part of the system because they can't pay or because they're not aware of the need to get dental care for children at an early age.

Dr. CAPLIN: Clearly. And the problem starts with education, and it's further enhanced by poor access, and is finally is wrapped up by an inability for compensation to get to the dentists for the services that they do perform.

So when you start to look at what that's turned into, you find that 65 percent of the third graders have had a history of dental decay. Forty percent of them have untreated decay. And we find that about 25 percent of the population represent about 80 percent of the overall disease.

And when we start to compound this with an inability to find someone to provide the care, you run into the situation with Deamonte Driver. And you have a circumstance where the parents aren't identifying the problem's need, and then once they identify it, there's nowhere for them to get service. And then the bureaucratic problems of a loss of coverage in the interim put off an appointment that would have saved his life.

And at the end of it, we end up having a 12-year-old boy who with - but for an $80 extraction dies, and we end up spending a quarter of a million dollars on multiple brain surgeries and 12 days in the hospital. So it is a clear catastrophic failure, but it really starts - it started a long time ago.

COX: We're told often that if you eat sweets, you're going to get tooth decay. Let's talk about the causes of tooth decay and the fact that, as I understand it, it's a communicable disease. Is that right?

Dr. CAPLIN: Absolutely. We - what most people - and this goes back to education - most people don't realize is if your child has a pacifier and it falls down and you decide to put it in your mouth and then put it in to the child's mouth, you've just inoculated the child with the bacteria you have in your mouth, which are the bacteria that cause the decay. Same thing with eating off of a spoon and then giving them the spoon. So we inoculate our children with that bacteria and communicate that disease from us to them. It's a concept that most people have missed.

It is a bacterial infection, and you mentioned that it's the single largest childhood disease. It's five times more prevalent than asthma. In schools, we've estimated that 51 million hours of school time is lost annually to dental visits and dental problems. So it's a problem where children aren't learning. They're missing time in school when they can't afford it. And clearly, where the children don't have the economic means to pay for the care, it's less and less available to them.

COX: Let's talk - as we bring this to a close, we've got about a minute left, doctor. You are trying through your organization to get more dentists involved and to bring the professionals closer to the people who need the help. How are you going about it?

Dr. CAPLIN: We created the Oral Health Impact Project, where we are involving ourselves in the education process. We're providing care at the schools themselves. So we're providing comprehensive care and creating a dental home for the children, and that dental home concept's important. At the same time, we are doing it in a way that is culturally sensitive and compassionate and working on infusing it into the education process.

The Oral Health Impact Project, if they wanted more information, they could go to the Web site, which is, and get more information. But there's a problem with number of dentists available. Therefore, we have difficulty with finding dentists who are interested in helping this population, and that of course has - impacts the access issue across the board. So we have difficulty finding dentists who are willing to help this population and provide this care onsite for these children, and we'd love help from any dentists that are interested in helping.

COX: Dr. Larry Caplin is CEO of the Oral Health Impact Project. He is currently stationed in Philadelphia and hoping to visit a city near you. He joined us from studios WHYY. Dr. Caplin, thank you so much for coming in.

Dr. CAPLIN: Thank you for having me.

Copyright © 2007 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.



Please keep your community civil. All comments must follow the Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

NPR thanks our sponsors

Become an NPR sponsor

Support comes from