Sooyun Christina Kim, Amreet Minhas, Beatrice Sixt
Project Smile Global
August 28, 2024
National Tooth Fairy Day is celebrated twice a year on February 28th and August 22nd, reflecting its beloved global relevance. The celebration allows children to make positive associations with their teeth, cultivating positive oral health habits (Dias and Neves 1). As such a widely celebrated day, it is only natural that it can be affected by external factors, such as economic trends. Inflation has affected tooth fairy givings, where a few generations ago, the typical amount left was 10 cents, then 25, and now, the average has risen to almost $4 for a singular tooth (Bennett). This drastic change illustrates how inflation can affect oral health by affecting the spending patterns of households, limiting funds for dental visits, and insurance coverage. Inflation also varies across the income distribution, exacerbating socioeconomic disparities and widening the gap to equitable oral healthcare.
Inflation has significantly affected consumer spending patterns, with the most notable repercussions centered on oral health. Rising costs of essentials such as food, housing, and utilities force lower-income households to prioritize immediate expenses, foregoing preventative dental checkups or necessary treatment (Guay and Blatz 287). For example, prices for food rose 12% and energy prices rose 42% between June 2021 and June 2022, marking the largest 12-month inflationary increase since the 1980s (Dhar et al.). In parallel, medical care prices typically outpace growth in the rest of the economy; since 2000, the price of medical care — including insurance, drugs, and medical equipment — outpaced overall economic growth, rising 121.3% while prices for all consumer goods and services rose 86.1% (Rakshit et al.). The combination of increasing costs and shrinking budgets tends to result in people delaying or avoiding dental visits, exacerbating oral health issues that eventually lead to more extensive and costly treatment; this creates a vicious cycle of rapidly increasing the financial burden of oral health (Dhar et al.). Additionally, during economic downturns, dental care is pushed aside compared to other healthcare needs; for instance, household expenditure on dental care decreased 10% from 2007 to 2012, while average healthcare expenditure increased 4% (Hung et al. 7).
Fig. 1. Rakshit et al, Percent Change in Consumer Price Index for Medical Care and for All Goods and Services, 2024
Inflation also varies across income distribution, with low-income households disproportionately facing harder economic challenges. During the COVID-19 pandemic, these households experienced an inflation rate of 1.12% in May 2020, compared to 0.57% of high-income families (Jaravel 609). This disparity further widens the gap between income levels in accessing timely and quality dental care (Dhar et al.). As mentioned earlier, inflation has also affected tooth fairy givings, with low-income households decreasing monetary gifts to prioritize more immediate expenses. This is worrying as people from low-socioeconomic backgrounds tend to experience higher dental anxiety, and helping children mitigate that fear through positive experiences with the tooth fairy is crucial (Dias and Neves. 1). Tools like the Tooth Fairy Calculator—where parents input variables including household income, education, and family size to determine the monetary value of a tooth—further highlight socioeconomic disparities in seemingly trivial traditions (Toumba 277). Ultimately, inflation not only reshapes expenditure patterns, but also disproportionately affects low-income households, deepening the divide in oral health access.
While many patients rely on insurance to cover dental care needs, cost remains the primary barrier to accessing adequate dental care (Vujicic et al. 2178). The results of this 2016 study indicated that this challenge applied to the majority of American adults, regardless of factors such as age or income (Vujicic et al. 2178). This conclusion was echoed in a report from earlier this year, outlining that dental care was most likely to be delayed or avoided in comparison to other health services due to associated expenses (Lopes et al.). Increased out-of-pocket costs in regards to healthcare can be attributed in part to higher demand for thorough preventative care and medications, specifically observed during and after the COVID-19 pandemic (Narita, 281; Choi et al., “Covid-19: Dental Care and Oral Health” 256). Additionally, this can further compromise the health of younger patients—a demographic that has experienced a notable increase in hospital visits related to dental care (Vujicic et al. 2179), as insurance tends to be more costly for young adults (Moss).
