Oral health care for the poor in Kentucky suffers under managed care as dentists leave Medicaid; how about your county?

Kentucky's serious oral-health problems are getting worse because fewer dentists are participating in the Medicaid program -- a result of "new paperwork issues compounding Medicaid's reputation" for low payments to providers, Laura Ungar reports for The Courier-Journal.

Ungar's source for that is Dr. Raynor Mullins of the College of Dentistry at the University of Kentucky, who told her that only 700 to 800 of the state's nearly 2,500 dentists, about 30 percent, accept Medicaid patients.

That makes now seem like a good time for journalists to ask their local dentists if they accept Medicaid -- and if not, why not; and if so, whether they are considering dropping it.

Ungar notes that 28 of Kentucky's 120 counties are deemed not to have enough dentists to serve the local population. Most if not all of them are rural. You can find out which counties are under-served by physical, dental or mental health providers at this federal Health Resources and Services Administration website.

Kentucky's serious oral-health problems are getting worse because fewer dentists are participating in the Medicaid program -- a result of "new paperwork issues compounding Medicaid's reputation" for low payments to providers, Laura Ungar reports for The Courier-Journal.

Ungar's source for that is Dr. Raynor Mullins of the College of Dentistry at the University of Kentucky, who told her that only 700 to 800 of the state's nearly 2,500 dentists, about 30 percent, accept Medicaid patients.

That makes now seem like a good time for journalists to ask their local dentists if they accept Medicaid -- and if not, why not; and if so, whether they are considering dropping it.

Ungar notes that 28 of Kentucky's 120 counties are deemed not to have enough dentists to serve the local population. Most if not all of them are rural. You can find out which counties are under-served by physical, dental or mental health providers at this federal Health Resources and Services Administration website.

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Brushing teeth twice a day, two minutes at a time, is the way to prevent cavities, a new campaign advises

Kids should brush their teeth twice a day for two whole minutes at a time, a new public-service campaign urges. The “Kids’ Healthy Mouths” campaign includes TV spots, print ads, a website, social media messages and other materials, reports Jennifer LaRue Huget for The Washington Post.

Campaign materials point out that “dental decay is the most common chronic childhood disease.” More than 16 million children across the United States suffer from it. In Kentucky, nearly 35 percent of third-grade students had untreated tooth decay, the Centers for Disease Control and Prevention's State Oral Health Profile shows.

“The mouth is the gateway to a person’s overall health, and an unhealthy mouth can be linked to diabetes and even heart disease,” the campaign says. “In the U.S., oral disease causes kids to miss 51 million school hours and their parents to lose 25 million work hours annually. Additionally, oral disease disproportionately affects children from low-income families and these children have almost twice the number of decayed teeth that have not been treated by a dentist as compared to others in the general population.”

The campaign includes a YouTube video channel on which there are videos that are each 120 seconds long. The goal is for kids to watch the videos while they’re brushing.

Research has shown brushing two minutes at a time, twice a day, is the “optimal prevention brushing regimen,” because it “takes two minutes for the tooth enamel to uptake the fluoride” in toothpaste, said Maria Lopez Howell, consumer adviser for the American Dental Association. When enamel absorbs fluoride it makes the surface harder and more resistant to bacteria. Brushing for two minutes additionally removes plaque on teeth. (Read more)

Kids should brush their teeth twice a day for two whole minutes at a time, a new public-service campaign urges. The “Kids’ Healthy Mouths” campaign includes TV spots, print ads, a website, social media messages and other materials, reports Jennifer LaRue Huget for The Washington Post.

Campaign materials point out that “dental decay is the most common chronic childhood disease.” More than 16 million children across the United States suffer from it. In Kentucky, nearly 35 percent of third-grade students had untreated tooth decay, the Centers for Disease Control and Prevention's State Oral Health Profile shows.

