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Short in the Tooth: State: Too Few Dentists in Valley

Posted on: Monday, 30 January 2006, 12:00 CST

By Melissa Mcever, Valley Morning Star, Harlingen, Texas

Jan. 30--Throughout the school year, the dentists who volunteer with Dentists Who Care take their mobile unit on the road, visiting Rio Grande Valley schools to examine the teeth and fill the cavities of fourth-graders.

For many of those students, it's the only time they'll ever see a dentist.

Many Valley residents simply can't afford to visit a dentist on this side of the border. While some travel to Mexico, others forego dental care entirely, allowing serious dental conditions to progress and heightening the risk of life-threatening conditions related to gum disease.

At this time, no one is tracking the number of patients who go without dental care, but officials and Valley dentists guessed that tens of thousands of Valley residents have never received care.

"Dental care is our number-one unmet medical need," said Dr. Brian Smith, director for the Texas Department of State Health Services' Region 11, which includes the Valley.

The state designates Cameron, Hidalgo, Willacy and Starr counties as dental professional shortage areas, and the ratio of dentists to residents is considerably lower than other areas of the state. According to state statistics, Cameron County has a ratio of 14 dentists per 100,000 people. In Hidalgo County, that ratio is 16 per 100,000. Many other areas of the state rank considerably higher -- Bexar County, for example, has 44 dentists per 100,000.

In the end, though, it's not the scarcity of dentists that's keeping away patients, but the high cost of care.

"We probably have as much dental care as there is money for, but because we have such a large indigent population, they can't afford to go," Smith said.

Dental problems and health risks

Availability of dental care is especially important along the border, which has a high rate of cavities and serious dental problems among its residents.

According to a report from the U.S.-Mexico Border Health Commission, Mexican-American children in the Southwest region have a two to three times higher rate of decayed permanent teeth than children in other regions. A high number of children on the border also need extensive reconstruction and complex dental procedures because problems weren't treated early.

Valley clinics also see many cases of "baby-bottle syndrome," which is decay that occurs after a bottle stays in an infant's mouth for a long period of time, such as when the baby falls asleep. Untreated decay and gum disease can affect children for life, leading to tooth loss and severe discomfort, dentists say.

As for Valley adults, officials said that they have high rates of diabetes-related gum disease, a chronic infection of the gums that can lead to tooth loss. Besides being painful and unsightly, gum disease and tooth loss can increase the risk of heart attack or stroke, studies have suggested. Bacteria sometimes can enter through the gums and travel through the bloodstream to the heart, reports the American Academy of Periodontology.

"Oral health is very important to overall, systemic health," Woolweaver said. "And it's always neglected in government programs."

Poor nutrition and bad habits contribute to the border's oral-health woes, experts said.

"People (here) tend to give a lot of sweets to kids, particularly sour candies," which are acidic and wear away enamel, Smith said. "And there's a high consumption of soft drinks. Factors like that will make dental problems worse."

Paula Gomez, executive director of Brownsville Community Health Clinic, said that parents need to be educated on the effects of excessive candy consumption.

"It's common sense to some, but for others the information isn't getting out," she said.

However, human nature also plays a role in making bad nutritional choices, Gomez added.

"For some, the information goes in one ear and out the other," she said.

Few places to turn

Once tooth decay sets in, it's usually too late to regret those extra sodas or candy. It's time to see a dentist, but that's a tall order for many Valley residents -- even for middle-income employees with health insurance.

"People who are fairly wealthy even have trouble affording major dental procedures because most insurance doesn't cover dental care," Smith said.

But for the working poor and the indigent, the problem is worse. Children's dental care is covered under Medicaid and the Children's Health Insurance Program, but adults have no federal or state assistance. In many cases, their only option is visiting one of the Valley's federally funded indigent clinics, but those clinics are overwhelmed by the need, Gomez said.

"We have 20,000 patients and two dentists," Gomez said. "We're already booked until July."

Each summer, the Texas Health and Human Services Commission, the Texas National Guard and military reservists hold Operation Lonestar, a temporary clinic that offers free medical and dental care. The immense need for dental care is apparent during that clinic, Smith said.

"When dentists are available, they'll (patients) come to the clinic and stand in line early the previous day just to be there for the next day," he said.

Although local dentists may do some charity work for the indigent, they must make a living as well, Woolweaver said. In the impoverished Valley, making a living as a dentist can prove difficult.

"It's very hard to get dentists here," Smith said. "We are underserved because we can't pay (for care)."

Although the volunteer dentists for Dentists Who Care would like to help everyone, the charity's funds are limited, he said.

More agencies and organizations are trying to intervene early and emphasize prevention, particularly in the younger generation

Every year Texas State Technical College-Harlingen and the Rio Grande Valley Dental Hygienists Association, with the assistance of volunteer dentists, offer free sealant applications to Valley children ages 4 to 18. Sealants are plastic coatings on back teeth that help prevent cavities. In addition, TSTC's dental-hygiene program offers low-cost teeth cleanings and X-rays to the community.

Barbara Bennett, director of the dental-hygiene program, said their services are much cheaper than paying out-of-pocket at the dentist's office. The clinic is helpful for those people who "fall through the gaps," she said.

Dentists Who Care offers free exams and treatment to fourth graders because at that age, children have both their primary and permanent teeth, Woolweaver said. The volunteer dentists also do X-rays and give out vouchers for dental care to school nurses for them to distribute to needy children.

As for adults, many of them cross the border for care. Because little regulation exists for dental practices in Mexico, though, patients are taking a big chance, Bennett said.

"They could get good care or could get awful care," she said.

And some of the Valley's poorest residents can't even afford to cross the border, or are undocumented and fear being caught, Smith said.

In the end, Gomez said, it all comes down to money.

"I don't know anyone who wouldn't prefer to get their dental work done here," she said. "But for some people, there isn't anything else."

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Copyright (c) 2006, Valley Morning Star, Harlingen, Texas

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Source: Valley Morning Star (Harlingen, Texas)

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