Look Mom! No Cavities!

Greetings

Recently I received a letter from the President and CEO of the Washington Dental Service, James Dwyer (I know what you are thinking-is she really going to talk about dentistry? But please read on). In this letter, Mr. Dwyer shares his concerns about a "growing childhood health problem - tooth decay and poor oral hygiene among very young children." Mr. Dwyer goes on to say that a recent state survey found that the rate of tooth decay among the children of Washington State is growing and that one in five elementary school-aged children have rampant untreated decay-cavities in seven or more teeth.

This report got my attention as I found myself in the dental chair last week for a root canal procedure. Since the Endodontist got to do most of the talking, he shared with me that his five year old daughter was going in to get her first filling for a cavity. This is the child of a dentist!

Following this story on a national level, I found this article from the American Academy of Pediatric Dentistry (AAPD). The article states, to keep the frequency and duration of sugar exposure in check, the AAPD offers these recommendations:

• Fill sippy cups with water only. Children shouldn’t sip on sugary drinks or munch on sugary foods for extended periods of time. If you give your child beverages other than water, serve them in a can or glass and limit consumption time. If you do provide sugary drinks in sippy or other types of cups, instruct children to finish them quickly. Take away the cup after a reasonable amount of time.
• Don’t let children go to sleep with bottles. Even milk can cause tooth decay. If you do put your child to sleep with a bottle, it should contain water only.
• Limit candy. Sucking on candy is another way that kids can extend exposure to sugar.
• Limit sweets and the time it takes for kids to consume them, and make sure children brush afterward.
• Brush after meals. Have your children maintain proper oral hygiene, including brushing after meals and snacks and daily flossing, to reduce the risk of cavities.
  

There is a federal program called the State Children's Health Insurance Program (SCHIP) that provides health and dental care to low income children.

All children enrolled in Medicaid are entitled to comprehensive dental services. Medicaid's "Early and Periodic Screening, Diagnosis and Treatment (EPSDT)" program, the nation's primary source of well-child care for low-income youth through age 20, must provide dental examinations for all children. The program must also provide necessary treatment or services to correct or ameliorate defects found, regardless of whether the follow-up services are otherwise covered under the state Medicaid plan.

The states have some flexibility in determining when the first dental examination occurs under EPSDT. Current recommendations by the American Academy of Pediatric Dentistry, the American Dental Association and the Bright Futures Project recommend the first dental visit at about age 1.

But being entitled to services and actually receiving them are two different things.

• In 1996, only about 17 percent of Medicaid-enrolled children received the required EPSDT dental services, down from 18 percent in 1994 and 1995.
  
• Only one in five children eligible for a dental screening actually gets it. When children do not receive the appropriate dental screenings, Medicaid pays the higher price of treating advanced dental disease in children. Five percent of the kids eligible for services consume 30 percent of the dollars spent on dental care.
• For example:
• Children with swollen faces, painful toothaches and abscessed teeth may end up in the emergency room. The treatments they receive in this setting generally address their infection and pain, but not the underlying disease-tooth decay. A visit to the emergency room averages about $100 and children may walk out the door with their teeth untouched.
• Baby-bottle tooth decay, a preventable disease, requires very expensive treatment if not identified and managed early. HCFA estimates that Medicaid pays at least $100 million and as much as $900 million per year for operating room charges associated with this disease on top of thousands of dollars in dental fees per case.
  

The other problem is that SCHIP is now up for reauthorization in September and all indications look like the funds will either be frozen at current levels, (which will lead to a significant shortfall) or it will be vetoed.

Keep an eye on this legislation. We can't afford to have our children go without medical and dental care. Their future is too important.

The tragedy of ignoring this was brought home to everyone when a young child died of untreated cavities during Oral Health Month this year.

We can do better