Archive for the ‘Children and Oral Health’ Category

News From Vt. State Dental Society

Thursday, October 11th, 2012

Thanks to member, Toby Kravitz, DDS, Upper Valley Oral Health Coalition is please to post this release from the Vermont State Dental Society on our website.

Subject: The Importance of Oral Health during Pregnancy and Early Childhood
 
Dear Vermont State Dental Society Members:
 
Below is the web link to Dr. Steve Arthur’s May 24th Vermont Department of Health’s Public Health Grand Rounds presentation, “Two is Too Late”, which is about the importance of oral health during pregnancy and early childhood.
 
It does not include an audio recording, but does include a link to the video portion of the presentation.  A link to the presentation is listed under Presentation Recordings and Slides, near the bottom of the page.
 
http://healthvermont.gov/events/grand_rounds/index.aspx
  
The take away message includes that oral health care is safe during pregnancy, and should not be delayed until the baby is born.  Bacteria that cause early childhood caries (ECC) are transferred from mom to infant by things like pretesting food and kissing on the mouth.  If babies are infected before their second birthday, they are set up for a lifetime of more severe decay.  ECC is a real problem in Vermont.  In FY 2009 over 400 Vermont children had to be treated under general anesthesia in a hospital setting, at a total cost of over $2.5 million dollars to treat this preventable disease.  Many of these children will grow up, and pass the decay onto their own children if this cycle is not broken. 
 
ECC is a complex problem, involving many aspects, and needs to be addressed at all levels of the Vermont Prevention Model.  Ideally, the importance of oral health would be addressed at a woman’s first prenatal visit; she would be given information about how pregnancy may put her at an increased risk for oral disease, how her oral health can affect gestational diabetes and preeclampsia, and how her oral health may affect that of her child.  She would be encouraged to have all needed preventive and restorative dental work done before her baby is born (even if that means needed x-rays and local anesthesia), and to decrease the bacterial count in her mouth by using mouth rinse and xylitol gum.  Appreciating their potential to positively affect this woman’s birth outcomes, and her oral health as well as her child’s, the local dental team would welcome this woman into their practice, and look forward to seeing her child on his or her first birthday.  At the women’s Head Start program and WIC, she would be getting consistent messages about the importance of prioritizing preventive oral health care (showing up for appointments and following through with homecare), limiting sugar sweetened beverages, and establishing a dental home for her child by age one (“Two is Too Late”).   
 
The California Dental Association Foundation (CDAF) has excellent resources on this topic that are being promoted by VDH:
 
CDAF’s “Oral Health in Pregnancy and Early Childhood: Evidenced Based Guidelines for Health Professionals” shared with OBGYNs, midwives, pediatricians, WIC, and Vermont dental practices in collaboration with the Dental Society, and patient/parent materials, “Cavity Keep Away.” 
 
http://www.cdafoundation.org/Learn/EducationTraining/PerinatalOralHealthEducation.aspx
 
I’ve also attached the ADA recommendations outlined in “Baby’s First Tooth”, published in JADA (February 2002).
 
Please review these materials and share them with your practice team.  It is important that we deliver a consistent message to patients.  We expect to continue working with Dr. Arthur, Robin Miller RDH, and the VDH team on this important topic.

Dartmouth Students Simple Design for Big Impact – Improving Oral Health during Pregnancy

Friday, June 1st, 2012

This year a group of Dartmouth College undergraduates including Lucas Yamamura, Karl Schutz, Melissa Saphier, Winnie Yoe, Hannah Kim worked with Tom Roberts and Good Beginnings to improve oral health for pregnant mothers.  They are part of the group Design for America (www.designforamerica.com), a national organization from Chicago that has established studios at colleges in the US to use design thinking as a way to solve local social issues.  Lucas and his colleagues learned that gum disease is a common problem for pregnant women, and poor dental health is usually correlated to negative birth outcomes.  Brushing teeth twice a day is the recommendation of most dentists – a simple strategy for healthy teeth and gum.  In order to tackle this issue, the group asked the following question: How to encourage pregnant moms to promote their own oral health?  The group’s answer is a tooth brush holder in the form of a simple, low cost cup and lid that holds the brush.  The cup is decorated in honor of the coming baby and and can include a copy of the baby’s ultrasound or any other picture or drawing the mom and family apply. That way, they intend to elicit a personal connection between the parents and the upcoming child, reminding future mothers that brushing teeth is part of the  Not yet in production, but the group will be suggesting this idea to a group of pregnant moms for their input.  Great work and let’s hope it works.

