Dental care during a recession.

he recent downturn in the economy has had far reaching effects on the lives of just about every American. This is particularly true in North Carolina as our state has been cited as having the third highest unemployment rate in the nation. Businesses have been forced to implement employee layoffs and other cost savings measures in order to survive. The increasing unemployment rate, along with a precipitous drop in consumer confidence, has had a negative impact on the utilization of dental services. As consumers become more concerned about their economic future, they become less likely to spend money on any product or service that is not considered to be essential. For many people, dentistry falls into this “elective” category. Since consumer spending is the major driving force in our economy, tighter wallets create a ripple effect, driving down revenue in both the private and public sector. A patient who has lost his or her job is more likely to cancel or postpone dental visits. This is especially true if their job loss also meant the loss of their dental benefits. While dentists in private practice are re-evaluating their business plans to determine how they will weather the storm, state government officials and members of theNorth CarolinaGeneral Assembly are struggling to balance a state budget projected to have a $4 billion shortfall. In order to create a balanced budget, lawmakers are proposing funding cuts that could unravel the carefully woven safety net programs developed to provide health care for the underserved. For families in the midst of a financial crisis, a decision to cancel dental appointments or to postpone dental care until their financial situation improves seems to be logical. However, that decision carries certain risks. Failure to maintain regular preventive care visits definitely savesmoney in the short-term, but it also deprives the patient of the opportunity for their dentist to diagnose dental disease in its early stages, when treatment is not only more straightforward but also less expensive. Research and experience indicate thatmost dental diseases do not go away without definitive treatment. In fact, without treatment many get progressively worse. As the disease process advances, treatment becomesmore complex, requiring procedures with a commensurately higher fee. Unfortunately, some patients delay treatment to the point that the tooth becomes nonrestorable and must be removed. Patients facing problems accessing dental care, whether those barriers are financial or geographic, are experiencing additional challenges due to the economic downturn. In fact, some have been placed in triple jeopardy: (1) they have lost their job, which means less or no income; (2) with the loss of their job, they may have also lost any dental benefits which were a part of employment arrangements; and (3) several