By Emily Bregel, Chattanooga Times/Free Press, Tenn.
Jun. 18–Chattanooga dentist Dr. Ruth Lima shakes her head when recalling teeth she has seen in the mouths of elementary school students.
“Some of them are very, very badly broken down,” she said. “They’ve been going to class. They’re in pain.”
Recently Dr. Lima had to remove six of a student’s baby teeth that were rotted “down to the gumline,” she said.
“Here we are in this day and age with fluoride and all the education — you would think you wouldn’t see that,” she said. “My focus is to try to get this child back to good oral health.”
Dr. Lima, the dentist for the Ronald McDonald Care Mobile dental clinic, spent three days last week at Brown Academy treating about 20 children who don’t have private dental insurance. The Care Mobile visits 22 Hamilton County schools on a rotating schedule. About half the children treated are uninsured and half have TennCare, the state’s managed Medicaid program that provides comprehensive preventive and dental services to enrolled children under age 21.
In recent years, dental health initiatives such as the Care Mobile have gained traction in Tennessee, public health advocates and state officials said.
A March study by researchers at the National Academy for State Health Policy pointed to Tennessee, Michigan and Virginia as states that drastically have overhauled their Medicaid dental programs in recent years, resulting in significant improvements.
The Tennessee Department of Health has given more than $1 million in grants in the past year to support adult emergency dental services, said Dr. Veronica Gunn, chief medical officer for the state health department, in an e-mail.
Dental health programs and grants to public health providers have boosted dental hygiene options for the uninsured and TennCare populations in a number of ways. Among those is the Care Mobile’s mobile dental clinic, which launched in 2003 as a collaboration between T.C. Thompson Children’s Hospital and the Chattanooga Ronald McDonald House.
In the past year, the mobile dental clinic has treated more than 1,900 kids and provided $400,000 in free care, said Ray Lallier, Care Mobile supervisor and an employee of T.C. Thompson.
Children who come to the Care Mobile typically have no other health care provider to treat their dental needs, Mr. Lallier said.
“The kids that we see are children that don’t see a provider,” he said. “Either because of financial issues or other issues, dental hygiene is just not high on the priority list. Families are struggling to make sure the kids are eating and other things.”
Poor oral hygiene has been linked to heart disease, diabetes and premature births, Dr. Lima said.
“It’s a systemic thing,” she said. “There are so many issues I think people don’t really correlate” with dental hygiene.
The February 2007 death of a 12-year-old Maryland boy from a lack of dental care brought the often-overlooked issue into the spotlight. The boy, Deamonte Driver, died after an infection from an abscessed tooth spread to his brain, the National Academy for State Health Policy study noted.
TENNCARE IMPROVEMENTS
The recent study by the Academy for State Health Policy pointed to TennCare as one of a few state Medicaid programs whose broad reforms to its dental benefit resulted in young enrollees using those dental services more frequently. The TennCare changes also sparked growth in the number of dental health care providers accepting TennCare patients, the study noted.
In 2002, TennCare increased its reimbursement for dental services, nearly doubling reimbursements rates to be as high or higher than the retail fees for 75 percent of dentists in the area in 1999, said Andrew Synder, one of the study’s authors and policy specialist with the National Academy for State Health Policy.
TennCare also bid out a contract for administration of the program, selecting Doral Dental to administer and manage the program, decreasing administrative hassles faced by dental offices that previously had to work with multiple managed-care organizations, he said.
“Instead of being faced with a program that they felt had bad administration and fees that weren’t adequate for them, (Tennessee dentists) were facing a program that had much more friendly administration and fees that were much more conducive to them participating in the program,” Mr. Snyder said in a telephone interview last week.
As a result, the number of dentists who participated in TennCare doubled from 386 to 700 in the first two years after the reform, increasing to 851 by 2007, the study said. In addition, the percentage of children making dental visits at least once a year increased from 26 percent in 2002 to 36 percent in 2006, the study found.
Between 50 and 60 percent of privately insured children typically receive dental care in a one-year period, Mr. Snyder said.
Dr. Jim Gillcrist, TennCare dental director, said that in the early 2000s TennCare officials worked with the state department of health and Tennessee Dental Association to improve the state’s dental public health program. A settlement in a 1998 class-action lawsuit alleging that the state was failing to provide adequate health services also raised the standard for what dental services TennCare would provide for children, he said.
“There was a confluence of events that really prompted changes,” Dr. Gillcrist said. “It’s been enormously successful. … We want to make this one of the best programs in the nation, and we’re constantly trying to improve it.”
DENTAL HYGIENE OVERLOOKED
Even among those with regular health insurance, dental coverage often is overlooked, experts said.
In 2006, 47 million people — or 15.8 percent of the population– did not have health insurance, according to the U.S. Census Bureau. But the number of Americans without dental insurance is more than twice that, Mr. Snyder said.
In Tennessee, a great need exists for adult dental health services, dentists here said.
“There’s a lot of adults that get cut off at 21,” said Dr. James Wheeler, dentist at the Dodson Avenue Community Health Center, which treats mostly uninsured and Medicaid patients who pay based on a sliding scale.
“Some of the patients have (teeth in) very bad condition. They have dental neglect that has occurred for many, many years. If the state had some system to pay for cleanings that would greatly help,” he said.
TennCare provides dental services for all enrollees up to age 21, but since TennCare reforms in 2005 the bureau does not offer dental coverage for adults, TennCare officials said.
The Chattanooga-Hamilton County Health Department this month received a $50,000 state grant to expand the minimal dental services it offers to adults. Now included in its services are exams, extractions, X-rays and some other services, said Dr. Andy Thomas, the local health department’s dental program manager.
“Throughout the state, adult dental (care) has been a problem, but I think we’re making good progress,” Dr. Thomas said.
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