A Personal Story: Insurance Issues – Melinda & Dave, Orford

Wednesday, April 4th, 2012

Melinda and Dave live in Orford, New Hampshire and have four children. Dave’s job offers dental insurance, but the rates are high. “We do have dental insurance available to us but. . . the family rate is so much higher than the individual rate, that unless you are going to have a lot of work done it doesn’t make sense financially to have the insurance for your kids. It’s cheaper to pay for expensive stuff out of pocket than to pay the higher rate for kids to be on our plan. . . We also have a dentist who we love that is not on the preferred provider list, and so it’s more expensive than if we had found somebody else. We’ve chosen to stay with her because we like her, we think she does good quality work, and we have a connection there. But it costs us more money.” Melinda explains that although the recommendation for cleanings is every six months, she tends to schedule cleanings for every eight months or so, in order to save money.

One of Melinda and Dave’s children, Angela, has special needs and is eligible for Medicaid. Because of her special needs she goes to a different dentist than the rest of the family, one who specializes in pediatric dentistry. Melinda feels that New Hampshire Medicaid is very good about dental care. They send regular reminders to go to the dentist, and they cover everything fully. Angela needed extensive sedated dental work done and it was all covered by Medicaid. Melinda’s one concern is that she feels that Angela’s dentist may have been able to catch some of her dental problems earlier if Melinda had started taking Angela to the dentist at a younger age. “I do think it’s kind of crazy how medical care and dental care are so separate. Even though we feel like we are getting really good medical care for her, her primary pediatrician was not saying, you need to take her to the dentist this year, even though she’s only one year old, just to see what’s going on. Somebody should have been telling us that. It wasn’t until it was to a crisis point that we took her to be seen and realized that there was all this horrible decay. I think that that’s not an uncommon story. I know that the pediatric dentist feels . . . that he’s seeing all these cases that should have been referred to him much sooner, and never were. I know he feels that the time line for checking out children’s teeth is too late. By the time they’re seen at age five, all their baby teeth have been in there for all this time and you could have seen decay happening but nobody ever looked.”

Illustration by Dennis Pacheco.

A Personal Story: NH Medicaid is Crippling – Jason, Lebanon

Monday, April 2nd, 2012

Jason is 34, with four children, and lives in Lebanon, New Hampshire. Jason’s daughter was born with Spina Bifida, which means, among other things, that her teeth are softer than most people’s and they are more susceptible to decay. At four or five years old she needed some extensive work done. Jason explains: “We had a dentist in Claremont, and with a busy schedule (my wife and I both work) and we have four kids we’re chasing around and bringing back and forth to different appointments. One of the appointments slipped our mind. When we realized we had missed the appointment, we called in to reschedule, and they told us that we couldn’t be seen there ever again.”

Jason couldn’t find any other dentist in the Upper Valley who would accept his NH State Medicaid. After looking around, Jason was referred to a pediatric dentist in Concord, New Hampshire. Jason traveled an hour and a half to get his daughter an exam, and then, a few weeks later, back for the surgery she needed. She needed a couple of teeth pulled, spacers put in, and caps on her molars. Jason feels lucky that the work was all covered by insurance. Still, “That’s a three hour trip. We were down there all day for the surgery, had to pull the rest of the kids out of school, so it’s definitely an inconvenience having to travel that far.”

Fortunately, Jason and his family have since found a dentist that accepts his insurance closer to home.

 

A Personal Story: No Phone, No Gas, No Dentist – Leslie, Lebanon

Thursday, March 29th, 2012

Leslie has spent 2 years out of work due to health issues and has been living on $500 a month for the past year. Nutritional deficiencies over the last few years have weakened her teeth so that now many of them have nerve damage and are falling out. She has no insurance for herself and so has been unable to address any of these issues. She has no income to cover the phone minutes to call dentists or the gas to drive to visit them in person.

A year and a half ago, Leslie’s daughter had an accident in school where she was hit in the face by a basketball and chipped her new adult tooth. Her daughter is covered by a dental insurance plan through her father, who lives further south in New Hampshire, as well as by Medicaid, but many of the prescriptions she needed for this accident weren’t covered and the root canal she needed meant that they still owed $450. “Even with insurance you can’t get in anywhere to get dental care…There are a couple of different children’s dentists around the Upper Valley but they aren’t taking new patients…” Or they don’t take Medicaid. Now her daughter needs orthodontia work, but she doesn’t have the money to start looking into addressing it.

Illustration by Dennis Pacheco.

A Personal Story: NH School Nurse Sees Problems in Kid’s Teeth – Norwich

Thursday, March 29th, 2012

Sylvia is in her 60s, lives in Norwich, Vermont, and works as a school nurse in New Hampshire. “We see a lot of kids coming in with just completely rotted out teeth.” She explains that it’s sometimes difficult to persuade parents in low-income families to participate in free dental care programs. “It’s really hard to convince that group that not only are they eligible, but that it isn’t a hand-out . . . Sometimes they’re afraid to get linked into the system, because a lot of these [dental care] groups say, well, we’ll give it to you for free but then there’s always some cost, even if the cost is, we need to see you four times a year so you need to get here. That’s a huge cost to a lot of people who are figuring out every day any place they can get to where they could possibly work for a day.”

