Pew issues report card on state policies affecting childrens dental health

Washington鈥擜 report issued Feb. 23 by the Pew Center on the States gives 35 states and the District of Columbia a C, D or F grade for their lack of government policies that help ensure dental health and access to care for children, but stresses that strategies like increasing Medicaid funding, implementing school sealant programs and fluoridating community water supplies could make dramatic differences in the oral health of children.

The report, “The Cost of Delay: State Dental Policies Fail One in Five Children,” says an estimated one in five American children鈥攁bout 17 million鈥攇o without dental care each year and two thirds of states don’t have effective policies to combat the problem. The report was released with support from the W.K. Kellogg Foundation and the DentaQuest Foundation.

“We welcome the Pew organization to our longstanding fight to improve the lives of American children by helping more of them enjoy the good oral health that too many of them now lack,” said ADA President Ron Tankersley. “Pew’s presenting its information in the form of a report card makes it easy for anyone to understand that too many kids in too many states are suffering. And we face huge challenges in changing that.”

The 74-page report, released during National Children’s Dental Health Month, uses eight policy “benchmarks” to measure states’ performance:

• state has sealant programs in place in at least 25 percent of high-risk schools;
• state does not require a dentist’s exam before a hygienist sees a child in a school sealant program;
• state provides optimally fluoridated water to at least 75 percent of citizens on community systems;
• state meets or exceeds the national average (38.1 percent) of children ages one to 18 on Medicaid receiving dental services;
• state pays dentists who serve Medicaid-enrolled children at least the national average (60.5 percent) of Medicaid rates as a percentage of dentists’ median retail fees;
• state Medicaid program reimburses medical care providers for preventive dental health services;
• state has authorized a new primary care dental provider;
• state submits basic screening data to the National Oral Health Surveillance System database.

“We don’t agree with everything in the report,” said Dr. Tankersley. “But certainly, it highlights some of the major policy areas that the ADA and state dental societies have advocated for years鈥攖hings like increased Medicaid funding, school sealant programs and community water fluoridation. It also highlights the urgent need for reliable routine data collection so that policies are well informed and kids are not left suffering. Even in states to which Pew awarded an A, countless children lack access to dental care and suffer as a consequence.”

The report notes that only one state, Minnesota, met the benchmark for authorizing a new primary care dental provider. (Alaska was not included because Alaska dental health aide therapists, or DHATs, are overseen by a tribal entity, not a state.) The report says that “a growing number of states are exploring new models” and also mentions the ADA’s Community Dental Health Coordinator model.

It should be noted that the community dental health coordinator, while mentioned in the report is not a primary care provider and differs in many ways from some of the other models and health professionals mentioned. The CDHC is best described as a community health worker with dental training. CDHCs will perform no surgical procedures, and their main functions will be oral health education and disease prevention.

“The report does omit some policy areas that we believe are equally important to improving children’s access to care,” Dr. Tankersley added. “For instance, some states have innovative programs鈥攍ike student loan forgiveness and tax incentives鈥攖o help dentists establish practices in underserved areas or practice in community health centers. And when it comes to fixing Medicaid, money is a huge issue, but it isn’t the only issue. Patients and parents need oral health education to help them take care of themselves and their families to prevent disease. Many of them need additional services, like transportation, in order to be able to get to dental appointments. If Medicaid did a better job of these things, treatment costs would decrease, because we would be preventing more disease and treating less.”

The report also highlights the ADA’s and state dental societies’ efforts to work jointly with other stakeholders address the problem through increasing Medicaid reimbursement rates, raising awareness for the issue through Give Kids A Smile and other charitable dentistry programs, studying workforce issues and addressing the oral health issues of American Indian/Native American individuals and other activities.

“The ADA and state dental societies have a long history as the nation’s leading advocates for oral health,” said Dr. Tankersley. “ADA members donated some $2.16 billion in free care to disadvantaged children and adults, both as individuals and through such programs as Give Kids A Smile and Missions of Mercy, in 2007 alone. But we’re the first to admit that we can’t do this alone, and charity is no substitute for an effective, equitable oral health delivery system. We’re grateful for assistance from the Pew Center and others who are willing to lend a hand in what undoubtedly will remain a long, tough fight.”

The report is available at the Pew Center on the States Web site: www.pewcenteronthestates.org. Click on the “News Room” link for a press release and links to the full report, individual state fact sheets and more information on the Pew Children’s Dental Campaign.