“The mouth is the gateway to a person’s overall health, and an unhealthy mouth can be linked to diabetes and even heart disease,” the campaign says. “In the U.S., oral disease causes kids to miss 51 million school hours and their parents to lose 25 million work hours annually. Additionally, oral disease disproportionately affects children from low-income families and these children have almost twice the number of decayed teeth that have not been treated by a dentist as compared to others in the general population.”

The campaign includes a YouTube video channel on which there are videos that are each 120 seconds long. The goal is for kids to watch the videos while they’re brushing.

Research has shown brushing two minutes at a time, twice a day, is the “optimal prevention brushing regimen,” because it “takes two minutes for the tooth enamel to uptake the fluoride” in toothpaste, said Maria Lopez Howell, consumer adviser for the American Dental Association. When enamel absorbs fluoride it makes the surface harder and more resistant to bacteria. Brushing for two minutes additionally removes plaque on teeth. (Read more)

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Looking for 'a few short-term wins' to start, Kentucky Oral Health Coalition formally reorganizes

By Amy Wilson
Kentucky Health News

LOUISVILLE, July 25 – There was no whitewashing the ruinous state of the state's teeth Wednesday when the Kentucky Oral Health Coalition formally reorganized with the goal of fixing as much as they can as fast as it can. With almost a fourth of Kentuckians over 65 having complete tooth loss and almost half of children between 2 and 4 already having twice the national average of cavities, there is work to be done on every front.

As the state with the 49th worst-looking mouths in the country, explained Andrea Bennett, senior policy analyst for Kentucky Youth Advocates, "What we're looking for is a few short-term wins."

It appears that the top priority, as voted by the coalition's members, is to improve oral health literacy and education. That means that members will be looking for ways – including maybe getting themselves a celebrity spokesperson – to explain what good oral hygiene is and how to get it.

Close behind in priorities will be efforts to expand school-based oral health services, including for those in Head Start and all child-care settings. Members also expressed a desire to increase the number of Kentucky dentists who accept Medicaid, thus expanding the numbers of those who can be treated.

How they do that is under discussion. The group, which existed a decade ago but lost momentum, has decided to revitalize into a more active, more inclusive, perhaps even more legislatively inclined group. It all depends on its new leadership, said Dr. James Cecil, a national leader in public health and a former University of Kentucky dental school professor.

Cecil, who now works with KYA, a nonprofit whose staff will handle a lot of the coalition's workload, explained that funding for the initial work of the group is expected to come from the renewal of a grant from DentaQuest, a continuous source of funding for Kentucky dental projects for three years. New programs, as drawn up by and agreed to by the new executive committee elected Wednesday, will seek other sources of funding through corporations and other grants, Cecil said. In their current treasury is $20,000, left over from the old KOHC.

The coaltion is now chaired by Laura Hancock Jones, Western Kentucky Dental Outreach Program director in the University of Kentucky College of Dentistry's Division of Public Health. A well-known and well-respected practicing pediatric dentist, she is self-described "passionate" advocate for education and literacy about oral health. She runs a program that provides a fluoride varnish on children as young as 2.

"I have seen how much we've done and it's not been enough," Hancock-Jones said. "We have not moved the needle." The answer, she said, is "from the bottom. You have to talk to the kids." In her own health-department experience, she dogged one family for three years, she said, through the school Family Resource and Service Center, social workers, and eventually the judicial system, to get their children care. Eventually, she did and "the kids are" getting care and thinking "It really is a good thing to go to the dentist."
 
Members of the coalition include dentists, dental hygienists, insurance providers, public health officers, school nurses and students. Donna Ruley, executive director of the Kentucky Dental Hygienist Association, was elected secretary of the group Wednesday. She said she believes it's important that her profession is at the table when talking about dental priorities and potential scope of job description legislation. "Our impact on education is huge," said Ruley. "The legislature just recently passed a public-health hygienist role that would allow for a greater number of people to be taught prevention services without a dentist's supervision." That, she added, is a great need in a lot of far-flung rural reaches of the state.

The vice chair of the group is Linda Poynter of the Kenton County Health Department. The treasurer is Dr. Lee Mayer of the University of Louisville dental school.

