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WEST VIRGINIANS lag behind the rest of America in dental care. In fact, dental disease is so bad in the Mountain State that reporter Eric Eyre found that 42.9 percent of state residents age 65 and older have lost all their teeth, the highest rate in the country.Part of the problem is that West Virginia’s poorest residents have no way to pay for emergency dental care, let alone routine maintenance that would let them keep their own teeth into old age.Medicaid, the state-federal program for low-income and disabled people, pays only for tooth extractions for adults, though it covers more thorough care for children. That means no regular cleanings and checkups. A person with a painful abscess who has insurance or who pays his own dental bill is often advised to have nerve roots removed. The remaining tooth is often crowned. But Medicaid won’t pay for those procedures, or for fillings that might preserve a tooth or dentures that someone needs after having their teeth pulled.While money is always a concern, this sounds like a foolish and inhumane policy. By denying routine care to people who need it, the state’s policy actually contributes to unnecessary tooth loss.It hasn’t always been this way. The Legislature cut dental care from the Medicaid budget in 1993, saying that dentists were gouging the system. No doubt some unscrupulous opportunists took advantage of the state. But there is something to what other dentists say — that after years of neglect, there was a lot of dental work needed by state residents. Of course, the bills mounted.Aside from the physical pain of those involved, dental health affects so much else. Decay and infection have been linked to heart disease, diabetes, pneumonia, stroke and babies born premature or underweight. Elsewhere in the same department that administers Medicaid, those who try to place people into jobs acknowledge tooth loss as an obstacle to employment. At various times, the state or charitable organizations have offered dental care and dentures as part of a jobs program.The state is currently redrawing Medicaid rules and coverage. Dental coverage should certainly be a part of that plan. With proper oversight, there is no reason why the state’s poorest residents couldn’t have decent dental care and taxpayers couldn’t have an accountable system to pay for it.