Dental care for low-income children
Early dental intervention prevents trouble later on
In children, tooth decay is the biggest problem that dentists see. “Twenty percent of kids have 80 percent of the cavities,” said Dr. Mary-Margaret Looker, dental director at Central Counties Health Centers, Inc., in Springfield, which provides preventative dental services to low-income patients.
“Oral health is important to overall health,” she said. “The mouth is connected to the rest of the body. If you get an infection in your mouth, it can circulate throughout the body. It’s important to keep the mouth in as good shape as possible.” But the mouth is one part of the body that people neglect.
The American Academy of Pediatric Dentistry recommends that children begin going to the dentist around age one, or within six months after the first tooth erupts. The first visit is generally a quick look inside the mouth and a talk about the importance of good oral hygiene and twice-a-year dental checkups.
It can be challenging talking to the parents. “Many don’t know where cavities come from,” said Dr. Looker. Many are missing multiple teeth themselves, and don’t see the benefit of going to the dentist. They think that bad teeth run in the family. It can be disheartening.
“It’s important to change behavior at home,” she continued. She sees a lot of young children with cavities; however, the decay rate decreases in older children as parents begin practicing better oral health. “Some parents blame themselves,” she said. For example, moms feel guilty for putting their child to bed with a bottle every night, which can lead to bottle tooth decay.
Parents should use a soft washcloth to gently clean their baby’s gums after feedings and before bed to remove bacteria. Once the baby teeth begin to erupt, use a soft toothbrush and fluoride toothpaste to brush your child’s teeth until they’re able to hold the brush themselves, usually around age two, and continue spot checks until age five or six.
Children should brush their teeth for two minutes, twice a day. Hold the toothbrush at a 45-degree angle and, using a circular motion, concentrate on cleaning a small area at a time, slowly moving around the mouth. It’s important to brush the front, back and biting surfaces of the teeth and the tongue. Remember to floss after brushing.
She also recommends using ACT fluoride rinse, adding that if you don’t rinse your mouth with water after brushing, the residual fluoride remains on your teeth.
It’s important to take care of baby teeth because they help with chewing and speech and serve as a natural space retainer until the adult teeth come in.
“Parents need to pay more attention to what their child eats and drinks,” she said. There are a lot of hidden sugars in apple juice and sports drinks, for example. Apple juice contains as much sugar as soda.
She recommends that children drink tap water to incorporate fluoride into their teeth. However, she notes that if you’re going to drink something sweet, have it at mealtime and drink it in 15 minutes rather than sipping it so you don’t keep bathing your teeth in sugar and acid.
Janet Crusen-Nelson, supervisor at St. Clare’s Health Clinic at Catholic Charities in Springfield, says this area needs more nonprofit health clinics that accept Medicaid patients. Sister Anne Carlino with the Third Order of the Hospital Sisters of St. Francis opened the clinic to serve low-income patients. Preventative dental care was added in 1997.
The clinic saw 133 patients last year. Forty-three were referred to Doctors With a Heart, a small group of area dentists who offer pro bono services.
Part of the problem is the lack of pediatric dentists in this area. There is a need for more pediatric dentists who offer pro bono services. St. Clare’s is always looking for dentists and hygienists who are willing to volunteer their time.
The clinic is not equipped to treat patients who need comprehensive dental care; those have to be referred to Chicago or St. Louis. Most children who need extensive dental work need to be sedated and there aren’t many who do sedation dentistry in this area. “We’re not a big enough city,” Crusen-Nelson said.
“It can be a real struggle,” she added. Parents have tried to find dentists but there are very few that accept Medicaid patients. Many are already saturated with patients and can’t accept new ones. Private dentists prefer to see patients pro bono because they don’t want to be put on the list of Medicaid providers.
“We’re struggling to keep up with the need we see in the community,” she said.
A local mom credits St. Clare’s Health Clinic for helping her three children maintain their good oral health. “They’ve had no problems with their teeth,” she said. She’s been taking her children there for 12 years. “It’s worked out great.”
She encourages her children to eat healthily and always makes sure they brush. She doesn’t like sweets so she rarely buys candy or sweets for her kids. Her children only drink 100 percent juice, water and milk. “I try to set an example,” she said.
“I had a hard time finding a dentist that would take the medical card,” she said. “I’m thankful they’re here. I don’t know what I would have done.”
There are 1.6 million children on Medicaid statewide; in Sangamon County, for fiscal year 2014, 22,289 children were on Medicaid.
In 2012, former Gov. Pat Quinn signed the Save Medicaid Access and Resources Together Act, which required 50 percent of Medicaid patients to enroll in a managed care program. The traditional dental Medicaid plan is administered by DentaQuest, which is overseen by the Department of Healthcare and Family Services (HFS).
HFS notified providers in 2015 that Medicaid payments would end pending passage of a fiscal year 2016 budget. A federal court ruled that the state had to continue making Medicaid payments retroactive to July 1. It is currently taking two to three weeks for providers to be reimbursed.
“Illinois has the lowest reimbursement fees in the entire nation,” said Dionne Haney, director of professional services at the Illinois State Dental Society. For example, a dentist may only receive $30 for a tooth extraction that costs more than $200, not including administrative expenses. “It hampers access,” she said. “The reimbursement rates need to be raised.”
Comprehensive services are reimbursed at the same rates as preventative services. The reimbursement fees to the provider and the hospital are so low that it’s not enough to cover the overhead. “It’s hard to find a provider for comprehensive care,” she said, adding many dentists prefer to see the low-income population at no charge.
“It’s not the child’s choice to have bad oral health,” Haney said.