By Amy Wilson
Kentucky Health News

LOUISVILLE, July 25 – There was no whitewashing the ruinous state of the state's teeth Wednesday when the Kentucky Oral Health Coalition formally reorganized with the goal of fixing as much as they can as fast as it can. With almost a fourth of Kentuckians over 65 having complete tooth loss and almost half of children between 2 and 4 already having twice the national average of cavities, there is work to be done on every front.

As the state with the 49th worst-looking mouths in the country, explained Andrea Bennett, senior policy analyst for Kentucky Youth Advocates, "What we're looking for is a few short-term wins."

It appears that the top priority, as voted by the coalition's members, is to improve oral health literacy and education. That means that members will be looking for ways – including maybe getting themselves a celebrity spokesperson – to explain what good oral hygiene is and how to get it.

Close behind in priorities will be efforts to expand school-based oral health services, including for those in Head Start and all child-care settings. Members also expressed a desire to increase the number of Kentucky dentists who accept Medicaid, thus expanding the numbers of those who can be treated.

How they do that is under discussion. The group, which existed a decade ago but lost momentum, has decided to revitalize into a more active, more inclusive, perhaps even more legislatively inclined group. It all depends on its new leadership, said Dr. James Cecil, a national leader in public health and a former University of Kentucky dental school professor.

Cecil, who now works with KYA, a nonprofit whose staff will handle a lot of the coalition's workload, explained that funding for the initial work of the group is expected to come from the renewal of a grant from DentaQuest, a continuous source of funding for Kentucky dental projects for three years. New programs, as drawn up by and agreed to by the new executive committee elected Wednesday, will seek other sources of funding through corporations and other grants, Cecil said. In their current treasury is $20,000, left over from the old KOHC.

The coaltion is now chaired by Laura Hancock Jones, Western Kentucky Dental Outreach Program director in the University of Kentucky College of Dentistry's Division of Public Health. A well-known and well-respected practicing pediatric dentist, she is self-described "passionate" advocate for education and literacy about oral health. She runs a program that provides a fluoride varnish on children as young as 2.

"I have seen how much we've done and it's not been enough," Hancock-Jones said. "We have not moved the needle." The answer, she said, is "from the bottom. You have to talk to the kids." In her own health-department experience, she dogged one family for three years, she said, through the school Family Resource and Service Center, social workers, and eventually the judicial system, to get their children care. Eventually, she did and "the kids are" getting care and thinking "It really is a good thing to go to the dentist."
 
Members of the coalition include dentists, dental hygienists, insurance providers, public health officers, school nurses and students. Donna Ruley, executive director of the Kentucky Dental Hygienist Association, was elected secretary of the group Wednesday. She said she believes it's important that her profession is at the table when talking about dental priorities and potential scope of job description legislation. "Our impact on education is huge," said Ruley. "The legislature just recently passed a public-health hygienist role that would allow for a greater number of people to be taught prevention services without a dentist's supervision." That, she added, is a great need in a lot of far-flung rural reaches of the state.

The vice chair of the group is Linda Poynter of the Kenton County Health Department. The treasurer is Dr. Lee Mayer of the University of Louisville dental school.

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Lacking money, insurance and dentists, oral health takes a back seat, and many rural areas are barely on the bus

A dentist works at a Remote Area Medical Clinic in Wise, Va.
(Associated Press photo by Steve Helber)

Dr. Nikki Stone is a dentist who works in Hazard, Ky., at a community-run clinic. A native of the mountains, she knew that children in the region weren’t getting enough dental care, but she was still "staggered by the prevalence of dental disease when she began examining them in 2004," Margot Sanger-Katz reports for the National Journal. "Large numbers of the kids had never seen a dentist. Half had untreated tooth decay, and nearly 20 percent had urgent needs -- more than six cavities or an active abscess. She and her staff 'cried a lot,' she recalls. Crisscrossing four counties in her van, she painted fluoride on all the teeth and sent notes home with the children who needed immediate attention. In the early years, only 8 percent of those youngsters with urgent problems got the care they needed. The job was like fighting a forest fire on a mountain, she says. 'I felt like I was standing here on the line of the fire with a squirt gun.'"

