Point of View

Troubling prospects for North Carolina dental care

July 15, 2012 

It’s estimated that as many as a million North Carolinians are eligible for adult Medicaid in North Carolina. Some may not realize that Medicaid also helps assure much-needed dental care in our state. It is, in fact, a safety net for those who have no other avenues for treatment from painful, debilitating and often medically dangerous oral decay and infection.

This is a problem that grows worse with every passing year, as Medicaid funding and reimbursement rates are slashed to help balance the state budget. Now, under federal health care reform legislation, states will have the option of redefining Medicaid eligibility by adjusting the height the income bar in ways that will prevent those in need from enrolling and culling out many who, under previous rules, qualified for coverage.

This sets the stage for a burgeoning dental care crisis among adults in North Carolina. With high unemployment and continuing layoffs, dental insurance coverage is being lost right along with jobs. This results in the unenviable choice of forgoing care or paying for it out of pocket, not a reasonable alternative for people who are out of work.

We see the problem firsthand. The N.C. Missions of Mercy program, operated by the N.C. Dental Health Foundation and staffed solely by volunteer dentists, offers free adult dental care at roughly a dozen locations throughout North Carolina each year. The numbers are staggering and getting worse.

Since the Missions of Mercy program came under management of the N.C. Dental Society in 2009, 22,670 patients have received free dental care amounting to more than $10.8 million. Even these staggering numbers barely scratch the surface. But what’s more troubling is that between 2010 and 2011, the number of patients treated in Missions of Mercy clinics rose 22 percent and the value of care given increased by a third. Additional patients, more expensive care, suggesting that not only do more people need help, their dental problems are becoming more acute and, thus, more expensive.

Where once the volunteers saw mostly the poor and destitute, the program is now treating many “working poor” right alongside them. These are people with low-paying jobs, no benefits and who are struggling to makes ends meet. Many reside in that gray income shadow where they don’t qualify for dental Medicaid, and yet cannot afford badly needed preventative and restorative dental care that’s needed to keep them healthy.

They teeter on the edge of a black hole. Earn too much and risk being kicked off the Medicaid list. Earn too little and, even with Medicaid, you may not be able to afford regular dental care.

So, you might ask, what’s so important about being seen by a dentist regularly?

Dental care is not a luxury. It is in fact a vital, indispensable part of the health care cycle. In recent years, we’ve learned that untreated dental disease, especially infections in the mouth, can contribute directly and sometimes disastrously to major maladies throughout the body. Infection can travel quickly and dangerously to the heart and other organs erupting into serious disease that can lead to death.

But beyond these worst-case scenarios, in many instances in our Missions of Mercy clinics tooth decay is so rampant that we must opt for multiple extractions, pulling a number of teeth that cannot be restored. This can interfere with eating and speaking and diminish self-esteem. Think of a job interview with all your front teeth missing.

The bottom line is that as Medicaid rolls shrink, more of us will be forced into that ugly limbo where regular dental care becomes impossible. If it comes down to a choice between buying groceries and a dental check-up, guess what will win out.

It is vital that North Carolina leaders do not balance the state’s budget on the backs of so many who need, and deserve, care. Medicaid is not the only answer and neither is Missions of Mercy. But in the midst of crisis we are called to do what we must and what is right for those in terrible need of care and attention.

So, as we move forward into the new and unknown territory of health care reform, lawmakers and regulators should weigh the consequences of letting more North Carolinians go unprotected. We cannot let the destitute and working poor go without help.

Dr. William Blaylock, D.D.S., is director of North Carolina Missions of Mercy.

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