USA - Withhold Dental Care
Withhold Dental Care
From the PoorMessenger-Inquirer
Mar 08, 08:19
The client's teeth were so jagged they lacerated his tongue. He had no money to fix them. His story is not unique, although a little more extreme than most Sharon Sharp hears at the Help Office. The 51-year-old man can hardly eat and can't brush his teeth. "He has to use a wet washcloth," said Sharp, the charitable agency's executive director.
The man isn't working and has applied for disability benefits, she said. Like many of the adults who come through the Help Office, he has no dental insurance or even Medicaid to pay for his dental care.
He is swept up in a complex problem that's part culture, part poverty, part politics and lack of legislative will, according to health care providers and advocates for the poor.
Kentucky "is No. 1 in adults, 18 to 65, without a single tooth in their head," said Dr. Julia Watts McKee, state dental health director in the Department for Public Health.
The issue has been getting renewed attention in Owensboro recently.
A coalition of local groups is forming a nonprofit group to open a dental clinic for patients who have no insurance or who are on Medicaid.
The Green River District Health Department, meanwhile, is using $10,000 from a state pilot program and $36,000 in district funds to get children across seven counties to a dentist, even if they don't have Medicaid or insurance.
The two projects will supplement the work of local dentists who accept Medicaid patients, volunteer at the Christian Dental Mission or quietly do charity work on their own.
It's barely scratching the surface of the need, though, advocates for the poor believe.
Nearly all the clients who come into the Help Office need dental work, but it has been tough to generate much community interest in the issue, Sharp said.
"The problem is huge," said Dr. Lee Mayer, director of community dental health at the University of Louisville School of Dentistry.
The gateway to health
Dental health is worth the attention because the mouth is the gateway to the body in more ways than one, experts say.
There's a direct link between oral health and cardiovascular health, McKee said. Gum infections pose a great risk to diabetics, who are "so compromised to heal from anything," she said. A pregnant woman's oral health can even affect her unborn baby.
Dental pain causes employees to miss time from work and prevents children from doing well in school, she and others said.
Despite all that, the poor and low-income working people still struggle to get help with such problems, social service providers say.
Last year, four area hospitals had 1,500 visits from patients seeking help with tooth pain, said JAT Mountjoy, director of administrative services at the Green River District Health Department. About a third of those cases involved children and teens.
"It's going to take a lot of pain for you to go to the (emergency room)," Mountjoy said.
State officials have found that 4,500 Kentucky 3-year-olds have dental pain each day, McKee said. Nearly half of preschoolers have untreated tooth decay.
About 600,000 Kentuckians have no medical insurance, which means about 2.5 times as many people have no dental insurance, McKee said. "There are huge employers across the state who do not have dental insurance that have comprehensive health insurance," McKee said.
"Our culture views dental care as optional care," McKee said. "It's perceived as expensive."
Medicaid would help some patients pay for treatment, but only about a fourth of the dentists in town are accepting new Medicaid patients.
Last year the Help Office referred 227 people to the Christian Dental Mission, Sharp said. The mission depends on volunteer dentists. Recently it was offering three half-day clinics a month.
The Help Office also spent at least $1,000 last year helping patients get dental care at other offices, Sharp said.
Her agency has helped some go to the University of Louisville School of Dentistry, which provides about $1 million a year in free or reduced dental care, Mayer said.
Sharp said workers at U of L told her this week that treatment there is now on a first-come, first-served basis and payment is expected at the time of treatment. Fees are discounted 30 to 50 percent, they told her.
"They said it might take a week for somebody to get in," Sharp said.
Her client with the jagged teeth and lacerated tongue is planning to borrow his aunt's car to make the trip. "He does not have a car that is road-worthy," Sharp said.
"If somebody's at an emergency situation" Mayer said, "they won't be turned away."
How do people get in this shape?
It's not fair to say all these untreated dental problems are the result of culture, Mayer said.
Food stamps, Sharp points out, don't pay for toothbrushes, dental floss or mouthwash.
More than 90 percent of Kentuckians have fluoridated water now, McKee said, but poor habits, including constant snacking, tobacco use and methamphetamine abuse, can more than eliminate any benefit derived from drinking treated water.
