The leading reason for uninsured or under insured young people to visit an emergency department is dental pain.
It’s a disturbing fact that ED doctors and hospital administrators have known for a long time. The Pew Center on the States studied the problem in-depth in a report released this week.
Unfortunately for dental patients who show up in our emergency rooms, hospitals are not staffed with dentists or oral surgeons. These patients are treated for pain and told to see a community dentist. But, with this state’s current dentist shortage and so many dentists not accepting MaineCare patients, these people — often in immense pain — struggle to find and pay for prompt care and often return to emergency departments for pain treatment.
It’s a costly and ineffective way to treat people, and does nothing to address prevention practices that could reduce the need for many of these emergency visits.
Just ask Deamonte Driver’s mother.
In 2007 in Maryland, Deamonte died when a tooth abscess became infected and bacteria spread to his brain.
He was 12 years old.
His mother didn’t have the money to pay for a dentist when Deamonte first told her about the toothache, and when the pain got worse she took the boy to an emergency room. Doctors treated the pain and told her to take her son to a dentist, but this low-income woman couldn’t find a dentist that would take Medicaid and, when Deamonte didn’t get better, she took him back to the hospital.
After eight weeks and two major surgeries, Deamonte died.
Marian Wright Edelman, president of the Children’s Defense Fund, blogged last year that “his life could have been saved by a routine dental visit and an $80 tooth extraction.”
The boy died because his family couldn’t pay for a dentist.
Shelly Gehshan, director of the Children’s Dental Campaign for the Pew Center on the States, has a solution: Expand the market by licensing more independent dental hygienists and public health hygienists, and expand the function of dental assistants so that patients — children in particular — have access to routine preventive care at an early age, learning to develop good dental hygiene habits as they age.
According to Pew, dental disease is the most common chronic disease among children in this country — five times more prevalent than asthma — so doesn’t it make sense to provide low-cost options?
The Maine Dental Association is not so sure, suggesting that Pew’s assertion that rural residents do not have adequate access to dental care is an illusion.
They do have access, although it may be miles away, and many of them are covered by MaineCare, MDA says.
According to John Bastey, director of governmental affairs for MDA, members also worry that expanding the market to additional classes of dental providers might be harmful because these providers do not have the same training as dentists and might not have the skills to treat patients in crisis.
Bastey acknowledges more dentists are needed, but points out that the number of new dentists licensed each year in Maine has climbed in the past 15 years.
According to the MDA, the average number of dentists licensed each year from 1997 to 2001 was 26.6; the average licensed from 2007 to 2012 was 43.6, with 59 licensed last year.
The University of New England will open its new College of Dental Medicine in 2013, and the hope is that graduates will establish practices in Maine.
That may increase the number of dentists over time, but it doesn’t solve the MaineCare reimbursement problem.
MaineCare provides dental coverage for all children under 18 years old, but not all of those children see dentists regularly. Some, not at all.
That’s because MaineCare’s reimbursement rate — 40 cents per dollar of office costs — doesn’t make financial sense for practitioners.
That may be so, but it makes less financial sense — from a taxpayer perspective — for dental patients to seek care in emergency rooms, spending excessive MaineCare dollars there instead of spending far fewer public dollars to pay for routine preventive visits in dental offices.
If there are not enough dentists accepting MaineCare patients, and independent dental providers are eager to take them, doesn’t it make sense to support that interest to improve dental health?
Deamonte Driver’s mother would say so.
The opinions expressed in this column reflect the views of the ownership and the editorial board.