Your mouth is full of bacteria. With daily brushing and flossing, supplemented by regular visits to the dentist, this bacteria usually isn’t a problem. But what if it goes unchecked?

“Ultimately, in rare instances, oral disease can be the focal point of a disease process that leads to death,” Dr. Bill Calnon, the president of the American Dental Association, tells FRONTLINE.

This is exactly what happened in two high-profile cases over the past five years. In 2007, 12-year-old Deamonte Driver (pictured above) died after bacteria from an abscessed tooth traveled to his brain. And in 2009, Kyle Willis, the nephew of musician Bootsy Collins, died after being unable to afford antibiotics to treat a tooth infection.

“The vast majority of dental disease is preventable,” says Calnon. Dying as the result of a toothache, he says, is “totally unnecessary.”

So how did Driver and Willis end up with this fate? Both of their stories highlight how easy it is to fall through the cracks of America’s patchwork dental care system. They also expose the nearly impossible decisions individuals and families face when seeking out lifesaving care they can’t afford or access.

The $80 Procedure That Could Have Prevented A Boy’s Death

Deamonte Driver’s tooth was bothering him. The same was the case for his younger brother DeShawn, who needed six teeth extracted. Both boys, from Maryland, were at some points covered by Medicaid. At critical times, though, they were dropped from the program because, according to their mother Alyce, their paperwork may have been sent to a homeless shelter where they lived for a short time.

Alyce, who worked a variety of jobs over the years, didn’t have insurance.

Mary Otto, who first covered the story for The Washington Post, found the Driver family after being contacted by Laurie Norris, a lawyer for the Public Justice Center of Baltimore. Norris was helping Alyce Driver navigate the dental system for DeShawn — making more than 20 calls in order to find a dentist that would accept Medicaid — when Deamonte became ill. After he was taken to the hospital to be treated for a headache, Deamonte became sicker, eventually needing two brain surgeries. He died less than a month later, in February 2007.

If it had been caught early, extracting Deamonte’s damaged tooth could have cost $80. The bill for two weeks of his care at Maryland’s Children’s Hospital was between $200,000 and $250,000, reports Otto. At the time of his death, only about 900 of Maryland’s 5,500 dentists accepted Medicaid.

Otto told FRONTLINE that in the wake of her story on Deamonte, there have been some changes in the way Maryland deals with children in need of dental care. A mobile clinic, bearing Deamonte’s name, began treating poor children in Prince George’s County a year ago. Otto says that some medical doctors in Maryland are now giving kids fluoride treatments as a preventative measure, and that almost 40 percent of kids with Medicaid received some dental care.

“You still think there are thousands of children out there who aren’t getting care, but compared to the 11 percent who were getting care in 2000, that shows a lot of progress,” says Otto. But she laments that less than half of kids in Maryland with Medicaid are not being treated.

But it’s not just children who are at risk.

Antibiotics or Painkillers? One Man’s Impossible Choice

In August 2011, Kyle Willis had a toothache. Like many Americans, what he didn’t have was a job — or health and dental insurance. The 24-year-old single father living in the Cincinnati area first went to a dentist, where he was told his wisdom tooth needed to be pulled. But without a way to pay for it, he put off the procedure.

Kyle Willis

A few weeks later, Willis got a headache, and his face became swollen. He went to the emergency room, where he was prescribed painkillers and antibiotics. The former cost $3; the latter cost $27, reported The Cincinnati Enquirer. Not able to afford both, Willis bought the painkillers but not the antibiotics. Soon after, he became delirious. The infection had spread to his brain. In early September, he was rushed to a local hospital, where he later died.

Kyle’s aunt, Patti Collins, spoke to the Enquirer after his death. “With people losing their jobs, they’re having to make serious choices — do I eat, or do I get my medicine? It’s crazy. And this is America.”

“Hospital emergency rooms are simply not equipped unless they happen to be associated with, for example, a residency program in dentistry of some type or another,” Dr. Frank Catalanotto, a faculty member at the University of Florida’s College Dentistry, told FRONTLINE. “All they’re equipped to do is give some pain medication, give some antibiotics if there’s an infection and refer the patient to find a dentist on Monday morning or the next day.”

“The problem is those patients can’t find the dentist, or for some other reason they neglect to do so.  They’re back in the emergency room,” Cantalanotto says.

Nearly 1 million Americans visit the emergency room each year because of dental pain, at a cost that runs into the hundreds of millions, according to a recent Pew study.

Tragically, in Willis’ case, the hospital where he died actually has its own dental center.

“The dental center is here to provide care for those who are insured, underinsured and who have no insurance,” University Hospital spokesperson Diana Lara told the Enquirer. “No one has to go without care when they are experiencing any sort of pain. We’re here for that reason.”

Willis probably didn’t even know it existed, which points to a major problem with the system: education about access. “There are places for people to get treatment,” ADA president Dr. Calnon told FRONTLINE. But “they have to know how to navigate the system to be properly placed into a treatment facility.”