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Dental Coverage as Essential as Health Insurance, Experts Say

By Whitney Blair Wyckoff, CQ Staff

July 28, 2008 -- Politicians must consider dental care as important as other areas of care when evaluating health policy, said speakers at a recent briefing on dental care access.

Speakers at the briefing, which was sponsored by the Alliance for Health Reform and the Kaiser Commission on Medicaid and the Uninsured, said more than 100 million Americans don't have dental insurance, which is more than 2.5 times the amount of people who don't have medical coverage, they said.

Jack Bresch of the American Dental Education Association said there are more than 3,700 geographical locations that don't have enough dental health professionals. This number has skyrocketed from where it was 15 years ago, when the figure was 792, he said.

Burt Edelstein of the Children' Dental Health Project said these figures don't factor in shortages of people practicing dental specialties, like pediatric dentistry or oral surgery.

To address dental professional shortages, some states are looking to expand the scope of practice for hygienists who obtain a high level of education and certification. This would mean these hygienists would be able to perform some dental health procedures and offer preventative care without the supervision of a licensed dentist.

Several panelists said while SCHIP and Medicaid do provide dental coverage, reimbursement is so low that many dentists can't afford to accept them. As a result, many with public dental insurance receive sub-standard care. Panelists also said there is a huge disparity between reimbursement rates for physicians and dentists.

"They (politicians) are very good at promising coverage and very bad at paying for care," said William Prentice, senior vice president for government and public affairs for the American Dental Association. Several of the speakers emphasized that dental care coverage should be included in the SCHIP reauthorization. Dental health provisions were included in last year's failed SCHIP reauthorization legislation.

Panelists also said nearly 100 percent of dental ailments are avoidable, referring to the case of the Prince George's County child who died after not receiving adequate dental care.

The child, Deamonte Driver, never had a primary care dentist—his mother couldn't find one willing to accept his Maryland Medicaid plan. Driver developed tooth decay which then progressed into a brain infection and, after two brain surgeries, Driver died at age 12.

The emergency treatment Driver received cost $250,000. However, the cost to extract the original decaying tooth would have been less than $100, said Harry Goodman, director of the Office of Oral Health in the Maryland health department.

"This is a tragedy in the greatest sense of the word," Goodman said. "This case was so preventable."

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