Smiling in business is as important as getting paid, maybe even more so. If you have bad oral health, you may end up not only broke, but even sick or dead. Many Americans don’t see the dentist unless something is wrong, and 56 percent of those without dental insurance skip preventive treatment altogether.

Their reasons for delaying or forgoing care: high costs and lack of price transparency, according to the "2013 U.S. Survey of Dental Care Affordability and Accessibility." But like forgoing health care, neglecting oral health could be a costly exercise in denial. Preventive care can be expensive (unless you have a dental discount plan or go to a dental school for treatment), but it comes at a far lesser price than treatment after something goes wrong.

The Centers for Disease Control and Prevention estimate that more than 27 percent of U.S. adults ages 20 to 44 have untreated cavities. Minor cavities can turn into major problems, and what would have only required a filling can eventually require a root canal or extraction if left untreated. In addition to financial costs, pain and embarrassment often accompany dental problems, as well.

Few pains are as brutal as a toothache, and few imperfections make you more self-conscious than missing teeth. Not taking care of your teeth impacts more than your oral health, however. Studies have linked bad dental care to a variety of poor, and even deadly, health outcomes.

Barriers to dental services are a problem nationwide, with more than 47 million people in the U.S. living in places with difficult access to care. Low-income adults are almost twice as likely as those with higher incomes to have no dental care in the previous year, according to a 2008 study by the Kaiser Family Foundation.

Provisions of the Patient Protection and Affordable Care Act guarantee dental care for children, but not for adults, as one of the essential health benefits (EHBs). But only three states require it to be purchased—Kentucky, Nevada, and Washington. And without such care, adults already struggling to get by find that obvious dental problems—teeth that are missing, discolored, broken or badly crooked—often make their situation even harder.

Most people, including employers, make instant judgments based on appearance, which can prevent potential employers from recognizing possible assets. If workers or potential employee hires have a job that requires them to interact socially with the public, it’s almost impossible for them to get that job if they have visible dental issues. Many good entry-level customer service jobs are typically not available to people who lack the basic ability to smile.

The problem is partly based on appearance, but also on the health effects of poor dental care, which have been linked to heart disease, diabetes, prostate cancer, Alzheimers and stroke. Acute dental conditions cost nearly two days of work per year per 100 people in the U.S., the Centers for Disease Control and Prevention finds. Even employed adults lose more than 164 million hours of work because of oral health problems or dental visits.

Eighty percent of people are aware that postponing or delaying routine visits will cost them more money in the long run, according to a survey of more than 1,000 adults conducted by ORC International and commissioned by Aspen Dental Management, Inc. Among the other key findings of the survey:

More than half of survey respondents (53 percent) consider routine dental visits for exams and cleanings a "nice to have" that can be delayed.
Nearly one in five respondents (17 percent) would fix problems with their car ahead of addressing pain in their mouth.

Even more troubling is the number of health care dollars being spent at hospital emergency rooms for dental care. Americans who delay dental care face serious long-term dental problems. More than two million visits are made to hospital emergency rooms each year for dental pain, where treatment is nearly 10 times more expensive than the cost of preventive care.

The cost of emergency room visits for dental care is nearly $1 billion a year, according to the American Dental Association (ADA). Most hospitals don’t have the facilities or staff to provide comprehensive dental care, so many patients receive only antibiotics or pain medication without the underlying dental problem being addressed. In too many cases, the patient returns to the emergency room with the same problem—or worse.

This is a short-term fix with costly implications. A study sponsored by the Agency for Healthcare Research and Quality (AHRQ) found that uninsured patients made slightly more than 40 percent of all dental condition related ER visits. Most of the dental problems could have been addressed in less costly and more effective ways, or prevented altogether, with routine professional and home care, the researchers noted.

The lack of insurance or the means to pay for care, geographical isolation, poor diet and poor oral hygiene all contribute to the oral conditions that drive people to hospitals. Yet such patients seldom find actual dental care on the visits; only treatment with prescription medications.

Emergency departments are poorly equipped to deal definitively with dental and oral health needs, according to a separate research study by the Rutgers Center for Health Care Policy and the Rutgers School of Dental Medicine. The Rutgers team found that young adults, particularly those lacking insurance or those covered by Medicaid, were the biggest users. The researchers cited lack of dental providers as one of the primary issues driving this issue. The more practical reason is that dental care is expensive, and the majority of ER users don’t have the money to pay for good oral health.

Most people acquire their dental benefits through their employer. Although retirees and those on Medicare are typically without a dental plan, options are available to them through other private pay plans, including senior dental insurance plans, discount dental plans and Medicare Advantage or Supplement plans that include a dental benefit in the benefit design.

Employees are seeking dental care as a key benefit in their compensation, even if it’s a voluntary purchase. According to the Principal Financial Group, offering an employee benefits portfolio that includes dental can help attract and retain the best employees. Of employer groups with six to 49 employees offering dental benefits, 93 percent consider dental an essential or a differentiator in their employee benefit portfolio.

About 60 percent of Americans have some form of dental plan. Group coverage also includes public programs like Medicaid, the federal Children’s Health Insurance Program, and TriCare, which provides coverage for the military. While individual dental coverage is limited, it is a growing area of focus for many dental carriers.

There are about 127 million Americans without dental coverage; 2.67 times more than the medically uninsured. These individuals are more likely to have extractions and dentures and less likely to have restorative care or receive treatment for gum disease. In addition, those without dental benefits report higher incidences of other illness; are 67 percent more likely to have heart disease; 50 percent more likely to have osteoporosis; and 29 percent more likely to have diabetes. They also visit the dentist less frequently, missing the opportunity for prevention and early treatment.

Dental plans offer a number of attractive benefits for both employers and employees. Dental plans vary by vendor and in some cases are customizable, based on the specific needs of employees and the size of the business. Your dental plan should also offer dental education for your employees, including on-site lunch-and-learns on important oral health topics, host Q&A sessions, participation in company health fairs, special education events geared to children, adults or senior citizens, and provide informational brochures and literature. The ADA gives Americans a “D” grade in oral health understanding, so there's plenty of room for improvement.

In 2014, a research study was completed by Cigna that aimed to identify key reasons employees don’t use their dental benefits. Researchers found that the three most common reasons people avoided their dental check-ups was a current lack of pain, dental anxiety, and cost. The study also concluded that although people know their oral health is connected to their overall health, they don’t understand why. This creates an opportunity for employers to educate their staff about the importance of regular dental care. With rising health care costs, it's more important than ever for everyone to think about their health in a preventative manner.

Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care and experience greater overall health. Access to dental care is improved with dental benefits, and dental care improves oral health. Americans also need more oral health education. Given increasing connections between oral and overall health, dental coverage is critical for everyone, including employers.

Instant Insights /

Dental coverage is key to a healthy smile (and company)

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