Another factor contributing to avoidance of dental care is healthcare debt. It was found that at present, approximately 41% of American adults have debt associated with medical or dental expenses (Lopes et al.). Coupled with increased cost of living, healthcare debt can generate more hesitancy towards seeking care, which can worsen oral health or preexisting conditions (Lopes et al.; Vujicic et al. 2181). If routine care is not maintained, serious issues can occur, which often result in a higher cost than initial preventative measures (Narita, 283; Vujicic et al. 2179). As dental insurance typically offers limited coverage, patients are often responsible for a large portion of their dental bills, leading to deferred care as they prioritize paying off existing debt (Vujicic et al. 2176; Lopes et al). This cycle of delayed care and increasing cost only intensifies against the backdrop of inflation, as patients are forced to prioritize everyday expenses over healthcare needs. This illustrates the well-known divide between health insurance and dental insurance (Choi et al., “Covid-19: Dental Care and Oral Health” 256). Dental insurance, especially government-funded plans, tend to be limited in scope, often covering only basic services such as cleanings, X-rays, and a certain number of fillings (Vujicic et al. 2179-2180). More complex procedures, such as crowns or root canals usually come with significant out-of-pocket costs, or may not be covered at all (Vujicic et al. 2179).
As covered earlier, the rising cost of essentials including housing, food, and transportation translates to less disposable income to allocate toward dental care. Simultaneously, inflation leads to higher insurance costs, both for health and dental coverage, which can be attributed to various factors. For example, increased stress is associated with periods of inflation (Duffy). In a stressed state, conditions such as bruxism or dental caries can arise, along with serious conditions such as gum disease, which can result from neglect due to stress and poor mental health (Choi et al., “Covid-19: Dental Care and Oral Health” 256). These conditions can lead to the occurrence of more stress-related illnesses, which can affect the number of claims made and the consequent insurance rate (Choi et al., “Covid-19: Dental Care and Oral Health” 257; Rakshit et al.).
The impact of inflation on oral health varies based on socioeconomic status and race. Those in low income communities and racial minorities already face higher rates of untreated dental disease, such as tooth decay (Choi et al. Race, Ethnicity, and SES on Tooth Decay pp. 1-13). A study observed large disparities among this issue, with Black and Hispanic children having much higher risks opposed to their White counterparts, mainly caused by insurance (Choi et al. Race, Ethnicity, and SES on Tooth Decay pp. 1-13). Insurance coverage gaps are large, with Black and Hispanic populations being two to three times more likely to be uninsured compared to White populations (Institute of Medicine (US) Committee on the Consequences of Uninsurance). Insurance type, which is largely impacted by socioeconomic status, also proved to be a factor (Hung et al.). Hung and colleagues observed that those with private insurance also had very high dental expenditure and closely matched the geriatric population. Those with public health insurance spent substantially less in dental care than those with private health insurance. Lastly, those who were widowed and those who were divorced experienced greater fluctuations in spending, with the most significant changes occuring in the past two decades.
In combination with this, the economic decline and rising costs make oral health much more difficult. These issues have more severe consequences for these communities, as seen at times such as the 2020 pandemic era recession, where higher rates of financial hardship were prevalent compared to White adults, as well as overall hardship (Alhomsi et al. 454). During previous recessions, such as the 2008 housing crisis, these disparities can also be seen (Manski et al.). At this time, low and middle class households were more likely to have lost 50% of their wealth, corresponding with a staggering 75% increase in the likelihood to stop dental care service use. Larger households, widowed or divorced adults, non-college graduates, and Black adults—all groups that face greater burdens or challenges—were also more likely to cease the use of dental care services (Manski et al).
Fig. 2. Hung et al, Annual Average Dental Care Expenditure Per Person Across Subgroups in the United States, 2020
In conclusion, inflation deeply impacts oral health worldwide. The effect of inflation on cost of living and everyday expenses force households to change their spending patterns, consequently delaying or forgoing dental visits entirely, potentially causing or exacerbating oral health issues. While private insurance can cover certain procedures and treatments, the coverage available through public insurance falls short in scope. The occurrence of stress-related health issues associated with economic inflation can also influence oral health, further contributing to the vicious cycle of delayed treatment and mounting healthcare debt. The effects vary based on outside factors as well, such as socioeconomic status and racial and ethnic background, with low income and minority groups feeling more intense repercussions as a result of these changes, amplifying existing health disparities.
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