As dental care and dental insurance costs rise, employers and individual policy owners cancel policies, take their chances, and more low-income people postpone treatment until conditions are serious. Children are particularly vulnerable. How should a compassionate community respond?
Family dentists are important.
More than half of our community’s economically disadvantaged youth do not have a “dental home” (a family dentist). With a family dentist, problems can be detected earlier, prevention and hygiene are more likely to be practiced by the patient and records can be more effectively maintained.
Low reimbursements discourage treatment. Approximately 11,000 Daviess County youth qualify for the Medicaid (or K-CHIP) program, but few dentists treat them because government reimbursements are only 35 percent to 50 percent of their normal fees. Reimbursements have not increased in many years.
Volunteer dentists conduct screenings.
Due to the generosity of volunteer dentists, students attending six local elementary schools are offered dental screenings. Participating elementary schools: Foust, Estes and Cravens in the Owensboro system; Utica, Tamarack and Sorgho in the Daviess County system. (There are 20 elementary schools and five middle schools in Owensboro-Daviess County.) Dental screenings also take place during the annual back-to-school “Readifest” that last year was attended by 1,725 students.
Many students get sealants.
As a follow-up to the screenings at schools and at events such as Readifest, many youth receive dental sealants at dentist offices. Sealants protect against future cavities, but they cannot be applied until existing cavities and other problems are treated.
Dental education is essential.
School nurses promote dental health and provide opportunities for students to brush their teeth at school. According to local dentists, in many instances, these worthwhile programs cannot offset the damage caused by the high-sugar diets and soft drink consumption so prevalent in youth today. Dentists stress that poor dental health leads to poor general health.
Many delay treatment due to cost of care and insurance.
Access to care is an issue for more than those who qualify for assistance. And only 25 percent to 30 percent of Medicaid/K-CHIP eligibles use their dental benefit. Many youth do not receive the treatment they need because they come from working families who cannot afford the cost of care or dental insurance. Most employers do not offer dental insurance as a benefit, and dental benefits are increasingly dropped as employers cope with rising health insurance premiums. Consequently, many people postpone dental treatment until conditions are serious or additional health complications occur.
Charity care is available, but limited.
Some dentists provide charity care in their private practices, generally in a discreet manner so as not to attract an unmanageable number of non-paying patients. The Christian Dental Mission, located in a low-income west end neighborhood, relies on volunteer dentists and hygienists, but has limited hours and a long waiting list. Occasional dental screenings and hospital emergency room care provide the only other options.
Missed appointments complicate care.
When patients miss appointments, dentists are more likely to discontinue reserving appointment slots for Medicaid and non-paying patients. “No shows” are typically caused by transportation problems or because the patient will lose pay or may not be allowed off work to see a dentist.
Many turn to the hospital ER.
An Owensboro Medical Health System (OMHS) hospital emergency room physician recently reported that approximately 10 patients per day turn to the emergency room for dental care. (Some claim that this is due, in large part, to the increased use of methamphetamine.)
Daviess County can meet demand, but not need.
There are 54 dentists listed in the local Yellow Pages phone directory, including 41 dentists in family/general practice. For Daviess County to be classified as underserved, 34 or fewer family/general practice dentists would be serving our community. This forumla measures the capacity to meet the “demands” of the market, but not “needs” of the uninsured, underinsured and poor.