Sylvia believes providing dental care through the schools is the best way to ensure access. There used to be a dental van that provided care to students at her school, but it has stopped. She remembers it being very successful. “The whole thing came here and the kids were already at school, so there wasn’t any cost [to the parents] . . . I don’t know what un-did that program . . . I don’t know whether they were asked by the state to stop, or whether something happened and there was some kind of a lawsuit.”

The van will be back, but as Sylvia understands it, only to provide cleanings and education. While she thinks that’s valuable, she also thinks it’s not enough: “If we’re seeing a fair number of kids coming with already serious problems, we’ve got to have treatment.”

 

A Personal Story: Pain Comes and Goes – Thomas, White River Junction

Wednesday, March 28th, 2012

Thomas is 29 and lives in White River Junction, Vermont. The last time he went to a dentist was about five years ago–he hasn’t been back because he can’t afford it. Thomas feels lucky that his teeth are in pretty good shape overall, and he’s taken good care of them over the years. However he does have one tooth that abscessed about eight months ago. “It got so infected that I couldn’t sleep, I couldn’t think, I couldn’t work. I went to the hospital. They told me they really couldn’t do anything about it. They told me to see a dentist, they tried to make me a dentist appointment. I didn’t have any insurance. They wanted to charge me a bunch of money I didn’t have. I’d just had a baby, too, at this point, so I just kind of took Tylenol and ibuprofen and kind of just waited it out. Every now and again it really really starts to hurt–it comes and goes.”

Thomas just found out about the free dental clinic in White River Junction, so he plans on making an appointment with them as soon as he can. He is frustrated by how expensive dental care is: “It should be free. One of the most important things in life is your teeth. I mean, the health of your teeth determines the health of the rest of your body, really.”

 

A Personal Story: Family Access – Robin, Lebanon

Wednesday, March 28th, 2012

Robin is a 33 year old single mom who lives in Lebanon, New Hampshire. Robin and her children have New Hampshire state Medicaid insurance, which is limited in the dental care it covers for kids and does not meet Robin’s family’s needs. Robin’s eldest daughter just had three cavities filled, only two of which were covered by her insurance. It’s especially frustrating for Robin that her dentist claims her daughter is not taking care of her teeth, when, in reality, her daughter’s decay is due to medication she is taking. Robin has Crohn’s disease, and her daughter has irritable bowel syndrome, which will likely turn into Crohn’s. She explains: “I’m already facing probably getting dentures because I’ve been on my medication for Crohn’s for the last ten years … My kids do not do soda, they do not do candy, she’s gluten-free. It’s just the medication makes your teeth bad, so they’re soft, so she’s had to get a couple fillings. And they pretty much tell me it’s preventive care that I’m not doing correctly, and that’s not it at all. So they cover two cleanings a year and two fillings and that’s pretty much where it stops and they do not help with braces at all whatsoever. So she’s not getting braces because I can’t afford them.”

To make matters worse, Robin’s regular dentist has just informed her that he is no longer accepting Medicaid payments as of January of 2012. Robin’s family can still go, and her bill will be a sliding scale fee based on her income, but she doesn’t have the additional money in her budget right now, so she’ll be looking for a different provider.

Robin works with families who primarily have Medicaid as their insurance, so she knows how hard it is to find a dentist in her area who will accept Medicaid patients. A dentist in Vermont she regularly refers families to just told her he’s full and has met his quota for Medicaid patients. Some of the families she works with go to Concord, New Hampshire, for their dental care. “For some of these families that’s a big hardship because a couple of my families don’t have a vehicle … so it’s them trying to find a ride and then of course it’s during the day and then the kids lose out on a day of school.” Some of Robin’s families have had to make repeated trips to Concord, because a tooth wasn’t filled correctly the first time, and it was bothering the child, and they had to go back to get it fixed. “The parents that do have vehicles … it’s just extra gas money that they don’t have.”

Lack of access to affordable dental care is a problem for the adults as well as the kids. “It’s hard for the parents. Because a lot of them get disability or Medicaid and they don’t have the dental services … a lot of my parents are just literally pulling their teeth out and they’re just going without. One of my parents just did that because she can’t afford the dentures. Her teeth were really bad, and she just now is toothless and she just lives that way. It’s hard. It’s very hard.”

 

A Personal Story: Pediatric X-ray Issues – Heather, Lyme

Friday, March 23rd, 2012

Heather is 40, with two young children, living in Lyme, New Hampshire. Her family has dental insurance, and can afford their dental care, but they drive all the way to Burlington, VT, a four hour round trip, for their son’s dental work. “Our oldest son began dental care locally, where I go, and he wasn’t able to bite down on the x-ray wings. He has a really strong gag reflex…. The fourth time he tried he was really determined to do it so he chomped really hard and split the roof of his mouth open. And he was really disheartened.” Their son had had a large cavity filled that had abcessed, and they were recommended to go to a pediatric dentist. They felt like they needed to make sure this dental experience was successful, and the pediatric dentists that were most highly recommended were in Concord, New Hampshire and Burlington, