By Tara Mancini
Dental cavities are the most prevalent chronic disease among children. Many children are not able to obtain the dental care they need due to cost barriers, a shortage of dental health professionals in their area or for other reasons. According to an Institute of Medicine (IOM) report, as many as 4.6 million children were unable to get dental care in 2008. A recent briefing held by the Alliance for Health Reform presented another timely opportunity to discuss the root causes and working solutions that have been developed to tackle these shocking and sobering statistics.
Many factors contribute to the startlingly high rates of poor oral and dental health among children, but lack of insurance and access to care are two of the most prominent. Due to the fractured nature of our health care system, dental insurance plans are commonly issued separately from regular health insurance plans. For the privately insured, that means paying another premium, and as many as 30% of privately insured children don’t have dental insurance.
Fortunately, all child beneficiaries of Medicaid and CHIP have coverage for dental benefits.
Still, access to insurance does not always mean access to care. About 15% of the U.S. population lives in dental health professional shortage areas according to the Kaiser Family Foundation. As I noted in a recent blog post, low provider reimbursement rates for dentists participating in Medicaid can make it difficult for children with Medicaid coverage to get a dentist appointment.
Considering these facts, it is not surprising that many children and adults end up in the emergency department (ED) for treatment of preventable oral and dental conditions. Earlier this year, the Pew Center on the States estimated that in 2009, over 830,000 ED visits were the result of preventable dental conditions. Of those ER visits, children accounted for 50,000. Dr. Sorkey, a panelist at the briefing noted that it was a rare occurrence for him to work an ER shift in which he did not encounter a patient who was seeking treatment for a dental ailment. Unfortunately, when the ED is the only resort for seeking dental care, patients are only provided temporary relief.
Most ED’s do not have dentists on staff and therefore the root cause of the problem cannot be addressed. The result is that patients often revisit the ED when their condition deteriorates. Moreover, hospitals and state and local governments are left paying the costs of these preventable visits.
Safety-net hospitals, already strained as a result of the economic recession, are especially feeling limited in their finances and capacity to serve patients. The ED is not a viable option for seeking dental care, and the reluctance of some states to opt-in to the Medicaid coverage expansion may further challenge the system. Expanding access to Medicaid coverage, accompanied by a reasonable reimbursement rates for dental providers can help. Yes, this will require budgeting more for Medicaid, but as the Pew report hinted, the costs associated with dental treatment sought in the ED is likely to cost taxpayers more than is an emphasis on prevention and access.
Still, the system will need to increase its capacity. In an effort to properly assess and respond to the need, the American Dental Association (ADA) is partnering with the U.S. Centers for Disease Control and Prevention (CDC) to track data on the patterns of ED use for non-traumatic dental conditions. The ADA has launched several other efforts to improve access, which includes collaborating with the National Association of Community Health Centers (NACHC), increasing coordination between medical and dental professionals, providing education to the public on oral health, and adding a new position to the community and public health workforce, the Community Dental Health Coordinator (CDHC).
States too, are addressing the issue of access and capacity by certifying or licensing new tiers of dental professions to their workforce. Since 2008, Alaskan Dental Health Aide Therapists (DHAT) have been providing dental care in remote Alaskan villages. Minnesota has created Dental Therapists and Advanced Dental Therapists to serve low-income and underserved patients. California’s Senate recently introduced legislation that would explore possibilities for similar additions to the state’s workforce.
There is no single solution to addressing the lack of oral health and health care, which is why it is encouraging to see organizations working together to confront its many barriers. For more about the briefing and resources on the issue, click here.