"All of us are a little bit timid about the dentist," Sharp said. Everybody's heard horror stories about pain in the dental chair, and these families have little money. "Unless we were taken when we were young, we're not going to seek out the dentist," Sharp said.
Even if they want to go, many low-income adults don't qualify for Medicaid, Sharp says. Many children who do qualify, McKee said, either haven't been signed up for benefits or their parents don't make sure they use those benefits for dental care.
Filling teeth, filling needs
Many dentists here don't accept Medicaid or don't want new patients through the program because Medicaid patients are notorious for missing appointments, partly because of all the struggles going on in their lives, observers say. When they don't show, it costs the dentist money.
Dentists also don't like many of the restrictions that come with the program or the low reimbursement rate that doesn't cover their costs, several people said.
The rate increase in June was the first in decades, said Dr. Mike Johnson, a local dentist who does a lot of dental care at Foust Elementary School. "Would you like to make a living on the salary you made in 1978 and your overhead is 65 percent?" he said.
Dentistry is an expensive field of medicine to offer, Mayer said, because "we're like little mini hospitals," with the cost of equipment, supplies, chemicals and personnel for each office. Educational debt is ballooning too, he said.
As dentists and community leaders have searched for a solution, they've wrestled with how to do it without making a charity or the government compete with providers in private practice.
It's unfair to paint dentists as the villains for not treating all these poor people, Johnson said.
The Christian Dental Mission has struggled over the years to recruit volunteers. But many dentists quietly do charity care through Head Start, local schools or on their own, he and several other observers mentioned.
The $46,000 the district health department will spend getting children in seven counties to the dentist won't go very far, Johnson said. What, he asks, will happen if the money runs out in the middle of a child's treatment?
"We've got a health bill right now before the (state) Senate," which calls for dental screening for all Kentucky children before they enroll in school, Johnson said. A similar bill is pending in the House of Representatives.
State legislators "don't want to pass it because it costs too much money," Johnson said.
Kentucky is 99.6% fluoridated:NYSCOF
From the PoorMessenger-Inquirer
Mar 08, 08:19
The client's teeth were so jagged they lacerated his tongue. He had no money to fix them. His story is not unique, although a little more extreme than most Sharon Sharp hears at the Help Office. The 51-year-old man can hardly eat and can't brush his teeth. "He has to use a wet washcloth," said Sharp, the charitable agency's executive director.
The man isn't working and has applied for disability benefits, she said. Like many of the adults who come through the Help Office, he has no dental insurance or even Medicaid to pay for his dental care.
He is swept up in a complex problem that's part culture, part poverty, part politics and lack of legislative will, according to health care providers and advocates for the poor.
Kentucky "is No. 1 in adults, 18 to 65, without a single tooth in their head," said Dr. Julia Watts McKee, state dental health director in the Department for Public Health.
The issue has been getting renewed attention in Owensboro recently.
A coalition of local groups is forming a nonprofit group to open a dental clinic for patients who have no insurance or who are on Medicaid.
The Green River District Health Department, meanwhile, is using $10,000 from a state pilot program and $36,000 in district funds to get children across seven counties to a dentist, even if they don't have Medicaid or insurance.
The two projects will supplement the work of local dentists who accept Medicaid patients, volunteer at the Christian Dental Mission or quietly do charity work on their own.
It's barely scratching the surface of the need, though, advocates for the poor believe.
Nearly all the clients who come into the Help Office need dental work, but it has been tough to generate much community interest in the issue, Sharp said.
"The problem is huge," said Dr. Lee Mayer, director of community dental health at the University of Louisville School of Dentistry.
The gateway to health
Dental health is worth the attention because the mouth is the gateway to the body in more ways than one, experts say.
There's a direct link between oral health and cardiovascular health, McKee said. Gum infections pose a great risk to diabetics, who are "so compromised to heal from anything," she said. A pregnant woman's oral health can even affect her unborn baby.
Dental pain causes employees to miss time from work and prevents children from doing well in school, she and others said.
