RICHMOND — In elementary school, a doctor appeared once a year to listen to the beats of our little hearts and ask us to take a deep breath or two. Perhaps follow-ups came for those who either had odd pulses or shallow lungs. Who knows? We also took home a sheet of paper that a dentist had to fill out — for some reason, most of us did it, but I have no memory of what dire consequences were threatened for non-compliance.

We would dutifully take the paper to our dentist, and he'd poke around in our mouths and sign it. The other major requirement of school children was that no one could enter kindergarten or first grade without a small pox vaccination. No vaccines existed for measles, rubella, mumps or chicken pox, so we had them all and suffered whatever they brought in the way of aches, fever, itch and frustration.

Years later, in Richmond, we encountered the Community Health Association of Richmond and West Stockbridge, a semi-private group that had already supervised the health of generations of children.

"These Republicans (the town had only a handful of registered Democrats at the time) seem to have no idea they are practicing socialized medicine," my husband chuckled. And so all the kids in the Richmond School regularly donned little white "nightshirts" once a year for the well-child conferences and had a more than cursory physical with a Pittsfield pediatrician. Just about everyone participated — it wasn't a welfare event, just something for everyone's welfare. While it was always orderly, with a crew of volunteer mothers, we liked to call it the wild-child conference.


In addition, all the kids, K-6, had a free session with a Pittsfield dentist in an upstairs office at the school. One of the benefits of that program, in addition to finding problems with teeth, was that the perennial phobias about DENTISTS were probably eased. The visits to the venerable chair were just something everyone else did, so pain and fear were rarely part of the deal. All these events took place in what has come to be called "back in the day."

These days, some people have dental insurance. But it often doesn't extend to the serious stuff. Covering expensive root canals and implants is often limited or non-existent. During a brief period when I actually had dental insurance, I learned that my dentist would accept GE's insurance but not mine. I switched dentists.

It's easy to not bother with teeth that don't hurt — and that's apparently what plenty of people in Massachusetts do. Then comes a searing pain, and the sufferer, not having a dentist, goes to the emergency room where it will cost much more than at the dentist's office — certainly more than regular cleaning and brushing and flossing. It's common practice with many Berkshire-ites.

While needy children in Massachusetts get dental coverage through Medicaid because it's mandated by the feds, adult dental care through Medicaid has the volatility of a Berkshire thermometer. The states provide — or don't — Medicare payments for adult dental care and decide what it will be. In a tough budget year, the analysts report, legislatures tend to slice chunks off that particular item.

Even then, though Massachusetts was listed by Pew in 2015 as having "extensive coverage" for adult dental care, Berkshire adults may not get the aid because they can't get an appointment with a dentist. Some dentists don't take Medicaid; some limit the number of Medicaid patients they'll accept, some are booked solid. Many say the reimbursement rate is too low.

Neglected, possibly rotting, teeth have been linked to diabetes, heart disease, breathing problems and dementia. If that knowledge is taken seriously by our legislators, they will not only adopt Smitty Pignatelli's proposal to establish a new category of dental care providers — the dental hygienist practitioner — but also stabilize and more generously fund Medicaid for dental needs.

More real-teeth smiles can't hurt.

Ruth Bass wants novocaine when she's approaching the dentist's door. Her web site is