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March 28, 2007:
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WASHINGTON - Dental care cannot be left out of the national discussion on health, experts told lawmakers Tuesday in a House hearing prompted by last month's preventable death of a Maryland boy from an abscessed tooth.
It is "cost efficient, humane and essential," said Dr. Burton Edelstein, the founding director on the Children's Dental Health Project, "I do not understand how the mouth can be cut out of the rest of the body" simply because of a gap in policy.
The mother of Deamonte Driver, 12, could not afford the $80 needed to treat her son's toothache because her Medicaid coverage had lapsed, possibly because the paperwork was mailed to the homeless shelter where the family formerly stayed.
One month, and approximately $250,000 of state funds later, Driver died after bacteria from the abscess reached his brain.
"If Deamonte Driver had had a dental home starting with the recommended age-1 visit, his disease may well have been prevented," Edelstein said.
While Driver's case is extreme, the case of a low-income child not receiving dental care is hardly unique.
"Unfortunately for Deamonte's family, like too many other low-income families, dental care is out of their reach," said House Majority Leader Steny Hoyer, D-Mechanicsville, in a statement to the House Energy and Commerce Subcommittee on Health.
In August 2005, the Centers for Disease Control and Prevention reported that a quarter of children ages 2-5, and half of children ages 6-11, have cavities, and Medicaid statistics reported that only 25 percent of children enrolled in the program had "at least one preventive dental visit - less than half the rate of services obtained by commercially insured children," Edelstein said.
Furthermore, "chronic infectious disease that causes cavities remains second only to the common cold in terms of prevalence in children," said Rep. Frank Pallone, D-N.J., in his opening remarks at the hearing.
"Unlike a common cold, however, tooth decay does not go away," he said, "it only gets worse."
In Maryland, HealthChoice, a program run by the Department of Health and Mental Hygiene, holds responsibility for coordinating the providers who accept Medicaid.
From its inception in 1997 to the latest data available in 2005, the percentage of children ages 4-20 enrolled in the program and receiving dental services has risen from 19.9 percent to 45.8 percent, or more than 100,000 out of the more than 225,000 children enrolled.
Edelstein and other witnesses pointed to a national lack of pediatric dentists, lack of dentists participating in the Medicaid program and of insufficient reimbursement of funds for the dentists who do participate, as explanations for the low numbers of children receiving dental benefits.
On the local level, blame was placed on a shortfall of school nurses, of oral health education, and of help navigating the complex aid policies available to low-income families.
During the hearing, one representative after another from states from California to New York, expressed outrage over the young boy's death and implored panelists to not only identify problems with the Medicaid and State Children's Health Insurance Program, but to provide solutions as well.
The American Dental Association suggested a "community health coordinator" -- a position designed to "work as a social worker, and provide services as well," said ADA President Kathy Roth in an interview after the hearing.
In Driver's case, the coordinator could have assisted the family through the complex application system, getting help for them before it was too late.
The reauthorization of SCHIP was touted as another solution by panelists, including Mr. Raymond Scheppach, executive director of the National Governors Association.
"Any further improvements in children's dental health must come from building on the strengths and successes of SCHIP, and that includes both funding and flexibility," Scheppach said.
According to the House Appropriations Committee, the proposed emergency supplemental spending bill "adds $750 million for SCHIP to ensure continued health care coverage for children in 14 states that face a budget shortfall in the program," including Maryland, which is due to run out of money in May.
The FY 2008 budget increases funding for SCHIP by $4.8 billion over the next five years.
A Maryland senator has already responded to Driver's death by introducing legislation on the Senate side that mandates dental coverage under SCHIP.
Democrat Ben Cardin introduced the Children's Dental Health Improvement Act of 2007 just three days after Driver's death, along with six other lawmakers.
In the meantime, Cardin said, "efforts are being made to improve dental services in our schools...preventative health care services, other community based programs to include dental care, and to improve Medicaid reimbursement rates so more (dentists) are willing to treat patients."