The healthcare gap: how can a child die of toothache in the US?
When a 12-year-old boy lost his life as a result of an untreated tooth abscess in Maryland in 2007, his story revealed how hard it can be for people on low incomes to get the dental care they are entitled to
On 11 January 2007, about 30 miles from Baltimore, a boy named Deamonte Driver a normally energetic child came home from school not feeling well. He kept complaining of a headache, his mother, Alyce Driver, said. His grandmother took him to Southern Maryland Hospital Center, not far from semi-rural Brandywine, where his grandparents red-and-white trailer home stood in the patchy shade of a grove of trees. He was given medicines for headache, sinusitis and a dental abscess. The following day, a Thursday, Deamonte went back to school.
That Friday he was worse, his mother said. He couldnt talk. She took him to Prince Georges County Hospital Center, where Deamonte received a spinal tap and a CT scan. They said he had meningitis, said Alyce. The child was rushed to the Childrens National Medical Center in Washington DC, where he underwent emergency brain surgery. They said the infection was on the left side of his brain. They had to remove a bone.
On Saturday, Deamonte started having seizures. The infection came back, Alyce said. They had to go back in.
Deamonte required brain surgery again, and this time the abscessed tooth was removed too. It was a molar on the upper-left side of his mouth: a so-called six-year molar, one of the first permanent teeth to erupt when baby teeth are shed, and particularly vulnerable to decay. This tooth was ruined, infected to the core. Bacteria from the abscess had spread to the boys brain. Alyce remembered a doctor telling her: This kid is fighting for his life. Her world, which was fraught with struggle on the best of days (she had been coping with homelessness since leaving a violent relationship), seemed to fall apart.
The extended family gathered around Deamontes bed and appealed to heaven. They called upon Jesus and asked him to save the boy. He slept for two days straight. I said, is my baby ever going to wake up?
Finally, Deamonte opened his eyes.
After more than two weeks at Childrens National, he was moved to the nearby Hospital for Sick Children, where he began an additional six weeks of medical treatment. He received physical and occupational therapy, did schoolwork, and enjoyed visits from his mother, his brothers and teachers from his school.
Yet Deamontes eyes seemed to be weak, his mother said, and his complexion got darker. On Saturday 24 February, he refused to eat but still seemed happy. He and his mother played cards and watched a show on television, lying together on his hospital bed. After she left him that evening, he called her and said: Make sure you pray before you go to sleep.
Next morning she got another call. Deamonte was unresponsive. Alyce found a ride back to the hospital.
When I got there, she said, my baby was gone.
In the 21st century, thanks to professional care and advances in antibiotics and water fluoridation, reports of death by dental infection in the US are mercifully rare. But in Baltimore, experts at the University of Maryland School of Dentistry were not so surprised that a child had died, having regularly seen the grave consequences of rampant oral disease. They knew that people with good jobs and dental benefits had access to the American dental care system but they also knew that people who were poor or working poor or underinsured, or who relied upon Medicaid, or who had no benefits of any kind, were often shut out.
Untreated cavities were common among the half a million poor, Medicaid-reliant children in Maryland, who included Alyce Drivers boys. According to a study by the University of Maryland dental school, the pain of untreated cavities made 8% of these children cry but Deamonte Driver did not complain about his teeth, his mother said. Maybe he felt that it was futile to complain. Or maybe he just took the pain for granted.
Deamonte had grown up in poverty, but in the shadow of great wealth and power. His grandparents home in Prince Georges County was about a dozen miles from Washington DC, the US capital. The state of Maryland is rich one of the richest states in the nation.