> ## Content Index > Fetch the complete content index at: https://inside-systems.ghost.io/llms.txt > Use this file to discover other available public pages before exploring further. # Your teeth were left out from the start - URL: https://inside-systems.ghost.io/your-teeth-were-left-out-from-the-start/ - Published: 2026-08-28T12:12:06.000Z - Updated: 2026-08-28T12:32:57.000Z - Author: Wendell Hollifield One line, written in 1965, decides where you end up at two in the morning. ![An oil painting of a kitchen table late at night: a small pill bottle, an unopened blister pack, a half-drunk glass of water and a folded pharmacy slip under a single lamp.](https://beehiiv-images-production.s3.amazonaws.com/uploads/asset/file/ed2cbe48-dda6-4695-8a67-9f616c50ffb3/imgonline-com-ua-Resize-Vys3MwRw0rxcir.jpg?t=1787667387) Hi, it's Lily. Tuesdays are mine now. Wendell has the rest of the week, and I've been told to stay on the body. That suits me. I want to start with a sentence I found last Thursday and have been irritated by ever since. Medicare doesn't cover your teeth because [a line in the 1965 law says it doesn't](https://www.cms.gov/medicare/coverage/dental?ref=inside-systems.ghost.io). Section 1862(a)(12). It excludes the care, treatment, filling, removal and replacement of teeth, along with the structures that hold them in place. No gap opened up over time here. It went in at the start and has sat there for sixty years. There are narrow exceptions, and they're worth knowing. Medicare will pay for dental work tied to something else it covers. An extraction before a heart valve is replaced. A check of the mouth before a transplant, or before dialysis starts. But that's the mouth being cleared out of the way. The tooth itself has never once been the point. So what happens instead A tooth doesn't stop hurting because the law says so. And that kind of pain won't wait until Monday. [Just under two million emergency department visits a year](https://www.cdc.gov/nchs/products/databriefs/db531.htm?ref=inside-systems.ghost.io) in this country are for tooth disorders. That's the CDC's figure, averaged across 2020 to 2022\. It covers every age, and the biggest group is people in their late twenties. Older adults are in there too. For them the arithmetic goes somewhere strange. Paid for by Medicare, 2018 213,700 emergency visits for dental problems Cost per visit $1,100+ for a room that cannot treat the tooth Those are the numbers [two health policy researchers put in front of Health Affairs](https://www.healthaffairs.org/content/forefront/rethinking-medicare-s-medically-necessary-dental-coverage?ref=inside-systems.ghost.io). Medicare paid, and paid properly. An emergency room is medical care, and medical care is covered. What an emergency department can offer a tooth is a look at it, an antibiotic, and something for the pain. There's usually no dentist on the premises, and no chair to put anyone in. So what the tooth actually needs done to it doesn't get done. The thing that started all this stays where it was. Which is why close to 40% of people end up back in that same room with that same tooth, [by the dental association's count](https://www.ada.org/resources/community-initiatives/action-for-dental-health?ref=inside-systems.ghost.io). The same researchers mention something else, which I read twice and then sat back from. In 2013, three hundred and twenty-nine older adults died while admitted to hospital for a dental problem. A tooth is not a small thing that got out of hand. It has a blood supply and it sits a short distance from places infection should never reach. So the programme pays eleven hundred dollars for the room where nothing can be fixed. And nothing at all for the chair where it can. I keep turning that over, looking for the part I've misread. I don't think there is one. It's what the law says, working the way it was written. What I'd want somebody to have told me If a tooth has started up and you've no dental cover, the emergency room is the wrong door. One exception matters. Swelling that's moving — up towards the eye, down under the jaw, or anything touching your breathing or your swallowing. A fever alongside it counts too. That's an emergency in the proper sense, and you go. Otherwise you're paying for a visit that ends with a prescription and the same tooth. The right door costs less than most people expect. Federally funded community health centres do dental care on a sliding scale, tied to what you earn. Most states also have dental school clinics. There the work is done by students, watched over by their teachers — slowly, and for a fraction of the price. Neither is advertised and both take some ringing round, so find yours now. On a Tuesday afternoon in August, with the number written down somewhere you'll come across it. Not at two in the morning with your face swollen and your judgement gone. Yours, Lily **P.S.** The 1965 exclusion covers teeth “or structures directly supporting the teeth”. That phrase does an enormous amount of work. It's the reason a jaw rebuilt after a tumour is covered, while a jaw wrecked by a bad tooth often isn't. Same bone. Different cause, different answer. Sources [Medicare dental coverage — the statutory exclusion and its exceptions](https://www.cms.gov/medicare/coverage/dental?ref=inside-systems.ghost.io) · Centers for Medicare & Medicaid Services [Emergency Department Visits for Tooth Disorders: United States, 2020–2022](https://www.cdc.gov/nchs/products/databriefs/db531.htm?ref=inside-systems.ghost.io) · National Center for Health Statistics, CDC [Rethinking Medicare's “Medically Necessary” Dental Coverage](https://www.healthaffairs.org/content/forefront/rethinking-medicare-s-medically-necessary-dental-coverage?ref=inside-systems.ghost.io) · Health Affairs Forefront [Action for Dental Health — emergency department referrals](https://www.ada.org/resources/community-initiatives/action-for-dental-health?ref=inside-systems.ghost.io) · American Dental Association Coverage rules and figures change. Nothing here is medical or legal advice — this letter reports what the statute excludes and where the official information is published.