RALEIGH — Fourteen percent of kindergarteners in North Carolina have untreated decay in at least one tooth, and nationally 21 percent of children ages 6 to 11 have cavities in their permanent teeth – evidence that children, particularly from low-income households, aren’t getting proper dental care, according to the N.C. Institute of Medicine.
Last week, a task force assembled by the institute – an agency chartered by the state to provide nonpartisan information on health issues – released 14 recommendations to increase the use of preventive oral health care among children covered by Medicaid and N.C. Health Choice, a state-run health insurance plan for uninsured children ineligible for Medicaid.
“Children with poor teeth have problems in school because they can be embarrassed to ask questions or speak, it affects their social ability, it causes oral pain and discomfort and can be a serious handicap,” said Dr. Frank Courts, a pediatric dentist in Rocky Mount and co-chairman of the task force.
Though the institute came up with the recommendations, it will be up to the state Division of Medical Assistance and the N.C. Dental Society to implement them, said Berkeley Yorkery, project director of the institute. A major objective is to improve communication between dentists and family physicians to encourage them to educate families about the importance of oral health for their children.
“We have very strong pediatricians and strong oral health programs,” Courts said. “We just need to connect the dots in terms of transition from the medical office to the dental office.”
To increase the utilization of preventive oral health services, parents need to take their children to the dentist during the first year of life, Yorkery said.
“Opinions in the dental community have varied widely, and only recently have they agreed on the first year of life,” she said. “We have to make sure our pediatricians are on the same page.”
The task force also hopes to correct confusion within the dental community about the effectiveness of sealants, a type of liquefied plastic painted over the chewing surfaces of back teeth to prevent food particles from being trapped and bacteria from forming. Sealants can reduce decay by more than 70 percent, according to a Surgeon General’s report in 2000, and promoting them and keeping dentists abreast of sealant technologies make up four of the task force’s 14 recommendations.
“It is such an underutilized service,” said Dr. Alec Parker, Executive Director of the N.C. Dental Society. “We have very good, long-term studies showing how effective they are; we need to be able to introduce practitioners to this newer information.”
Some of the task force’s recommendations may be more challenging, such as increasing the number of dentists who participate in Medicaid and N.C. Health Choice.
Nationally, only about 20 percent of the nation’s 179,000 practicing dentists accept Medicaid. They, like other medical practitioners, are reluctant to accept Medicaid patients because they receive lower reimbursements than from private health insurance and because low-income patients do not reliably keep their appointments, Courts said.
Parker said the Dental Society will encourage dentists to considering accepting Medicaid patients by featuring dentists it calls dental champions and showing “how they implemented business plans that allow them to accept Medicaid patients.”
Other recommendations require action by the state.
The task force’s report recommends that the N.C. State Board of Dental Examiners reduce barriers for out-of-state licensed dentists to work in the state and urges the General Assembly to increase funding to the Oral Health Section of the Division of Public Health to hire more dental hygienists.
In fact, the state budget approved by lawmakers this week would cut 15 positions in the Oral Health Section effective Oct. 1.
Care in low-income schools
The task force also recommends creating a pilot program of private dental practices providing basic care in schools in low-income areas. That would require the Board of Dental Examiners to reverse a law that requires an on-site dentist when a dental hygienist provides basic care, as well as obtaining permission from principals and school boards, Courts said.
“For children from low-income backgrounds whose parents work and may find transportation difficult to get, it is most efficient to find these children in their schools,” Courts said.
Though state dental practitioners and health organizations worked together to create the report, each organization will prioritize the recommendations individually. The entire N.C. Dental Society board planned to look over the report for the first time together Friday, Parker said.
“I think looking at this realistically, sometime in 2015 we can expect meaningful change,” he said.