Emma Snuggs’ smile is still a white flash of straight teeth, though it has been nearly two years since she last had money to visit a dentist.
“You have to choose the necessities,” said Snuggs, 26.
On Monday afternoon, though, she watched as her son Michael Hunsaker, 7, had his teeth checked at the Sacramento Native American Health Center on J Street.
Michael is covered by Denti-Cal, the dental arm of the state’s public insurance program, Medi-Cal.
Snuggs, a single mother and a student at Sacramento City College, is on Medi-Cal as well. But last July the state cut dental services for adults in a move that was expected to save $115 million.
Now, Snuggs is one of millions of California adults without dental insurance. Some had their Denti-Cal benefits taken away. Others are among the working poor who receive no dental benefits through their jobs.
They make up a population of Californians whose oral health – and overall health as a result – is at risk of a dangerous decline.
A variety of studies have found a correlation between oral infections and ailments such as heart disease, stroke and diabetes, according to the federal Centers for Disease Control and Prevention. In people with depressed immune systems, bacteria from oral infections can spread into the bloodstream.
“Dental disease often progresses slowly, so when people stop going to the dentist, they don’t get in trouble right away,” said Paul Glassman, director of community programs at University of the Pacific’s School of Dentistry.
“We’re sitting on a little bit of a ticking time bomb that’s going to manifest itself some years down the road.”
About 16 million adults in the state don’t have dental insurance, said Anthony Wright, executive director of Health Access California. They have to buy insurance or pay for services out of pocket.
Many, like Snuggs, don’t see either as a possibility.
Inability to pay for care will lead to more people ignoring cavities and oral infections until they need emergency treatment, Glassman said. It’s a big health risk, and it could also hurt the patient financially.
Treating an abscessed tooth at a dental office costs around $250. An emergency room visit for dental problems could cost thousands of dollars, said a Sacramento County doctor at a county Board of Supervisors meeting Tuesday.
The Native American clinic is the only one in Sacramento right now offering full dental services. It charges adults on an income-based sliding scale but turns no one away in case of emergency, said director Britta Guerrero.
Four or five people with dental emergencies usually walk through its doors each day.
Patients often “show up needing three or more teeth pulled, or have one or more abscessed teeth,” Guerrero said.
Ron Brown, a glazer who lives in Rancho Cordova, has never been to the clinic. He wakes up every day with his mouth throbbing from three abscesses – molars that are rotting away – but says he can’t afford to get them fixed.
Denti-Cal still pays for adults with “emergency cases,” but the state defines that as extractions only, said Marty Keale, executive director of the Capitol Community Health Network.
Brown, 31, chooses to live with the pain.
“I don’t want to get them pulled out and lose all my molars,” he said.
He has little help coming on the federal level. Health care reform requires that all people up to age 21 have dental coverage and provides funding for oral health education, but it says nothing about coverage for adults.
The federal legislation could assist indirectly, by providing subsidies for overall health care coverage. That could conceivably free up more money for people to spend on their teeth.
But Richard Ragudo, 33, a Sacramento City College student who also runs a non-profit serving inner city youths, wonders how many low- or moderate-income adults would use this extra money for insurance.
If money weren’t an issue, Ragudo said, he would fix an infected molar, replace a missing tooth, repair his multiple chipped teeth and maybe splurge on a cleaning.
As things are, he has more basic worries.
“Will I be able to pay my phone bill to call my kids that I have every other week? Will I be able to afford materials for classes? It’s some real-life choices I’m having to make.”
For Emma Snuggs, her son’s oral health is a priority. It helps that Michael still has Denti-Cal, although coverage doesn’t always mean care for children, according to a study by Sacramento consulting firm Barbara Aved Associates.
Sacramento County children on Denti-Cal often have trouble just getting to the dentist for appointments – be it from lack of transportation or the fact that many families don’t know the importance of oral health, the study found.
At the same time, many dentists don’t take Denti-Cal patients because the program is not user-friendly and pays 40 percent of normal fees at best, Barbara Aved said.
Those offices that do take it can be overwhelmed by demand. After Snuggs reapplied for Medi-Cal last July, she had trouble getting Michael into the dental clinic where they were first referred.
They found the Native American clinic soon after. Now, Michael gets dental care almost every other week – “catch-up” after a year with no care at all.
For her own teeth, Snuggs uses traditional Native American treatments along with modern home care, and hopes she doesn’t develop any problems. She is making sure that Michael’s mouth is healthy before she starts paying for her own dental visits.
There, she sees no choice.
“My teeth come second to his,” Snuggs said. “My health comes second to his.”
