W.Va. paper chronicles state's oral health problem Date: 05/22/08
By Eric Eyre
Charleston (W.Va.) Gazette
Seven years ago, former U.S. Surgeon General David Satcher declared oral health disease a "silent epidemic," saying those who suffer the worst are poor Americans. That description is especially true in West Virginia.
In a series of articles published last year, I chronicled the abysmal state of dental health in West Virginia. In clinics and private dentists' offices, I found people suffering with painful toothaches, gaping cavities, abscesses, lip cancer, gum infections and molars cracked off because of an unsuccessful attempt at do-it-yourself dentistry.
Lingbing Hang/Charleston (W.Va.) Gazette
With no money or insurance to pay to fix her aching teeth, Deborah Crites, 50, took matters into her own hands. Crites said she numbed herself with moonshine and pulled two of her teeth with a pair of pliers.
The story started with a tip from Tom Merriman, a television investigative reporter in Cleveland, whom I met during a seminar at the Poynter Institute in St. Petersburg, Fla. Merriman mentioned a radio report he had heard about oral health: West Virginia had the dubious distinction of having some of the highest rates of tooth loss in the nation.
After returning to West Virginia, I immediately went to the CDC's National Oral Health Surveillance System Web site and examined a host of dental health indicators. West Virginia had the highest percentage of older adults who have had all their natural teeth removed – a worse rate, I would later learn, than adults in impoverished countries such as Madagascar, Cambodia and Gambia. Other survey data showed that West Virginia had a low percentage of people who had their teeth cleaned and visited a dentist at least once a year.
Weeks later, I received a Kaiser Family Foundation Media Fellowship. The program allowed me to travel the state and interview dentists, hygienists, dental assistants and patients. Some people, who were in obvious pain, wouldn’t consent to interviews. The places I visited were often very busy – a blur of activity – so I’d often have to catch dentists and hygienists for interviews at lunch or on their way out the door.
During my reporting, I discovered that tooth loss wasn't a problem exclusive to West Virginia's elderly. Previously unreleased data obtained by special request from the CDC showed thousands of younger West Virginians had multiple teeth extracted because of disease or decay. (The CDC’s oral health Web site lists tooth-loss statistics for adults 65 and older, but survey data is available for all adults over 18 broken down by age categories. You have to contact CDC’s oral health division and request it.)
I also learned that the state’s Medicaid program – like most states – paid for pulling adult teeth, and nothing else. Not even pregnant woman are eligible for basic dental services under West Virginia Medicaid. Children are eligible for a full range of dental services, but Early and Periodic Screening, Diagnosis and Treatment (EPSDT) data showed that only about one of every three Medicaid-covered kids in the state visits a dentist each year. State-by-state data related to the number of children who receive medical and dental exams is available from the Centers for Medicare and Medicaid Services. The EPSDT program is a mandatory Medicaid program for kids that focuses on prevention and early diagnosis and treatment.
Also, through the state Freedom of Information Act, I obtained and analyzed a database of all state Medicaid dental claims over the past four years. The state Medicaid office declined to release the database, which included 3.3 million claims, but I was able to obtain the same information – after months of negotiations – from the West Virginia Health Care Authority, a regulatory agency that monitors health care costs and collects Medicaid claims data. The analysis showed that dentists were billing the state more for extracting poor children's teeth than for cleaning them. In other words, prevention was taking a back seat to drilling and filling teeth – and taking them out.
In the days after the first stories were published, I was inundated with phone calls and e-mails from readers desperate to find a dentist. Many were in pain, unable to afford treatment. Others wanted to get their teeth fixed or get a new set of dentures. Using contacts made during my reporting, I referred them to free- and low-cost dental clinics. At the end of the year, the Gazette published a first-ever comprehensive statewide dental directory where low-income children and adults could seek help.
Lingbing Hang/Charleston (W.Va.) Gazette
Larry Coleman's old denture, right, hadn't been replaced in 25 years. The denture was stained by the tobacco Coleman chews every day.
In response to the articles, state legislators established a special committee to investigate West Virginia's oral health problems. The committee recommended a number of dental health reforms.
State and House leaders introduced legislation to establish a statewide office of oral health and hire a full-time director – a bill that was ultimately defeated because of a spat between dentists who wanted the law to require a licensed dentist to fill the position and hygienists who insisted that any health professional should be hired.
There was some good news, however. Legislators passed a bill that will allow hygienists – for the first time – to practice in schools, nursing homes, hospitals and health clinics without a dentist being present. That should ultimately lead to more low-income West Virginians receiving treatment to help them get out of pain and start smiling again.
Reporters in other states interested in covering dental health might want to start by reviewing the online state-by-state CDC data and several reports from a group called Oral Health America. Unfortunately, the organization’s most recent report was published in 2005. Nonetheless, the group grades individual states on numerous oral health measures, such as availability of dentists, fluoridation laws, Medicaid dental policies and state oral health program budgets. You can see where your state is passing and failing, then find out why.
Do “on-site” reporting. Spend the day at a dental clinic or a same-day denture practice that serves low-income patients. Find dentists willing to show you the “good, bad and ugly,” as one West Virginia dentist promised me. It’s a largely untold health story that deserves attention.
Eric Eyre is a health reporter at the Charleston (W.Va.) Gazette. His series, “State of Decay,” won a 2007 Award for Excellence in Health Care Journalism.