USA - Study: Dental Care Lacking Among Poor Children
Study: Dental Care Lacking Among Poor Children
HAGERSTOWN, Md. (AP) ―
Fewer than a third of Maryland's nearly 500,000 Medicaid children were seen by a dentist in 2006, according to a study that found a chronic shortage of pediatric dentists willing to deal with Medicaid paperwork.
Experts consider the situation serious, since a lack of routine dental care can lead to pain and illness that disrupts eating, sleep and learning, and can even lead to death.
"One abscess is all you need," said Ilaya Rajagopal, a University of Maryland dental fellow working a two-year stint at the Walnut Street Dental Clinic in downtown Hagerstown.
The clinic receives a federal grant to provide care to the poor.
On a recent day, Rajagopal treated an 18-month-old who had six cavities and gently lectured the child's mother about the damage caused by putting a baby to bed with a bottle. He also taught a 3-year-old how to brush and installed a wire space-maintainer for a girl who had lost two teeth to decay.
In February, a 12-year-old Prince George's County boy whose Medicaid coverage had lapsed died after bacteria from an untreated dental abscess spread to his brain.
The death of Deamonte Driver revealed failures of the state and federal Medicaid system to provide dental care to poor children.
Patients in rural areas, such as western Maryland and the Eastern Shore, often travel miles to find care. In urban areas, including Prince George's County, dental offices might be closer, but there are other barriers -- including a lack of available care, according to the state Dental Action Committee.
The committee, a panel of health providers, insurance officials, health officials and children's advocates convened after Deamonte's death, found that just 26 percent of the 85,000 Medicaid children in Prince George's had a dental visit in 2006.
According to a congressional inquiry begun after Deamonte's death, seven dentists provided most of the care.
Prosthodontist Rahim Tofigh, one of the most active providers of dental care to poor children in Prince George's, said the Medicaid bureaucracy is burdensome and the fees low.
"I cannot even hire a root-canal specialist or an oral surgeon who is willing to see patients under the current fee schedule," said Tofigh, whose specialty involves implants and reconstructive dentistry. "In fact, my periodontist (gum specialist) stopped seeing medical-assistance patients due to the difficulty of getting reimbursed for his services."
The state's reimbursement rates for many dental procedures are far below the median fees charged by dentists in the region.
Maryland's Dental Action Committee has called for an additional $40 million a year -- about half state and half federal funds -- to raise reimbursement rates to the median as a way of encouraging more dentists to treat poor children.
The committee also has recommended a broad restructuring of the state's Medicaid program. Following criticism from Congress, health insurer United Healthcare has focused on reaching out to people who have gone for years without a dental visit and on expanding their provider network to make it easier for patients to find dentists.
The company also funded a new pediatric dental fellowship at the University of Maryland, Baltimore, and has begun working with other academic institutions to expand community dental services in Prince George's.
And Prince George's Health Department dental clinics will again see Medicaid children. Treatment of those children was discontinued for a decade to concentrate on serving people without any dental coverage. "We are expanding to include Medicaid children as patients," said county Health Officer Donald Shell. "No child with a dental need will be turned away." Reaching Medicaid families can be a challenge, health providers said. Some parents face language barriers. Others are unaware of what services are necessary or available or how to find them.
Some are likely to miss appointments or delay care until the patient is in pain.
Arphine Ackerman, who presides over the federally funded Choptank Community Health System dental clinic in Cambridge, said parents who call the office often don't seem to grasp the urgency of getting care, even for a serious problem such as an abscess.
"They say, 'My kid has a marble, a gum ball, a bump,"' she said. Ackerman and Connie Richardson, office manager for the Walnut Street Dental Clinic in Hagerstown, both expressed frustration over missed appointments. "I'm not above making people feel guilty," Richardson said. Yet Richardson said she tries to remember the challenges poor families face. "Their lives are way different from ours," she said. "Transportation is a huge problem. They don't call because they don't have time on their cell phones. We have to be compassionate."
