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Health-Care Cavity; Millions Of Americans Have No Dental Insurance

While the national health-care act passed in spring will increase the number of people eligible for medical insurance, its effects on dental will be mixed...

Copyright 2010 Philadelphia Newspapers, LLCAll Rights Reserved The Philadelphia Inquirer
July 26, 2010 Monday CITY-C Edition
SECTION: FEATURES MAGAZINE; Inq Daily Magazine; Pg. D01
LENGTH: 1487 words
HEADLINE: Health-care cavity; Millions of Americans have no dental insurance and haven't seen a dentist in years. The new legislation will be no remedy.
BYLINE: By Brooke Minters; Inquirer Staff Writer

It began with a toothache. Tori Pence, 23, could feel the hole that had suddenly developed on her tooth, and she couldn't stand either hot or cold food. The bespectacled girl with electric-blue hair had worked a string of odd jobs and hadn't seen a dentist for at least five years.

When she finally got in to see one, she needed a root canal. And fillings for 15 cavities.

"Dentally speaking, I am healthy now," says Pence, who lives in Lansdowne and has been making monthly visits to the University of Pennsylvania's dental clinic for almost a year. "But I still have seven more [cavities] to go."

Pence is one of the estimated 132 million people in the United States without any sort of dental insurance. It's an endemic problem among the unemployed, the poorly paid, and those without medical insurance.

While the national health-care act passed in spring will increase the number of people eligible for medical insurance, its effects on dental will be mixed.

The law increases coverage for children, and will eventually cover more adults under Medicaid, the joint state-federal health plan for the poor. But adult dental services are often hard to find: Less than one-third of dentists in Pennsylvania and New Jersey participate in Medicaid.

Many people don't see the value in preventive dental care - or they dread it - and postpone routine checkups. That is, until it becomes too painful to chew or a front tooth is chipped.

In Philadelphia, geriatric dentist Ann Slaughter says many elderly patients she has examined at inner-city senior centers haven't seen a dentist for up to 15 years.



Foresters Advantage Plus: Participating Whole Life Insurance But "oral health is intimately connected to overall health," she says.

Periodontal disease can cause or worsen heart conditions, strokes, and respiratory illness.

It can be perilous for diabetics. Germs from gum disease can make them more prone to complications, says Slaughter, an assistant professor at the University of Pennsylvania School of Dental Medicine and a member of the city Board of Health.

More than 200 diseases of the mouth can also cause problems elsewhere in the body. The plaque on teeth can travel into the blood and contribute to hardened arteries, a risk for heart attack.

In 2000, Surgeon General David Satcher called dental and oral diseases a "silent epidemic" facing the nation.

"We're in 2010, and we haven't made many advances," Slaughter notes. "That's the sad part."

One problem is the many gaps in dental insurance, which unlike medical insurance, was never intended to completely cover anything.

For those without insurance, the median price for a root canal in Philadelphia is $862, according to a survey that dentists use to price procedures. A crown can cost as much as $1,200.

And while 172 million Americans under 65 have private health insurance, just 45 million of them have any sort of dental plan, according to the National Center for Health Statistics.

In Pennsylvania, 40 percent of the entire population of adults and children lacks dental insurance, according to the Pennsylvania Dental Association.

Medicare has substantial holes as well. It covers health care for virtually all seniors and some younger people with permanent disabilities. But it doesn't pay for routine dental care.

When people turn 65, says Slaughter, "those with disposable incomes pay out of pocket or they keep their dental insurance."



Foresters Advantage Plus: Participating Whole Life Insurance Medicare does cover dental procedures that are connected to a larger medical issue. A surgeon won't perform an open-heart operation on a patient who has a mouth abscess, for example, until a dentist has treated the problem.

Medicaid poses its own challenges. There are 508,000 recipients in Philadelphia, but many of the adults aren't eligible for dental because they aren't permanently disabled or fail to meet other criteria.

Those who are eligible can have a hard time finding a dentist.

"Just because you have insurance doesn't mean you have access," says Laval Miller-Wilson, the executive director of the Pennsylvania Health Law Project.

Pennsylvania has some of the lowest reimbursement rates in the country, according to a recent report by the Pew Center on the States. Pennsylvania's Medicaid program reimbursed dentists 53 percent of what they customarily charge. The national average for Medicaid is 60.5 percent.

New Jersey had among the nation's lowest reimbursement rates until recently, but now pays 103 percent of the customary fee, according to the Pew Center, which nevertheless gave the state an F on its dental report card due to other limitations of coverage for the poor. (Pennsylvania also got an F.)

Miller-Wilson says some dentists' aversion to Medicaid is about more than money. The paperwork is cumbersome. And broken and late appointments are common among the poor.

Instead of accepting Medicaid, "many dentists say they would rather treat patients during free clinics or pro bono," says Rob Pugliese, spokesman for the Pennsylvania Dental Association.

