Who is to Blame for a Child's Poor Oral Health

in the wake of 12-year-old Deamonte Driver's death in Prince Georges County, Maryland, dental professionals, legislators and community groups weighed in on the issues that led to his death. In a nutshell, his mother was living in a shelter by the time his tooth developed an abcess. She had applied for Medicaid but moved to another shelter before her confirmation of coverage was received. The problems are three-fold in this situation.

The dental professional's perspective.
A huge debate started with everyone trying to figure out what had gone wrong. Why did the mother let the problem get that bad? How could she not have known that there was a problem? Was she guilty of being irresponsible in teaching her children good oral hygiene? There are many great dental professionals out there who have to deal with Medicaid patients not keeping their appointments, frustrating red tape when filling out the paperwork, and poor compensation for the work that is done. Medicaid still pays much less then a dental professional in private practice can accept and still remain in practice. The dentists tend to write off up to 50% of their fees. Health Choice was offered in North Carolina, and initially offered a great payment but ended up reducing the payments. This was compounded by the fact that they did not offer a fee schedule (http://www.themountaineer.com/archives/2007/03/16/topstories_dentiststhesystemist.html). This is just one example of the issues dentists face. How often should a dentist make an appointment and then lose another potential patient who could have filled the slot of a patient who ends up not showing up? Unoccupied slots translate into lost revenue. Dental professionals are genuinely concerned about making services available and have found innovative ways to donate time to organizations that cater to underserved populations. They also provide educational workshops, seminars, and clinics at community functions, that help reach a large number of the population.

The underserved patient's perspective.
Lack of transportation, no dental insurance, a lack of education, and no dental providers in their immediate transportation area all conspire to lead the underserved patient down the road to dental decay and gum disease. Deamonte's mother was working jobs that did not provide insurance and did not have the transportation that she needed to get back and forth to the dentists that accepted Medicaid. Her bout with homelessnes put her in a position to miss the letter that was probably sent to the last address on file for her. Medicaid patients usually have a stigma attached to them that does not allow them to be treated like they are able to process information (Disclaimer: This is not always true, but is a disturbing pattern). I have been on the uninsured end of the stick and know how it is to not receive the necessary information about proper care. Jaded dentists and dental professionals, tired of dealing with a large number of poor paying patients usually want to push them out quickly so that they can see the next one quickly. It is frustrating to be given an asprin with no real treatment done, because of your lack of insurance. If you are working a job that is not flexible then it is difficult to get time off during the times that dental offices are open. You can't risk losing your job as it is the one barely paying the bills. You can't afford transportation (a car), so you rely on public transportation to get you around. Information is not widely disseminated so knowledge about the dangers of a toothache are not widespread. If you are aware of an educational/informational seminar, the times are inconvenient for you.

Possible solutions.
The fact that the mother had such a hard time locating a dentist that would take their insurance, and one that was close to therm, is an indication that there is a larger problem at hand. Legislative changes need to be made to make Medicaid insurance more attractive to dentists. It should also provide a database that is easily accessible for people to locate dentist within their communities. Educational seminars should be conducted in underserved communities, at convenient times, to help spread the information more widelyand help people learn ways to keep tooth decay and gum disease at bay. It could be conducted in conjunction with dental clinics, to take care of obvious problems immediately. Parents need to exercise common sense when handing out food and snacks to their children. Too much candy and soda is not good for your child. Help them make healthy choices; make healthy choices for yourself. The better care you take of your diet, the less likely you will be to have to deal with tooth decay and gum disease.

Changes need to be made in the Medicaid process but if we take personal responsiblity for us and ours, we are sure to need less time in the dental chair and more time enjoying life. Here's to no tooth decay or gum disease!