*Note: This package of clips highlights feature, investigative and breaking news 

journalism I produced as a reporter for The Examiner in Independence, Mo, in 

2007.

April 21, 2007

Section: News

Eastern Jackson County Has Tooth Decay 

James A. Foley 

james.foley@examiner.net

When Cathy Gray learned that many of the children who came into the nurse’s offce were not receiving adequate dental care, she decided to do something about it. Gray, a nurse for the Lee’s Summit School District, arranged for 10,000 of the district’s students to have dental screenings. About 30 of the students screened went on to receive free dental services. For her efforts, Gray recently received the Children’s Mercy Hospital Excellence in School Nursing Community Outreach Award for her work in coordinating dental screening services for all elementary and middle schools in the school district.

Tooth decay is one of the most prevalent yet easily preventable diseases in America. Gone untreated, it can lead to overall health problems that can end up hurting children physically or, in extreme cases, even killing them.

In February, The Washington Post reported that a 12-year-old Maryland boy from a poor family died from a severe brain infection that was caused by bacteria from a decaying tooth. A routine tooth extraction probably would have saved his life.

Gray was motivated by hearing that story and by the situation of one of her students who had signifcant tooth decay and found it nearly impossible to see a dentist, even though the student, who is on Medicaid, received ample medical assistance for her asthma.

The dental screening program Gray established has helped many students who were out of reach of necessary dental care, hopefully preventing another unnecessary tragedy. Once the screenings were completed, the parents of the students with the most signifcant dental problems were contacted. Those without access to dental care were given the names and numbers of dentists who volunteered their services. Twenty-four dentists and oral surgeons provided free dental care.

A recent study on oral health in America done by U.S. Department of Health and Human Services noted inequities and disparities that preclude many Americans from achieving an optimal level of oral health.

The American Dental Association states that tooth decay is one of the most prevalent and easily preventable of diseases in this country. Dental experts agree oral health is often underpriortized and unaffordable for many. Eastern Jackson County is no exception. Many families are forced to place dental insurance on the back burner in lieu of paying general health insurance and other premiums—if they can even afford insurance in the frst place.

Most area dentists The Examiner spoke with agreed that preventative dental care in children is the most effective step in solving the dental health problem, yet most dentists in the metro do not accept children on Medicaid.

Jackson County has 354 licensed dentists. According to the Department of Social Services Web site, 109 dentists in Jackson County accept Medicaid.

“It’s a problem that gets worse and worse,” said Gray, adding that Lee’s Summit has no dentists who accept Medicaid. Data from the Department of Social Services show that for the 2006 fscal year, fewer than half  (48 percent) of the children enrolled in Missouri Medicaid program received dental services.

Gray is skeptical the percentage is that high. “From my experience, I wouldn’t believe it,” she said. Gray has been a school nurse for 15 years and spent the previous 15 as an intensive care nurse.

Old news 

Dr. Paula Livingston, director of the Jackson County Health Department, said that lack of dental care is “the number one [health] problem in Eastern Jackson County.” She said lack of funding has made the dental health problem worse. “We thought we had accomplished our goals … but we realize (the problem) has come back,” Livingston said.

Or did it ever leave?

A 1998 Health Resources and Services Administration survey of Eastern Jackson County stated that “persons in eastern Jackson County who are enrolled in the Medicaid program or who are uninsured do not have adequate access to dental health services.”

An August 2006 study found the same thing. An impact analysis done by the Eastland Community Foundation states that dental care for uninsured and the underinsured is a “particular priority.”Dental care was rated as the highest need by those surveyed, refecting a shortage of dentists and limited accessibility to services for those without dental insurance or other resources.

Broken system 

Cliff Anderson is a pediatric dentist in private practice in Independence. He used to accept Medicaid, but 2005 state budget cuts in health care priced him out. “Reimbursements are so low, I was going broke,” he said. He had to stop accepting Medicaid to stay in business. The Medicaid reimbursements are so inadequate that he wasn’t even breaking even. He said the system is “totally broken down.”

New rules for Medicaid reimbursements have taken away much of the paperwork, but dentists are still leery of accepting Medicaid patients. John LaBarca, a dentist in private group practice in Independence, said his offce has never taken part in Medicaid. “A lot of private dentists choose not to be involved (with Medicaid) because it’s run so poorly,” he said.

LaBarca said it’s easier for him to do the work for free rather than abide by bureaucratic quotas and regulations. He helped organize Dental for Kids, a free children’s dental care program. The state does have the MC+ health care program for uninsured children which includes dental coverage, but a family must be hovering near the poverty line to be eligible. Gray, the school nurse, said that there are many children in the community with family incomes high enough to not qualify for Medicaid, but still don’t have dental insurance because their parents can’t afford it.

“The U.S. needs to know that these services are being chipped at until there’s nothing left,” Gray said.

Local action 

With state cuts in Medicaid and a seeming lack of urgency by the government to provide affordable health care, local organizations are making a grassroots movement to get dental care to those who need it the most.

