SALISBURY — The chances of finding a dentist are slim for Lower Shore children who receive health insurance through the state, leading to tooth decay rates here that exceed both Maryland and national averages.

Health specialists attribute the high rates of oral health disease to a shortage of dentists willing to accept the low reimbursement rates for treating Medicaid patients.

“One and 2-year-old poor kids can’t get into the dental office. By 3 or 4 years of age, about half have dental disease,” said Dr. Bob Jones, a dentist who works with the state Department of Health on the Eastern Shore.

To treat Medicaid patients, doctors say they take a financial hit.

“The reimbursement level is less than the cost of keeping the doors open,” said Dr. Rowland Holsinger, president of the Eastern Shore Dental Society.

If a procedure costs $100, doctors may receive a reimbursement as low as $60, he said.

“And if the patient doesn’t show up, we get hit twice,” Holsinger said.

The arrangement has resulted in school-age children on the Eastern Shore suffering from high levels of tooth decay.

In a study by the University of Maryland Baltimore, 53.7 percent of the region’s school-age children had some form of untreated dental decay during the 2000-2001 school year. The state average is 41.6 percent, and the national average is even lower, at 23.1 percent.

For people with private health insurance, access to dental care also is not guaranteed.

“Employers who take the cheapest dental package available, these people have a similar problem,” Jones said.

The lack of access is more acute on the Lower Shore, where per-capita income is below the state average. Metropolitan doctors also have an edge in attracting young dentists.

“In dentistry, the fees generated in Baltimore can be 100 percent higher,” Holsinger said.

Dr. Celeste Ziara, a Salisbury dentist who shares a practice with another doctor, said medical assistance patients aren’t accepted at her office.

“A lot of doctors have tried it and gotten burned. The system has to change. It takes so long to get reimbursed. It’s not that we don’t want to see these kids,” she said.

Ziara, a past president of the Eastern Shore Dental Society, said a better approach would be for the state to set up and manage clinics where doctors can volunteer their time to treat patients.

Alice Burton, an administrator in Maryland’s Medicaid program, said reimbursements to dentists are low, but they have improved in recent years.

“We may not be where we need to be, but we’re getting there,” she said.

Dental hygienist factor

Compounding the problem of access to care on the Lower Shore is a shortage of dental hygienists.

Doug Wilson, a strategic planner with Peninsula Regional Medical Center, has been working with the Tri-County Council to identify the extent of the shortage.

In the health care industry, the shortage of hygienists is more extreme than the nursing shortage, he said.

“It’s a huge issue. We really need a program here on the Shore,” Wilson said.

With three training programs in the state — one in Allegany County and two in Baltimore City — discussions to bring a distance learning program are under way at Wor-Wic Community College.

Murray Hoy, president of Wor-Wic, said it would be too costly to create an independent program on the Lower Shore.

However, technology is available that can deliver live video instruction from Allegany or Baltimore to classrooms at Wor-Wic, he said.

“We’re in preliminary discussions. It is something that could conceivably happen,” said Hoy, who predicted that a local program could fill the shortage in two years.

Wilson said hygienists earn an average salary of $60,000 on the Lower Shore, and the field has been identified by the American Association of Community Colleges as one of the top paying jobs for two-year degrees.

According to the U.S. Department of Commerce, Maryland’s median household income of $53,530 is the second highest in the country and 27 percent above the national average.

Jones said the state should have better access to dental care.

“Maryland should never be in this situation. We’re too affluent as a state,” he said.

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SIDEBAR ARTICLE

The problem

* During the 2000-2001 school year, 53.7 percent of the region’s school-age children had some form of untreated dental decay.

The state average is 41.6 percent, and the national average is even lower, at 23.1 percent.

Source: University of Maryland Baltimore study

* Health specialists attribute the high rates to a shortage of dentists willing to accept the low reimbursement rates for treating Medicaid patients. Compounding the problem is a shortage of dental hygienists.