In a world of medical priorities, dentistry takes a back seat to most, and In a world of health care, and rural America sometimes appears to not even be on the bus. The net result, writes Sanger-Katz, is that 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," she notes, "making it tough for many residents to find someone to fix their teeth."

There seems little hope for any change soon in rural America, even if the federal health-reform law survives. "It deems dental coverage an essential part of any health plan for children, but regulators have yet to spell out what insurers must cover to meet that definition," Sanger-Katz writes. "The law expands existing loan-repayment funds for dentists who relocate to underserved areas, but it offers no expansion of dental coverage for adults and doesn’t try to integrate dental health into the larger health care system."Dental disease is the largest unmet health need in the U.S. among both children and adults, according to the Pew Children’s Dental Campaign. The worst-off are the poor, the young, the old, and those in rural America, reports Margot Sanger-Katz reports.

Dental disease is among the most common reasons that children miss school. It’s the most common medical reason that soldiers can’t deploy. It is a leading cause of emergency-room visits in several states. For proponents of a freer health care market, who want patients to be motivated by financial incentives to shop around and avoid “unnecessary” care, the dental system offers a glimpse of how such a system might work. And research shows that poor oral health can lead to disease elsewhere in the body.

"For more than 100 years, dentistry has run on a separate -- and more laissez-fair -- track than the rest of medicine," Sanger-Katz writes. "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. This is the free market. And, in some ways, it has worked: People do not drive up insurance rates by seeking frivolous procedures. Patients tend to shop around for care, and prices vary according to local economies. The rate of dental inflation, although higher than the rate for the economy overall, is lower than the rate in medicine, which is typically several points above the growth rate of the gross domestic product. (You don’t hear policymakers complain about the burden of 'runaway' dental costs.)"

“It’s very much a free market, with a greater spread between the haves and have-nots,” said Burton Edelstein, a professor of dentistry at Columbia University and the founder of the Children’s Dental Health Project. "Dental insurance is much less widespread than medical insurance; 130 million Americans lacked dental coverage in 2009, but only 50 million lacked medical coverage," Sanger Katz-writes. "And with most payouts capped at $1,000 to $2,000 per year, insurance can’t cover much beyond basic services. Medicare does not pay for dental care at all, so 70 percent of seniors lack any dental coverage, according to an Institute of Medicine report. Medicaid also fails to provide meaningful dental access for many of its beneficiaries: The program pays dentists so poorly for treatment that only about 20 percent of them see Medicaid patients." Meanwhile, seven of 61 dental schools closed in the last 30 years, meaning 2,000 fewer dentists every year, a 33 percent drop in supply, just as an older generation of dentists started retiring.

The result is a crisis. And, in a few lucky rural towns, the result looks like this: A mobile van outfitted with a volunteer dentist comes to a rural elementary school and offers free check-ups but no fillings. Or, better yet, a volunteer army of dentists, dental students and oral surgeons in a region volunteer for a two-day event at a vast arena where everyone is welcome to camp overnight for a place in line for care. Some of the dental expertise and hospitality is donated by Ronald McDonald House, or Remote Area Medical out of Knoxville, Tenn., or local community health centers. And while are limited in their ability to do much more than prevention, others can offer real dental care but no follow-up. The result is often a brutal kind of dentistry that involves, at best, mass extraction, some advice about what not to drink and explanations about how oral health is connected to overall health. (Read more)

A dentist works at a Remote Area Medical Clinic in Wise, Va.
(Associated Press photo by Steve Helber)

Dr. Nikki Stone is a dentist who works in Hazard, Ky., at a community-run clinic. A native of the mountains, she knew that children in the region weren’t getting enough dental care, but she was still "staggered by the prevalence of dental disease when she began examining them in 2004," Margot Sanger-Katz reports for the National Journal. "Large numbers of the kids had never seen a dentist. Half had untreated tooth decay, and nearly 20 percent had urgent needs -- more than six cavities or an active abscess. She and her staff 'cried a lot,' she recalls. Crisscrossing four counties in her van, she painted fluoride on all the teeth and sent notes home with the children who needed immediate attention. In the early years, only 8 percent of those youngsters with urgent problems got the care they needed. The job was like fighting a forest fire on a mountain, she says. 'I felt like I was standing here on the line of the fire with a squirt gun.'"