“People often think in the suburban community that kids have all the help and care they need. Unfortunately, that’s not true,” said Janet Smith, director of Blue Springs WellLink, a non-profit group that runs a free dental health program called Dental for Kids.

Since the program was launched, close to 400 children have received dental services. Sixteen dentists, two oral surgeons and an orthodontist who practice in Eastern Jackson County have donated more than $250,000 of dental services to Blue Springs WellLink. Smith said the program’s goal is to get every child in Eastern Jackson County to see a dentist.

“The need is so big that there are still so many children that need care,” she said.

Cynthia Starr is a Blue Springs mother of three. Her job as a claims manager does not provide dental insurance for her or her kids. “I can’t afford it, and my ex-husband doesn’t help,” she said. Her 12-year-old son, William, had mouthful of oral problems that required a root canal to remedy. William was able to get the dental care he needed through WellLink. “If I didn’t have them, my son wouldn’t have been able to have a root canal,” said Starr about the WellLink dental program.

Damage control 

There are “safety net” providers, such as Samuel Rogers and Swope Health Services, that provide dental and other health services to the Medicaid and uninsured community, but visiting a downtown clinic is often diffcult for an working family who may not be able to afford the time off-the-clock to spend hours waiting at a clinic while their child receives care. Lack of transportation is also an issue for some families.

The dental care problem is not isolated to children. Adults need care too, and affordable dental services are even less prevalent for the over-19 crowd. The 2005 state Medicaid cuts eliminated dental care for nearly everyone older than 19 years.

Five clinics on the Missouri side of the metro provide services to the uninsured: Truman Medical Center, Swope Health Services, Samuel Rogers Health Center, Unifed Government and UMKC dental school.

The 2005 Medicaid cuts did not affect dental services for children, but they have limited the adult Medicaid community in need of preventative and elective dental care. “Prior to the cuts, about 70 percent of clients were covered by Medicaid. Now it’s 35 percent,” said John Dane, director of the dental program at TMC Lakewood, which sees about 1,400 patients a month.

Because of the state Medicaid cuts, TMC, and in turn Jackson County taxpayers, must absorb the fnancial costs when dealing with situations of medical necessity. Dane said the dental program has lost about 15 percent of their self-pay patients because of Medicaid cuts. Despite the cuts, the Department of Social Services, which oversees state Medicaid, insists they’re getting the job done.

“The department is committed to providing affordable health care for all Missourians, especially children,” said Ana Compain-Romero, spokesperson for DSS.

The state health care budget and the future of health care in Missouri is currently being debated among legislators in Jefferson City.

Education necessary 

Not everyone agrees that accessibility and affordability of dental care are the core issues. Wesley Christian, a dentist in private practice, says education on dental health is what’s most important.

“I believe it boils down to education. Access is not this issue,” he said, “You could put a dental office at every street corner and it wouldn’t help.” He said more of an effort to educate parents and their children on dental health is needed in order to get them on the “dental bandwagon.”

“It’s something that should not just be taught at the grade school level,” he said. Christian said most of the tooth decay he sees in children is a result of too many sugary drinks and too much sugary food. In his offce he has a canister of sugar that’s equal to the sugar content of one can of soda. He said most people are amazed when they see it. A typical can of regular soda has more than 20 grams of sugar. Tooth decay is caused by bacteria that digest residual sugars in the mouth, producing acid that decays teeth.

“I’ve seen children come in here with a cavity in every tooth because they drink pop,” he said.

Put your money where your mouth is 

This month the Missouri Dental Association has testifed and lobbied before the state legislature to get adult emergency dental care as well as increased Medicaid reimbursements for private dentists. MDA member Kenneth Weinand, one the few local dentists who takes Medicaid patients, participated in discussions with legislators about the need for dental care to be included in MO HealthNet, Gov. Matt Blunt’s proposal to overhaul the state Medicaid program.

Weinand said funding for dental services in the new proposal is important to the many Missourians who lost their dental Medicaid coverage in 2005.

He had James Bramson, executive director of the ADA, backing him up. In a letter to state senator Chuck Purgason, who chairs the Senate Committee on Health and Mental Health, Bramson said that costs to state Medicaid would likely reduce with the addition of improved adult dental Medicaid benefits.

He pressed legislators to provide funding to include emergency dental services and to raise the reimbursement rate for children’s Medicaid dental coverage to a level on par with other states. Weinand said Missouri private dentists who accept Medicaid are only reimbursed about 30 percent of their expenses, adding that neighboring Arkansas has a 95 percent reimbursement to dentists accepting Medicaid.

Vicki Wilbers, executive director of the Missouri Dental Association, said she’s optimistic that the legislature will appropriate money for emergency dental care by the end of session in May. But she’ll have to keep trying for increased Medicaid reimbursements, as there is no language in the fiscal year 2008 budget to increase the reimbursement level. Wilbers said that increasing Medicaid reimbursement is the best way to address oral health problems.

“They’re both in a grave state, actually. That comes back to inadequate reimbursement.”

Copyright 2007, 2008 The Examiner, All Right Reserved.