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

Their reasons for delaying or forgoing care: high costs and lackof price transparency, according to the "2013 U.S. Survey ofDental Care Affordability and Accessibility." But likeforgoing health care, neglecting oral health could be a costlyexercise in denial. Preventive care can be expensive (unless youhave a dental discount plan or go to a dental school fortreatment), but it comes at a far lesser price than treatment aftersomething goes wrong.

The Centers for Disease Control andPrevention estimate that more than 27 percent of U.S. adultsages 20 to 44 have untreated cavities. Minor cavities can turn into majorproblems, and what would have only required a filling caneventually require a root canal or extraction if leftuntreated. In addition to financial costs, pain andembarrassment often accompany dental problems, as well.

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

Barriers to dental services are a problem nationwide, with morethan 47 million people in the U.S. living in places with difficultaccess to care. Low-income adults are almost twice as likely asthose with higher incomes to have no dental care in the previousyear, according to a 2008 study by the Kaiser FamilyFoundation.

Provisions of the Patient Protection and Affordable Care Actguarantee dental care for children, but not for adults, as one ofthe essential health benefits (EHBs). But only three states requireit to be purchased—Kentucky, Nevada, and Washington. And withoutsuch care, adults already struggling to get by find that obviousdental problems—teeth that are missing, discolored, broken or badlycrooked—often make their situation even harder.

Most people, including employers, make instant judgments basedon appearance, which can prevent potential employers fromrecognizing possible assets. If workers or potential employee hireshave a job that requires them to interact socially with the public,it’s almost impossible for them to get that job if they havevisible dental issues. Many good entry-level customer service jobsare typically not available to people who lack the basic ability tosmile.

The problem is partly based on appearance, but also on thehealth effects of poor dental care, which have been linked to heartdisease, diabetes, prostate cancer, Alzheimers and stroke.Acute dental conditions cost nearly two days of work per year per100 people in the U.S., the Centers for Disease Control andPrevention finds. Even employed adults lose more than 164 millionhours of work because of oral health problems or dental visits.

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

• More than half of survey respondents (53 percent) considerroutine dental visits for exams and cleanings a "nice to have" thatcan be delayed.

• Nearly one in five respondents (17 percent) would fix problemswith their car ahead of addressing pain in their mouth.

Even more troubling is the number of health care dollars beingspent at hospital emergency rooms for dental care. Americanswho delay dental care face serious long-term dental problems. Morethan two million visits are made to hospital emergency rooms eachyear for dental pain, where treatment is nearly 10 times moreexpensive than the cost of preventive care.

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

This is a short-term fix with costly implications. A studysponsored by the Agency for Healthcare Research and Quality (AHRQ)found that uninsured patients made slightly more than 40 percent ofall dental condition related ER visits. Most of the dental problemscould 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, geographicalisolation, poor diet and poor oral hygiene all contribute to theoral conditions that drive people to hospitals. Yet such patientsseldom find actual dental care on the visits; only treatment withprescription medications.

Emergency departments are poorly equipped to deal definitivelywith dental and oral health needs, according to a separate researchstudy by the Rutgers Center for Health Care Policy and the RutgersSchool of Dental Medicine. The Rutgers team found that youngadults, particularly those lacking insurance or those covered byMedicaid, were the biggest users. The researchers cited lack ofdental providers as one of the primary issues driving this issue.The more practical reason is that dental care is expensive, and themajority of ER users don’t have the money to pay for good oralhealth.

Most people acquire their dental benefits through theiremployer. Although retirees and those on Medicare are typicallywithout a dental plan, options are available to them through otherprivate pay plans, including senior dental insurance plans,discount dental plans and Medicare Advantage or Supplement plansthat include a dental benefit in the benefit design.

Employees are seeking dental care as a key benefit in theircompensation, even if it’s a voluntary purchase. According to thePrincipal Financial Group, offering an employee benefits portfoliothat includes dental can help attract and retain the best employees. Of employer groups with sixto 49 employees offering dental benefits, 93 percent considerdental an essential or a differentiator in their employee benefitportfolio.

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

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

Dental plans offer a number of attractive benefits for bothemployers and employees. Dental plans vary by vendor and in somecases are customizable, based on the specific needs of employeesand the size of the business. Your dental plan should also offerdental education for your employees, including on-sitelunch-and-learns on important oral health topics, host Q&Asessions, participation in company health fairs, special educationevents geared to children, adults or senior citizens, and provideinformational brochures and literature. The ADA gives Americans a“D” grade in oral health understanding, so there's plenty of roomfor improvement.

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

Americans with dental benefits are more likely to go to thedentist, take their children to the dentist, receive restorativecare and experience greater overall health. Access to dental careis improved with dental benefits, and dental care improves oralhealth. Americans also need more oral health education. Givenincreasing connections between oral and overall health, dentalcoverage is critical for everyone, including employers.