In a world of medical priorities, dentistry takes a back seat to most, and In a world of health care, and rural America sometimes appears to not even be on the bus. The net result, writes Sanger-Katz, is that 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," she notes, "making it tough for many residents to find someone to fix their teeth."

There seems little hope for any change soon in rural America, even if the federal health-reform law survives. "It deems dental coverage an essential part of any health plan for children, but regulators have yet to spell out what insurers must cover to meet that definition," Sanger-Katz writes. "The law expands existing loan-repayment funds for dentists who relocate to underserved areas, but it offers no expansion of dental coverage for adults and doesn’t try to integrate dental health into the larger health care system."Dental disease is the largest unmet health need in the U.S. among both children and adults, according to the Pew Children’s Dental Campaign. The worst-off are the poor, the young, the old, and those in rural America, reports Margot Sanger-Katz reports.

Dental disease is among the most common reasons that children miss school. It’s the most common medical reason that soldiers can’t deploy. It is a leading cause of emergency-room visits in several states. For proponents of a freer health care market, who want patients to be motivated by financial incentives to shop around and avoid “unnecessary” care, the dental system offers a glimpse of how such a system might work. And research shows that poor oral health can lead to disease elsewhere in the body.

"For more than 100 years, dentistry has run on a separate -- and more laissez-fair -- track than the rest of medicine," Sanger-Katz writes. "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. This is the free market. And, in some ways, it has worked: People do not drive up insurance rates by seeking frivolous procedures. Patients tend to shop around for care, and prices vary according to local economies. The rate of dental inflation, although higher than the rate for the economy overall, is lower than the rate in medicine, which is typically several points above the growth rate of the gross domestic product. (You don’t hear policymakers complain about the burden of 'runaway' dental costs.)"

“It’s very much a free market, with a greater spread between the haves and have-nots,” said Burton Edelstein, a professor of dentistry at Columbia University and the founder of the Children’s Dental Health Project. "Dental insurance is much less widespread than medical insurance; 130 million Americans lacked dental coverage in 2009, but only 50 million lacked medical coverage," Sanger Katz-writes. "And with most payouts capped at $1,000 to $2,000 per year, insurance can’t cover much beyond basic services. Medicare does not pay for dental care at all, so 70 percent of seniors lack any dental coverage, according to an Institute of Medicine report. Medicaid also fails to provide meaningful dental access for many of its beneficiaries: The program pays dentists so poorly for treatment that only about 20 percent of them see Medicaid patients." Meanwhile, seven of 61 dental schools closed in the last 30 years, meaning 2,000 fewer dentists every year, a 33 percent drop in supply, just as an older generation of dentists started retiring.

The result is a crisis. And, in a few lucky rural towns, the result looks like this: A mobile van outfitted with a volunteer dentist comes to a rural elementary school and offers free check-ups but no fillings. Or, better yet, a volunteer army of dentists, dental students and oral surgeons in a region volunteer for a two-day event at a vast arena where everyone is welcome to camp overnight for a place in line for care. Some of the dental expertise and hospitality is donated by Ronald McDonald House, or Remote Area Medical out of Knoxville, Tenn., or local community health centers. And while are limited in their ability to do much more than prevention, others can offer real dental care but no follow-up. The result is often a brutal kind of dentistry that involves, at best, mass extraction, some advice about what not to drink and explanations about how oral health is connected to overall health. (Read more)

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