Maryland is 94% fluoridated: NYSCOF
HAGERSTOWN, Md. (AP) ―
Fewer than a third of Maryland's nearly 500,000 Medicaid children were seen by a dentist in 2006, according to a study that found a chronic shortage of pediatric dentists willing to deal with Medicaid paperwork.
Experts consider the situation serious, since a lack of routine dental care can lead to pain and illness that disrupts eating, sleep and learning, and can even lead to death.
"One abscess is all you need," said Ilaya Rajagopal, a University of Maryland dental fellow working a two-year stint at the Walnut Street Dental Clinic in downtown Hagerstown.
The clinic receives a federal grant to provide care to the poor.
On a recent day, Rajagopal treated an 18-month-old who had six cavities and gently lectured the child's mother about the damage caused by putting a baby to bed with a bottle. He also taught a 3-year-old how to brush and installed a wire space-maintainer for a girl who had lost two teeth to decay.
In February, a 12-year-old Prince George's County boy whose Medicaid coverage had lapsed died after bacteria from an untreated dental abscess spread to his brain.
The death of Deamonte Driver revealed failures of the state and federal Medicaid system to provide dental care to poor children.
Patients in rural areas, such as western Maryland and the Eastern Shore, often travel miles to find care. In urban areas, including Prince George's County, dental offices might be closer, but there are other barriers -- including a lack of available care, according to the state Dental Action Committee.
The committee, a panel of health providers, insurance officials, health officials and children's advocates convened after Deamonte's death, found that just 26 percent of the 85,000 Medicaid children in Prince George's had a dental visit in 2006.
According to a congressional inquiry begun after Deamonte's death, seven dentists provided most of the care.
Prosthodontist Rahim Tofigh, one of the most active providers of dental care to poor children in Prince George's, said the Medicaid bureaucracy is burdensome and the fees low.
"I cannot even hire a root-canal specialist or an oral surgeon who is willing to see patients under the current fee schedule," said Tofigh, whose specialty involves implants and reconstructive dentistry. "In fact, my periodontist (gum specialist) stopped seeing medical-assistance patients due to the difficulty of getting reimbursed for his services."
The state's reimbursement rates for many dental procedures are far below the median fees charged by dentists in the region.
Maryland's Dental Action Committee has called for an additional $40 million a year -- about half state and half federal funds -- to raise reimbursement rates to the median as a way of encouraging more dentists to treat poor children.
The committee also has recommended a broad restructuring of the state's Medicaid program. Following criticism from Congress, health insurer United Healthcare has focused on reaching out to people who have gone for years without a dental visit and on expanding their provider network to make it easier for patients to find dentists.
The company also funded a new pediatric dental fellowship at the University of Maryland, Baltimore, and has begun working with other academic institutions to expand community dental services in Prince George's.
And Prince George's Health Department dental clinics will again see Medicaid children. Treatment of those children was discontinued for a decade to concentrate on serving people without any dental coverage. "We are expanding to include Medicaid children as patients," said county Health Officer Donald Shell. "No child with a dental need will be turned away." Reaching Medicaid families can be a challenge, health providers said. Some parents face language barriers. Others are unaware of what services are necessary or available or how to find them.
Some are likely to miss appointments or delay care until the patient is in pain.
Arphine Ackerman, who presides over the federally funded Choptank Community Health System dental clinic in Cambridge, said parents who call the office often don't seem to grasp the urgency of getting care, even for a serious problem such as an abscess.
"They say, 'My kid has a marble, a gum ball, a bump,"' she said. Ackerman and Connie Richardson, office manager for the Walnut Street Dental Clinic in Hagerstown, both expressed frustration over missed appointments. "I'm not above making people feel guilty," Richardson said. Yet Richardson said she tries to remember the challenges poor families face. "Their lives are way different from ours," she said. "Transportation is a huge problem. They don't call because they don't have time on their cell phones. We have to be compassionate."
Maryland is 94% fluoridated: NYSCOF
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