Appalachia states are reportedly dealing with a myriad of health problems including smoking, chewing tobacco, opioid addiction and "Mountain Dew mouth," which is when the acid from sugary soda drinks erodes the teeth and results in decay.
According to AlterNet, cigarettes, chewing tobacco and many prescription medications may also play a part in tooth decay by causing dry mouth and lowering saliva flow. A Gallup poll in 2014 found that Kentucky had the highest smoking rate at 30.2 percent, while nearby West Virginia was second at 29.9 percent.
Sarah Baird, a food critic for Eater, recalled in 2015 how Mountain Dew was an integral part of her upbringing in Kentucky:
Growing up in Eastern Kentucky, Mountain Dew (and its diet counterpart, my beverage of choice) was an omnipresent force, its signature emerald-tinged, translucent 20-ounce bottles filling up coolers at backyard barbecues and littering the weed-lined backroads.
My teachers drank it, my doctor drank it and prisoners would drink it while picking up the littered roadside bottles. It was not a novelty, not an ironic goof -- just simply a way of life.
Dr. Edwin Smith told CNN in 2016 why he set up his mobile clinic, Kids First Dental Services, in 2005 to provide free dental care to children in Kentucky: "I would see a lot of kids who had a mouth full of rotting teeth. They were in pain, and they'd be hurting at school."
Smith also recalled seeing folks who tried to remove their own teeth with pliers, patients who glued teeth (that had fallen out) onto their gums, and others who were ill from chronic oral infections.
The Pew Charitable Trusts reported in 2016 that the Affordable Care Act (Obamacare) forces private insurance plans and state Medicaid programs to cover children's dental care, but not adults.
Adults do get limited public coverage in some state programs, such as emergency dental care (pulling teeth) and limited care based on charges and procedures.
The Pew Charitable Trusts noted that in 2013 Medicaid or other types of public insurance were accepted by only 34 percent of general dentists.
Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville in Kentucky, told USA Today in 2015 that dental emergencies from long-delayed dental care were common: "This is something I deal with daily. And there is not a week that goes by that we don't have someone hospitalized. … People still die from their teeth in the U.S."
The American Dental Association (ADA) analyzed federal data, and concluded that dental ER visits increased from 1.1 million in 2000 up to 2.2 million in 2012, which comes down to one emergency visit for dental issues every 15 seconds.
The Washington Post reported in May 2017 that some Americans can afford to spend over $1 billion annually for whiter teeth --- $2,000 per tooth on porcelain veneers -- but millions of other Americans have to use emergency rooms and charity clinics for basic care.
People who have dental insurance are usually only covered up to $1,500 per year; the ADA’s Health Policy Institute says that over one-third of Americans do not have dental coverage.