Decaying statistics prompt a renewed dental-health push by Colorado and private officials
posted by: Guest Blogger
As he lies back and chats with dentist Zach Houser about soccer, the Patriots and his next taekwondo class, 8-year-old Matthew Fellows is all that is good and getting better about teeth. Matthew knows what floss is. He brushes twice a day and doesn’t want emergency crowns, like some of his decay-plagued friends get. He has parents who bring him to the dentist twice a year and hang on every word of advice.
But with a quiet “Uh-oh” from the dentist, Matthew suddenly becomes another example of all that remains intractable and worrisome about oral health.
One of Matthew’s 6-year molars has a cavity eating through enamel that never formed quite right. He’ll have an appointment with the drill in a week or two. And Matthew has just joined a set of stubborn statistics that have prompted a renewed dental-health push by state and private officials: Fifty-seven percent of Colorado third-graders had cavities in the latest survey in 2007, exactly the same number as in 2004, despite years of effort.
“That doesn’t mean we’re going to stop trying,” said Children’s Hospital Colorado dentist Brad Smith. “A lot of people just have a low dental IQ. We’re not going to get complacent and say we’re not going to ever do better than this.”
The past 10 years have brought major changes to public health knowledge of mouth health.
Dentists persuaded pediatricians to include a recommendation for a dental visit by age 1 in their family treatment protocols.
Researchers learned fluoride toothpaste is safe — and extremely helpful in prevention — for all ages, down to infants with mere bumps in their gums.
Children’s Hospital Colorado has twice as many dental residents as in the 1990s, and Smith is the hospital’s first medical staff president in 109 years who is a dentist.
Colorado officials made oral health one of the top 10 “winnable” public health battles of the next decade, and legislators will consider extending dental coverage to pregnant Medicaid moms.
Eroded by setbacks
Yet many of the advances are eroded by setbacks:
B Widespread acceptance of fluoridated tap water, called one of the top 10 public health achievements of the century by the Centers for Disease Control and Prevention, is now undercut by adults and children drinking more bottled water and energy drinks.
B Efforts to push fluoride-enriched “varnish” to more kids — even by training pediatricians and nurses to apply it away from dental offices — are constantly battled back by increased childhood snacking. Recent dental research shows candy is not the only culprit. It’s bacteria from any source: A Triscuit is as bad as a Tootsie Roll from that perspective, dentists say.
B Calls for filling enormous geographic gaps with new oral care — Colorado has nine counties without a dentist — are stymied by resistance to giving midlevel providers such as hygienists the power to drill and perform other basic functions.
And so Colorado sees some improvements offset by slow decay: The number of third-graders with untreated cavities recently dropped by 1.6 percentage points, to 24.5 percent. Still, only 68 percent of the overall population saw a dentist in 2010, dropping from 69.5 percent in 1999.
Researchers have found 20 to 25 percent of all kids, across all socio-economic groups, have high levels of decay bacteria in their mouths. Wide disparities remain in how those kids are treated: Colorado surveys show 37 percent of third-graders in low-income schools had untreated decay, compared with only 17 percent in higher-income schools.
While oral health uses a relatively small portion of overall medical spending — 4 to 5 percent — researchers increasingly find dental problems signaling greater dangers. They are investigating bacterial connections to heart disease and other serious illnesses.
Dr. Jeff Kahl, one of the Colorado Springs partners who treats the Fellows family, estimates that nearly 40 percent of adults with dental insurance don’t actually use it. That deficit makes Kahl and other dentists shrug in bewilderment.
“Dentistry is a funny thing. Nobody likes sharp, noisy things in their mouth, and so they avoid it at all costs,” Smith said.
Colorado’s dental safety net has grown in recent years. Kahl says many more dentists now accept Medicaid patients than when he began practice.
Public health officials team with clinics and private dentists across Colorado to give away millions of dollars in oral care each year. The University of Colorado’s School of Dental Medicine serves 35,000 people a year at reduced rates in its student and resident-staffed clinic. Eighty percent of the dental work at Children’s Hospital Colorado is Medicaid, and the hospital subsidizes thousands of dental clinic visits a year with discounts and grants.
The state health finance department provided 9 percent more preventive dental services to Medicaid children last year, a spokeswoman said.
Still, only 49 percent of covered Medicaid children saw a dentist, compared with 58 percent of kids on private insurance. The state now pushes dental care to children by sending letters to Medicaid parents who haven’ t taken their kids to the dentist in a year.
The Affordable Care Act requires states to include some oral care for children in all insurance policies — public or private — when state insurance exchanges launch in 2014. But there is no mandate for adult dental care, and states can choose whether to include it in their “essential benefits” checklists.
Health advocates are instead trying to target smaller populations where oral care can make the biggest difference, capitalizing on recent research about mouth bacteria and how early it becomes dangerous.
Bacteria passed down
State Sen. Jeanne Nicholson, a Black Hawk Democrat and a public health nurse, is sponsoring a bill to add prenatal and postpartum oral care for Medicaid moms. While the bill would cost $1 million in state money, with federal matching funds, Nicholson believes it would make a significant dent in the $9 million Colorado spends on emergency oral health care to pregnant moms.
Mothers with poor mouth care pass on teeth-eroding bacteria to their children, dental research has shown. Many Medicaid moms also need instruction on caring for their kids’ teeth after birth.
Smith treated a foster child in a contested adoption, as part of the extensive Medicaid program at Children’s Hospital Colorado.
He overhauled teeth ruined by nursing-bottle decay, filling a dozen of the girl’s browned teeth under a general anesthetic. When the troubled birth mother saw the results, Smith said, she stopped contesting the adoption. Smith recounted how the mother said, “I can’t give her that.”
Dental warnings for kids used to focus just on sugar, Smith said. Moms of “bottle babies” took flak for letting infants hold juice-filled bottles all night long for comfort.
“Calling it that was a misnomer,” said Kahl, who serves on state pediatric dentistry task forces. “It wasn’t the bottle. It was the frequency of carbohydrate intake.”
Now dentists know that the frequent snacking associated with obesity and diabetes issues in kids is ruinous to teeth apart from sugar worries.
“Cookies and ice cream every day at 3 p.m. is not as big a concern as eating potato chips all afternoon,” Smith said. “That’s hours of feeding the bacteria that make cavities.”
By the numbers
68 percent of Coloradans saw a dentist or went to a dental clinic in 2010
13.4 percent of Coloradans 65 or older reported complete tooth loss in 2010
37 percent of Colorado third-graders had sealants on some permanent teeth in a 2006-07 survey, an improvement from 35 percent in the 2003-04 survey
57 percent of Colorado third-graders had decay, treated or untreated, in 2006-07, the same as in 2003-04
Where to turn for dental care
Many Colorado organizations offer access to reduced-cost or free dental care to those in need. Here are a few places to start:
The Colorado Dental Association has listings of providers offering reduced-rate services. Go to cdaonline.org and click on “Low-Cost Dentistry.”
Children’s Hospital Colorado treats many Medicaid patients and uses grants and donations to extend care to others. Call the Pediatric Dentistry Department at 720-777-6788.
Kids in Need of Dentistry links families to Medicaid, CHP Plus and other low-cost dental options. Go to kindsmiles.org or call 303-733-3710.