Dr. Frazier Moore, the dental director at Watts Health Clinic, isn't trying to fool anybody about the popularity of his trade. He's actually surprisingly honest about it.
"We provide a service no one really wants," he said with a knowing smile. "But eventually they have to come see us."
Moore's department tends to a patient population that's scattered throughout South Los Angeles and in dire need of dental care.
"The most common problem is tooth decay," he said. "We see that from early childhood all the way to adulthood."
Part of the reason is that people don't come in for preventive care. They only come "when they're in pain," explains Moore – for "acute, episodic care."
"The whole thing about preventive dentistry is not really something at the front of patients' mind to get routine care," said William Hobson, the president and CEO of the clinic and Watts Healthcare Corporation. "That's what's needed."
A worldwide problem
A new U.K.-based study published in the Journal of Dental Research estimates that nearly 4 billion people worldwide have "untreated oral conditions." That's more than half the international population.
Researchers found that dental cavities were the most common of 291 major diseases and injuries in 2010, affecting 35 percent of the world's population.
"There are close to 4 billion people in the world who suffer from untreated oral health conditions that cause toothache and prevent them from eating and possibly sleeping properly, which is a disability," said Professor Wagner Marcenes, the study's head researcher, in a statement. "This total does not even include small cavities or mild gum diseases, so we are facing serious problems in the population's oral health."
The study found that between 1990 and 2010, the global burden of oral disease rose 20 percent, mostly because of population growth and aging.
The access obstacle
Preventive care could alleviate a good number of those problems. But Dr. Moore says in addition to not wanting to come in to the dentist's office, or not thinking about it, many patients in the South L.A. area simply can't.
"The numbers are overwhelming for us," he said. While Watts Health Clinic will give same-day care to anyone who comes in complaining of pain, the staff has to be a bit more methodical in scheduling routine preventive care.
"We open up our schedules two months at a time, and we tell our patients to call in on the first of that particular month," said Moore. "Appointments are gone within four hours."
Watts and some of the area's other federally-qualified health centers offer dental services; so does L.A. County, to some extent. But safety-net dental care is difficult to find. The latest data from the county's public health department says in South L.A., nearly 15 percent of children and 35 percent of adults didn't obtain dental care over the previous year because they couldn't afford it.
In 2012, Watts' dental wing tended to nearly 4,500 patients over more than 12,600 appointments. Of those, 88 percent were at or below poverty, and 67 percent were either uninsured or on Medi-Cal.
Hobson, the CEO, says they can take care of most Medi-Cal patients, and can find programs to help cover the uninsured. But plenty of other people in the area get "priced out of dental care," he said.
"We don't turn anyone away because they can't pay," Hobson said.
Moore attributes the high rate of dental decay in the area to two factors: "poor nutritional choices and just a lot of neglect."
Poor nutritional choices refers in big part to overconsumption of sugar, and sugary drinks in particular, he said. But the reasons for neglect are a bit more complicated.
"People still have this concept of dentistry being such a painful visit," Moore said. "I'm not saying an injection is comfortable, but with our techniques now we make it pretty [non-traumatic]."
He described a few misconceptions he's heard regarding dental care: that the baby teeth don't matter because they're going to fall out anyway, or that people only need to come to the dentist when they're in pain.
One of the older myths Moore doesn't hear much of anymore is where women who'd just given birth would attribute rotten teeth to the fact that their bodies were taking calcium away from their teeth so it could nourish their unborn babies.
The goal is getting patients into a preventive mindset when it comes to dental health, he said.
"It's just getting them to understand that, if they can get in early enough, we can restore these teeth and they don't wind up seeing me," said Moore. He's an oral surgeon, and when he sees patients, it's almost always for a tooth extraction.
That means young children – babies, too – should start seeing a dentist as soon as possible, he said.
"A good portion of our patient population probably feels that their primary care on the medical side would be at a higher [priority] level than the oral health care," said Moore. "That's another thing we're trying to educate the population on: You can't separate the two."
Moore explained that "there's definitely a correlation between oral health and general health," noting, for example, that diabetics have a much harder time fighting off oral infections.
The Journal of Dental Research study was carried out as part of a study on the global burden of disease, injury and risk factors.