Despite all that, the poor and low-income working people still struggle to get help with such problems, social service providers say.
Last year, four area hospitals had 1,500 visits from patients seeking help with tooth pain, said JAT Mountjoy, director of administrative services at the Green River District Health Department. About a third of those cases involved children and teens.
"It's going to take a lot of pain for you to go to the (emergency room)," Mountjoy said.
State officials have found that 4,500 Kentucky 3-year-olds have dental pain each day, McKee said. Nearly half of preschoolers have untreated tooth decay.
About 600,000 Kentuckians have no medical insurance, which means about 2.5 times as many people have no dental insurance, McKee said. "There are huge employers across the state who do not have dental insurance that have comprehensive health insurance," McKee said.
"Our culture views dental care as optional care," McKee said. "It's perceived as expensive."
Medicaid would help some patients pay for treatment, but only about a fourth of the dentists in town are accepting new Medicaid patients.
Last year the Help Office referred 227 people to the Christian Dental Mission, Sharp said. The mission depends on volunteer dentists. Recently it was offering three half-day clinics a month.
The Help Office also spent at least $1,000 last year helping patients get dental care at other offices, Sharp said.
Her agency has helped some go to the University of Louisville School of Dentistry, which provides about $1 million a year in free or reduced dental care, Mayer said.
Sharp said workers at U of L told her this week that treatment there is now on a first-come, first-served basis and payment is expected at the time of treatment. Fees are discounted 30 to 50 percent, they told her.
"They said it might take a week for somebody to get in," Sharp said.
Her client with the jagged teeth and lacerated tongue is planning to borrow his aunt's car to make the trip. "He does not have a car that is road-worthy," Sharp said.
"If somebody's at an emergency situation" Mayer said, "they won't be turned away."
How do people get in this shape?
It's not fair to say all these untreated dental problems are the result of culture, Mayer said.
Food stamps, Sharp points out, don't pay for toothbrushes, dental floss or mouthwash.
More than 90 percent of Kentuckians have fluoridated water now, McKee said, but poor habits, including constant snacking, tobacco use and methamphetamine abuse, can more than eliminate any benefit derived from drinking treated water.
"All of us are a little bit timid about the dentist," Sharp said. Everybody's heard horror stories about pain in the dental chair, and these families have little money. "Unless we were taken when we were young, we're not going to seek out the dentist," Sharp said.
Even if they want to go, many low-income adults don't qualify for Medicaid, Sharp says. Many children who do qualify, McKee said, either haven't been signed up for benefits or their parents don't make sure they use those benefits for dental care.
Filling teeth, filling needs
Many dentists here don't accept Medicaid or don't want new patients through the program because Medicaid patients are notorious for missing appointments, partly because of all the struggles going on in their lives, observers say. When they don't show, it costs the dentist money.
Dentists also don't like many of the restrictions that come with the program or the low reimbursement rate that doesn't cover their costs, several people said.
The rate increase in June was the first in decades, said Dr. Mike Johnson, a local dentist who does a lot of dental care at Foust Elementary School. "Would you like to make a living on the salary you made in 1978 and your overhead is 65 percent?" he said.
Dentistry is an expensive field of medicine to offer, Mayer said, because "we're like little mini hospitals," with the cost of equipment, supplies, chemicals and personnel for each office. Educational debt is ballooning too, he said.
As dentists and community leaders have searched for a solution, they've wrestled with how to do it without making a charity or the government compete with providers in private practice.
It's unfair to paint dentists as the villains for not treating all these poor people, Johnson said.
The Christian Dental Mission has struggled over the years to recruit volunteers. But many dentists quietly do charity care through Head Start, local schools or on their own, he and several other observers mentioned.
The $46,000 the district health department will spend getting children in seven counties to the dentist won't go very far, Johnson said. What, he asks, will happen if the money runs out in the middle of a child's treatment?
"We've got a health bill right now before the (state) Senate," which calls for dental screening for all Kentucky children before they enroll in school, Johnson said. A similar bill is pending in the House of Representatives.
State legislators "don't want to pass it because it costs too much money," Johnson said.
Kentucky is 99.6% fluoridated:NYSCOF
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