Lack of increased funding for Medicaid dental services is a major reason the American Dental Association opposed the health-care bill.

In 2014, when the new law enables millions more Americans to join Medicaid, many advocates wonder if there will be longer lines to see dentists as well as doctors.

"The health-coverage bill is going to exacerbate the current supply problem," says Miller-Wilson, adding that the state of dental care now may foreshadow what is to come.



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Many advocates point to the 2007 death of 12-year-old Deamonte Driver in Prince George's County, Md., as the impetus for Congress to make sure that dental was included in the basic benefits package for children on Medicaid.

 

Driver died from a bacterial infection caused by an abscess in his mouth. His mother had been unable to find a dentist who would accept his Medicaid.

 

Philadelphia's Slaughter wonders whether "it will take another catastrophe like Driver's to get policy makers' attention."

 

Even if coverage is broadened, other issues remain.

 

Pence, the woman with 15 cavities, is in many ways typical of her generation. She was cut off from her father's health and dental insurance when she turned 18. She ignored her teeth for several years as she worked part time.

 

Last September, the pain became overwhelming. Following her aunt's advice, she went to Penn's dental clinic to get treated at a reduced rate.

 

In March, she started working a full-time job with benefits. She can now afford yet another fix: the skin graft she needs at the base of her bottom front teeth. Her tongue piercing had worn down the gums so much that "you can see the roots of my teeth," Pence says.

 

She has since removed the piercing. She promises to see her dentist regularly in the future.

 

Reduced-Fee Dental Clinics in Region

 

Donated Dental Services

 

717-238-8721

 

www.nfdh.org (Locations throughout Southeastern Pennsylvania)

 

Philadelphia

 

City health centers

 

Seven of the clinics offer dental services. Call 215-686-1776 for locations, or go to www.phila.gov/health/Services/Serv_DentalCare.html

 

(Medicaid accepted)

 

Afton Family Dental PC

 

215-462-6229

 

Fairmount Primary Care

 

Center

 

215-684-5349

 

www.dvch.org

 

Maria de los Santos Health Center

 

215-291-2509

 

www.dvch.org

 

(Medicaid accepted)

 

Frankford Avenue/Hunting Park/Snyder Dental/Wilson Park Medical Centers

 

215-229-1390

 

www.gphainc.org

 

(Medicaid accepted)

 

Vaux Family Health Center

 

215-236-8289

 

www.qchc.org

 

(Medicaid accepted)

 

QCHC Family Health Center

 

215-227-0300

 

www.qchc.org

 

(Medicaid accepted)

 

University of Pennsylvania School of Dental Medicine Dental Clinic

 

215-898-8965

 

www.dental.upenn.edu

 

(Medicaid accepted)

 

Ronald McDonald Care Mobile

 

215-427-8877

 

(Free for qualified children; Medicaid accepted)

 

Clinic of Temple University Kornberg School of Dentistry

 

215-707-2900

 

www.temple.edu/dentistry

 

(Senior citizen discount; Medicaid accepted)

 

Bucks County

 

Bucks County Health Improvement Project

 

1-800-347-6803 (Free for qualified children)

 

Ann Silverman Community Health Clinic

 

215-345-2410

 

HealthLink Medical Center

 

215-364-4247

 

www.healthlinkmedical.org

 

Chester County

 

Community Volunteers in Medicine

 

610-836-5990

 

www.cvim.org

 

(Free)

 

The Children's Dental Clinic

 

610-240-1213

 

Delaware County

 

ChesPenn Health Services

 

610-874-6231; 610-497-2900

 

Montgomery County

 

Manor Dental Health Center

 

215-887-7617

 

www.manor.edu

 

Greater North Penn Dental Initiative

 

1-877-466-7764

 

(Medicaid accepted)

 

Norristown Regional Health

 

Center

 

610-278-7787

 

www.dvch.org

 

(Medicaid accepted)

 

The Abram and Goldie Cohen Dental Programs Center

 

610-526-6015

 

www.harcum.edu

 

(Medicaid accepted)

 

Camden County

 

Camden County College, Dental Hygiene Clinic

 

856-374-4930

 

CamCare Health Corporation - East

 

856-635-0307

 

(Medicaid accepted)

 

CamCare Health Corporation - Gateway Center

 

856-963-8768

 

(Medicaid accepted)

 

CamCare Health Corporation - Clementon

 

856-627-7701

 

(Medicaid accepted)

 

UMDNJ - Somerdale

 

856-566-6969

 

(Medicaid accepted)

 

Virtua Dental Health Center

 

856-246-3545

 

(Medicaid accepted)

 

SOURCES: Pennsylvania and New Jersey dental associations

 

Contact staff writer Brooke Minters at 215-854-2244 or bminters@phillynews.com.

 


GRAPHIC: Photograph by: Tony Fitts
LOAD-DATE: July 26, 2010
Copyright © 2010 LexisNexis, a division of Reed Elsevier Inc. All Rights Reserved.
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