By Vijeta Limbekar

shutterstock_110116076“The dentist told me I had to get two of my teeth pulled a while ago.  I didn’t have the money to replace them, and frankly, I’d like to keep the few teeth I have.   I can’t even remember the last time I smiled. ”

This was Diane’s story, a Boston resident who was in desperate need of dental care.  She called me at BPHC’s Office of Oral Health seeking assistance and guidance in making a tough decision.  Either she kept the severely decayed teeth she had remaining and risk the high chance of further infections, or she could have them extracted, leaving her with even fewer teeth.  Sadly, this is the kind story that I hear on a regular basis from residents who call the Boston Public Health Commission’s Office of Oral Health.

Diane, like many Boston residents in need of oral health care, was older, of low income, and on MassHealth.  During the recession of 2008, the state legislature cut MassHealth adult dental benefits, leaving 86,000 residents like Diane with incomplete dental coverage.  Although some MassHealth benefits, such as all fillings, extractions, and x-rays, have since been restored it is far from comprehensive.  MassHealth still fails to cover root canals, partials, dentures, and teeth implants that are necessities for older adults like Diane.  These procedures are labeled as “cosmetic,” which translates to expensive, out-of-pocket costs.  This was Diane’s reality.

Boston is lucky to have eighteen community health centers that have dental clinics, and two dental schools that provide care to low income residents.  The community health centers offer dental services at reduced rates, and patients can pay on a sliding scale based on their income.

However, there are still problems with access to dental services for lower income Boston residents.  Often times, the community health centers are booked for months, leaving patients like Diane suffering.   Even when Diane is finally able to be seen, she may be left with a financial burden.

Oral health issues are often overlooked, underappreciated, and underfunded.   Oral health doesn’t only impact the mouth; it is linked to the body’s overall health.  Bacterial infections in the mouth can travel to other vital areas in the body, and have been linked to issues such as stroke, cardiovascular disease, and diabetes.

The system needs to change.  First, there needs to be a focus on prevention.  Most of the severe oral health issues that stem from bacterial infections can be prevented through proper oral health hygiene.   Next, the legislature should restore full MassHealth adult dental benefits, including root canals, bridges, implants and dentures.  Finally, people must be able to access care in a timely fashion.  Accessibility to care means increasing the number of dentists to support the growing patient loads, and to have dentists that accept more MassHealth patients.  Currently, MassHealth reimbursements rates are so low that it leaves dentist at an economic disadvantage to take MassHealth patients on.

Oral Health is critical to overall health, and it’s time that we treat it as such.  Contact your local elected officials to discuss your concerns.  If you are not sure who your local representative is, visit

Together, with your support we can improve Boston’s oral health climate!

Vijeta is the Manager of the Office of Oral Health at the Boston Public Health Commission.