Pediatric Dentistry:
How Can Dental Care for Low-Income Children Be Improved?
The "silent epidemic" of dental diseases that disproportionately affect the nation's most vulnerable populations gained public attention early last year when a twelve-year-old Maryland boy died after an untreated tooth infection spread to his brain. A November ABC News investigation into a national dental chain that treats many children on Medicaid, and a New York Times front-page story in December reporting on the widespread dental problems in Kentucky -- where one in ten people have no teeth and half the state's children have untreated cavities -- underscored the national urgency of the problem.
A new report by The George Washington University School of Public Health and Health Services (GW/SPHHS) places these stories in context, providing background on the unmet dental health needs of the nation's poorest children, the health and social consequences of untreated childhood dental disease, and possible policy changes to improve care.
Among the report's findings:
- Approximately 25% of children ages 5 to 17 account for 80% of the cavities in permanent teeth, according to the U.S. General Accounting Office.
- Fewer than half of children in families living below the federal poverty line report that their teeth are in either "excellent" or "good" condition (compared to almost 83% of children whose family incomes were 400% of that line or higher), according to the National Survey of Children's Health.
- Dental problems in childhood can result in poor nutrition, pain, embarrassment, lost school days, and occasionally, severe or life-threatening infections. They also set the stage for serious health problems in adulthood.
- Children covered by Medicaid or the State Children's Health Insurance Program (SCHIP) are more likely to see a dentist than children without any kind of insurance. However, the great majority of dentists do not accept Medicaid patients, primarily because of low reimbursement rates and perceived burdens associated with Medicaid provider participation.
Among the opportunities that have been proposed to strengthen pediatric dental services:
- Increase Medicaid reimbursement rates, which the American Dental Association calls "one of the most critical strategies for improving access to oral health."
- Include a mandated dental benefit in the State Children's Health Insurance Program. President Bush vetoed SCHIP reauthorization legislation that would have required all states to cover dental services for children. The bill signed into law on December 29, 2007 extends the current program, which does not include a dental mandate.
- Expand funding for federally qualified health centers, which care for one in four low-income children and which registered 5.16 million patient visits to 1,900 health center staff dentists in 2006.
- Expand the use of dental health aides, including dental therapists who can drill cavities, extract teeth, and provide other primary oral health care services.
- Promote replication of the many state models that have been used to improve access to dental care. For example, under the Robert Wood Johnson Foundation's State Action for Oral Health Access initiative, six states have tested and evaluated new strategies.
While the appropriate combination of these approaches will surely require further debate, the importance of improving pediatric dental health for the nation's most vulnerable children does not.
About the George Washington University Medical Center:
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area for 176 years. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation's capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.
