Child Dies for Lack of Dental Care

The Washington Post reported today that a twelve year old Prince George's County, Maryland boy died Sunday after the infection from an abscessed tooth spread to his brain. The boy had not been receiving routine dental care.

According to the report, twelve year old Diamonte Driver first complained of a headache six weeks ago. He was treated at a hospital for a tooth abscess, sinusitis and the headache. Shortly after beginning treatment, he was hospitalized at Children's Hospital in the District of Columbia and underwent two brain surgeries, the Post said.

Diamonte's mother did not have dental insurance or Medicaid coverage; a timely $80 tooth extraction could have saved his life, according to the Washington, Post.The Post reported that when Diamonte first began experiencing a toothache, his mother was having trouble finding a dental provider who would accept Medicaid to extract six abscessed teeth from Diamonte's younger brother DeShawn.. After finally finding an oral surgeon who would accept Medicaid and making an appointment for DeShawn, she learned that her Medicaid coverage had lapsed and cancled the appointment. The coverage lapse apparently occurred when her family moved had moved from the homeless shelter address listed on the Medicaid application.

A 1996 study by the American Dental Association supports the conclusion that health insurance coverage relates positively to children's receipt of dental care. The study showed the 56% percent of children with private dental insurance made at least one dental visit during the year 1996 while only 28% of those eligible but without such coverage made at least one dental visit. For those with Medicaid insurance, 28 % made at least one dental visit during the year 1996 as compared with 19% of noncovered children in the Medicaid program (coverage varies from state to state). The study concluded that private insurance increased the likelihood of a child receiving dental coverage more than having Medicaid insurance did.

Based on 1989 data, reviewed in the ADA study, the researchers noted that children with no dental coverage are three times more likely to have a dental need than children with dental coverage. The study concluded that "since Medicaid dental coverage,unlike its private-sector counterpart, seems to have a lesser effect on the likelihood of a child's visiting a dentist, the effectiveness of Medicaid dental coverage should be further investigated. Perhaps improving oral health for poorer children may depend in part on improving Medicaid dental coverage programs."

States are required to provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to children enrolled in Medicaid. It is up to each state to determine in conjunction with dental experts what coverage intervals meet reasonable standards of dental practice. At a minimum, Medicaid must cover pain relief, treatment of infections, tooth restorations and maintenance. Had Diamonte's Medicaid coverage not lapsed, treatment for an abscess would have been covered assuming his mother could have found a dentist willing to treat him.

Sources: The Washington Post, 2/28/07, msnbc.com, http://jada.ada.org/cgi/content/full/132/8/1137, http://www.cms.hhs.gov/MedicaidDentalCoverage/