'Silent epidemic' of dental disease threatens poor kids' health
Updated 11:55 pm, Sunday, March 4, 2012
Every time Dr. Martee Engel treats a young patient whose teeth have brown or white chalky spots, she's reminded of an acute problem affecting children - particularly poor children.
Engel sees more than her share of early childhood tooth decay as dental director at Denver Harbor Clinic in northeast Houston. The clinic treats mostly poor children who are twice as likely as more affluent children to have untreated tooth decay, studies show.
While overall oral health care for adults and children has improved, tooth decay continues to be the most common chronic disease among children. It can have serious social and health consequences when untreated and, in rare cases, can be fatal.
"The children with the highest need are the poor," said Engel, a pediatric dentist for 20 years. "Their tooth decay occurs more rapidly and is more pervasive."
A surgeon general report in 2000 called the problem a "silent epidemic." It estimated that children lose more than 51 million school hours because of toothaches. Children whose families are below the federal poverty line suffer 12 times more restricted activity and loss of school hours than other children, the report said.
Texas has done a better job than most states in improving access to dental care during the past decade, according to a study by the Pew Center.
Texas was one of nine states to receive a B for meeting national benchmarks.
In 2007, the state added $258 million to Medicaid to increase dental reimbursement rates on average by 50 percent, which has increased dentist participation.
The action was part of a settlement of a class-action lawsuit.
But even with more access through Medicaid and the Children's Health Insurance Program, use of benefits remains low. Only 60 percent of the 3.3 million Texas children enrolled use their dental benefits, according to state officials. Figures in most other states are lower.
Waiting for weeks
Health policy analyst Julia Paradise said more dentists, especially pediatric dentists, must participate in public insurance programs to fill the gaps. The need is greatest in rural areas and inner-city communities, she said.
"Coverage is not the same as access," said Paradise, an analyst with the nonprofit Henry J. Kaiser Family Foundation. "It gets you to the door, but the door has to open."
In Houston, community health clinics, such as the Denver Harbor Clinic, are picking up the slack. They accept public insurance and provide free or discounted services, but the need is so great that families sometimes wait weeks to see a dentist.
Many parents don't come back or don't show up for scheduled appointments because they can't afford to miss work or can't arrange transportation, Engel said. By the time many poor children get to a dentist, they often need complex work that's sometimes expensive.
One of Engel's worst cases involved a 4-year-old boy with an abscess on his baby teeth. He showed up at the Denver Harbor medical clinic with a swollen face, complaining of pain and not being able to sleep.
He was referred to Engel at the dental clinic next door.
The boy was so infected that Engel had to first treat him with antibiotics. She told his parents to bring him back in four days to have his teeth removed, but he never returned.
The clinic searched for his homeless family and found them two weeks later so that Engel could remove his teeth.
The family likely didn't return because they couldn't afford the procedure, Engel said. Had the family continued to delay care, the boy probably would have landed in a hospital emergency room for treatment, which is common, she said.
Tooth decay is caused by bacterial infection that can spread if untreated. Dental disease has been linked to cardiovascular conditions, diabetes, and strokes.
In 2007, a 12-year-old Maryland boy died when a tooth infection spread to his brain. His family had recently lost its Medicaid benefits. A tooth extraction would have saved his life, dentists said.
While poor dental hygiene and nutrition contribute to dental disease, other factors such as lack of insurance, access to dental care and cost of dental care exacerbate the problem for low income families.
Fabiola Saldana said she went to the dentist every six months as a child because her parents had dental insurance. She hasn't always been able to do the same for her two children.
Saldana's daughter, now 15, had to have four baby teeth removed when she was 2 because of decay. Saldana said she noticed the chalky white spots on her daughter's teeth but delayed taking her to the dentist because she didn't have insurance and couldn't afford to pay out of pocket.
She took a different path with her 2-year-old son. She enrolled in Medicaid three years ago and took him to his first dentist appointment when he was 6 months old.
It was during her prenatal care at the Denver Harbor medical clinic that she learned about the importance of early dental care.
"I didn't know you could take kids in at six months, Saldana said.
A recent survey by the Institute for Health Policy at the University of Texas School of Public Health found that 73 percent of Houston children had coverage for dental care at some time during the year.
However, 15 percent of residents surveyed said they delayed dental care because of cost or coverage considerations. The figure went up to 31 percent if they had no dental insurance and up to 52 percent if they had neither medical nor dental coverage, survey results show.
Among those whose children are covered by Medicaid or CHIP, only 9 percent delayed dental care. However, 18 percent of those whose children were covered by Medicaid or CHIP, thought they had no dental coverage of any kind, the survey said.
She said families need to establish a dental home, the strongest predictor of success in oral health care.