Tag Archives: dentistry

Campaign strives to improve access to care; critics say ADA misses mark

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Give Kids a Smile event

Photo by um.dentistry via Flickr

Advocates for the poor and uninsured have worked long and hard to bring attention to the shortage of dental care for millions of Americans.  On Wednesday, the American Dental Association weighed in on the problem too, announcing a nationwide campaign designed to respond to address what leaders called the nation’s “dental crisis.”

“We’ve made great progress with each generation enjoying better dental health than the one before,” ADA President Robert Faiella, D.M.D., noted. “But there is still a dangerous divide in America between those with good dental health and those without. Our mission is to close that divide. Good oral health isn’t a luxury – it’s essential.”

Yet many go without that care.

While a vast majority of middle- and upper-income Americans reported good access to dental services, nearly half of lower-income adults said they had not seen a dentist in a year or more, according to a Harris poll released by the ADA as part of the campaign’s launch. The poll also found that poor Americans are more than two times as likely to be toothless than their wealthier counterparts and that low-income adults were far more likely to seek last-resort care in emergency rooms than their better-off counterparts. Continue reading

Investigators look into allegations of Medicaid dental recruiting of Dallas children

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Byron Harris of WFAA-Dallas reports authorities there are investigating cases in which at least six children allegedly were recruited at a convenience store, paid $10 and then taken to a dental clinic where they underwent procedures without parental consent.

WFAA obtained one child’s medical records and found the clinic billed Medicaid for more than $2,000 for 25 procedures.

The clinic, All About Dentistry, “admits it employs recruiters to bring in new Medicaid patients, but will not reveal how much it pays for each new patient a recruiter brings in.”

In July, Harris reported that Texas is cracking down on “questionable Medicaid dental payments” and, as a result, dentists who previously treated Medicaid patients are turning those patients away because their claims are being rejected.

Tens of thousands of patients are affected. In 2010, Medicaid paid for braces on about 80,000 kids in Texas. Treatment commonly takes two years.

Last year, Harris and producer Mark Smith, in a nine-month investigation, found that Texas regulators seldom deny procedures for hundreds of thousands of children. WFAA aired a half-hour news special, “Crooked Teeth,” raising questions about other Medicaid reimbursements nationally, including a troubling payment policy by one of the nation’s largest government contractors.

Strict Medicaid regulations prohibit payment for braces installed for merely cosmetic reasons. WFAA-TV, however, discovers through statistical analysis and basic “gumshoe” reporting that Medicaid orthodontic payments are widespread in Texas. In fact, dental offices have signs and advertisements that promise “free” braces and travel to children.

Elsewhere in Texas, a jury has indicted an Amarillo orthodontist on 11 counts of Medicaid fraud of more than $1.5 million. Authorities allege he performed services he knew were solely cosmetic and scheduled dozens of patients on a daily basis.

In another recent case, a Brooklyn, N.Y., dentist “pleaded guilty to fraud, admitting he paid recruiters to solicit homeless Medicaid patients with cash.”

American dentistry, a parallel medical universe

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

NationalJournal’s Margot Sanger-Katz reports on the sometimes woeful state of American dental care, especially for low-income children. And yes, her piece is datelined “HAZARD, Ky.” But that’s where its anecdotal focus ends and Sanger-Katz paints the bigger picture.

dentistPhoto by dbgg1979 via Flickr

The United States faces a shortage of dentists that is particularly acute in poor, rural regions. Huge pockets of the country have few (or no) providers. The federal government counts 4,503 mostly rural regions where more than 3,000 people share one dentist, making it tough for many residents to find someone to fix their teeth.

For more than 100 years, dentistry has run on a separate—and more laissez-faire—track than the rest of medicine. Dentists have their own schools and treat patients in their own offices; fewer laws and regulations govern the field. Insurance plans typically demand high co-pays and limit their payouts for invasive procedures. About half of all dental expenses are paid out of pocket, compared with less than 10 percent of costs in the overall medical system.

In some ways, what Sanger-Katz calls a “free market” has worked. Folks shop around, and they only get dental care when they really needed. Prices don’t inflate as quickly as they do in medicine in general, and American dental health is still getting better. Continue reading

With state funds gone, Okla. dental programs still serve needy

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for the local NPR StateImpact outlet, Logan Layden looks at how dental programs for the needy are coping in the absence of state funding. In the 2010 state budget crisis, Layden writes, “Funding for several programs, including Dentists for the Disabled and Elderly in Need of Treatment, was totally eliminated.”

Among those was Oklahoma’s D-Dent, which provides a sort of superstructure that takes care of logistics and tests in order to allow dentists to donate their work to the needy and elderly. Since the cuts, the statewide program has gone from supporting about 800 patients a year to about 600. They no longer get state funds, though they still rely on the health department for most of their referrals, as well as a little moral support.

“We here are entirely supportive of this program,” Jana Winfee, Chief of Dental Health Services the Department of Health, said. “They have our support, just no funds.”

For more on NPR’s StateImpact project and a list of current participants, check out their lab.

Critics say New York soft on disciplining dentists

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The (Syracuse, N.Y.) Post-Standard‘s James Mulder has found that, when it comes to cracking down on less-than-competent dentists, his state appears pretty lax.

teeth

Photo by radiant guy via Flickr

In New York, the 18,000 dentists are among, Mulder writes, the 800,000 people from “48 professions — from acupuncturists to veterinarians — policed by the state Education Department’s Office of Professional Discipline.” Last year, the board disciplined 24 of them, revoked the licenses of two and accepted the surrender of four more licenses.

The office took 1.54 disciplinary actions per 1,000 dentists last year, about half the rate of disciplinary actions taken against medical doctors and physician assistants. Discipline against doctors accused of misconduct in New York is handled by a different arm of state government — the state Health Departments Office of Professional Medical Conduct.
Also, the number of serious disciplinary actions against New York dentists declined by 53 percent between 2006 and 2010.

Calif. dental care crisis could get worse

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Laurie Udesky, writing for The New York Times, has found that that pediatric dental care in the state has reached rock bottom, especially for children from low-income families. Unfortunately, in California, it’s starting to look like there may be a floor even lower than rock bottom. Udesky writes: “If Gov. Arnold Schwarzenegger’s recent proposed cuts remain — amounting to a $16.5 million reduction to Healthy Families and a $523 million reduction to Medi-Cal —more cases of untreated dental-related illnesses are likely.”

California children’s dental health was ranked third from the bottom in the National Survey of Children’s Health, above only Arizona and Texas. In the Bay Area, children and teenagers up to the age of 17 made nearly 1,980 visits to emergency rooms for preventable dental conditions in 2007. The cost of these visits averaged $172, but if a problem required hospitalization it cost an average of $5,000.

Today, experts interviewed said the dental care crisis had reached an even more alarming level. “We can only go up from here,” said Dr. Jared I. Fine, the dental health administrator at Alameda County Public Health Department. “We have an epidemic of dental disease in children that’s absurdly pervasive.”

For more on children’s dental health, check out The Cost of Delay (PDF), a report the Pew Center on the States released earlier this year. It seeks to answer the questions “What can states do to ensure better dental care?” and “How many states are doing those things right now?” and includes a strong body of statistics and analysis within its 74 pages.

The National Survey of Children’s Health, last fully updated in 2007, is still a comprehensive source for national data on pediatric dental health. There are data fields for overall dental health, as well as for specific oral health issues in children. For an overview of the data, I just pulled the overall health numbers and mapped a subset of them.

dental

Wisconsin’s low Medicaid fees create dental woes

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Wisconsin State Journal‘s David Wahlberg reports that access to adequate dental care is a major public health issue throughout the state, especially among Medicaid recipients. Federally funded clinics are starting to fill the gaps, but there is still quite a bit of catching up to do. Waiting lists are long, and it’s the nature of remedial dental care that getting each mouth back on track is a long and involved process.

dentistPhoto by dbgg1979 via Flickr

Dentists told Wahlberg that they are reluctant to serve Medicaid recipients because the state’s reimbursement rates are too low. According to HHS, Wahlberg writes, “Just 23 percent of the state’s enrollees got dental care in 2008. Only Delaware, Florida and Kentucky fared worse.”

Rural areas have only about half as many dentists per person as urban areas do, making the search for dental care even harder in small towns.

That, combined with low fluoride levels in many rural drinking water supplies, means more tooth loss and untreated decay for many rural residents, state health officials say.

“Of all of the holes (in health care), dental care is the biggest and the deepest,” said Greg Nycz, executive director of the Family Health Center of Marshfield, which serves much of rural, northern Wisconsin.

The article is the latest in Wahlberg’s yearlong look at rural health care. Wahlberg will be moderating a panel about oral health for rural residents at next week’s Rural Health Journalism Workshop in Kansas City.

Ind. TV station uncovers underground ‘dentist’

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Bob Segall of WHTR-Indianapolis chronicles the results of an investigation in which the station uncovered a “dentist” who has been operating under the radar in the United States without a license for 14 years. The man in question, who said his name is Alex Galiano, said he received dental training in Honduras before he left that country at age 22 and worked out of his apartment, charging rock-bottom prices and catering to Hispanic immigrants who did not have health coverage.

Segall talked to a patient named Julia who had been hospitalized with a bone infection related to the phony dentist’s handiwork. Julia said the man’s apartment didn’t even have dental chairs or lights: “‘He opened the window to be able to look at my tooth because there weren’t any other lights,’ she said.” Lights weren’t the only thing missing from the office of a man who said he cleaned his instruments with cotton balls:

Julia says during the procedure, the dentist did not wear gloves and did not give her water to rinse blood from her mouth. Bleeding heavily, she was told to spit into a garbage can filled with food scraps. The dentist tried to stop her bleeding by using napkins he got from the apartment’s kitchen.

Julia has filed an official complaint against the rogue dentist, who said he also operates in Kentucky.

An undercover WHTR producer who visited Galiano saw dental instruments and vials of liquid anesthetic. Galiano told the producer that he sterilizes everything using cotton balls and alcohol – a procedure that is not considered adequate by experts. The producer also purchased a prescription antibiotic that is not approved in the United States.

Economy down, gnashing of teeth up (literally)

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Gabriella Boston of The Washington Times finds that dentists across the country have reported an increase in patients grinding their teeth, an increase which coincides with the current economic downturn. Teeth-grinding causes, headaches, muscle pain, and eventually moved or damaged teeth.

“We are very stressed right now, and one of the ways that stress manifests itself is we grind our teeth,” said Dr. Robert Emami, a dentist in Dedham, Mass. “It’s a serious problem that can lead to the movement of teeth, and ultimately to the loss of teeth.”