Despite decades of community water fluoridation, fluoride toothpaste use, improvements in nutrition and hygiene education, dental caries — also known as cavities — remain the most common childhood disease in America. They lead to pain, infections, nutritional deficits, lack of sleep, poor concentration, slower physical growth and a loss of about a dozen school hours per child.
Families with incomes below the federal poverty line — often families of color — experience twice the incidence of dental caries compared with higher earning families. Part of the problem is that they’re not receiving the treatment they need. A quarter of all children from low income families have not seen a dentist before kindergarten, according to the National Institute of Dental and Craniofacial Research.
This lack of access persists for a variety of reasons, and its remedy will require a multi-pronged policy approach. Primarily, a greater proportion of dentists must to be willing to see children with public insurance. This should be encouraged by paying them more per visit and providing other financial incentives to dentists who establish practices in underserved populations. Research has demonstrated that increased Medicaid Fee for Service reimbursement rates to dentists significantly increases provider participation, thereby increasing treatment rates and utilization by children enrolled in Medicaid. According to the U.S. General Accounting office, only 38 percent of children between the ages of 2-17 years enrolled in either Medicaid or state-run children’s health insurance programs saw a dentist in the past year, compared to 55 percent of their privately insured counterparts.
Tackling the issue will require more than raised reimbursement rates, however. Maryland has been a leader in taking a varied approach to the problem. In addition to increasing rates, the state separated dental care from managed care, increased its dental provider network and improved administrative and customer service. A 2013 study by the American Dental Association (ADA) found that the changes resulted in the largest increase in treatment rates for children enrolled in Medicaid, relative to any other state.
Texas was able to boost treatment rates for children enrolled in Medicaid actually above the rate for children with private insurance after the state increased reimbursement for dental procedures by more than half, implemented loan forgiveness programs for dentists in underserved regions and increased funding to community dental clinics. Connecticut also began a worthwhile program of case management in an attempt to minimize appointment cancellations.
The lack of permanent and sustainable access to dental care for children of low income American families has dire consequences. All American children deserve to experience a high quality of life, and as dental caries are 100% avoidable and preventable, the government should improve its preventive efforts to eliminate this silent plague.
Sarah Uehara is a dental student at the University of Maryland Baltimore
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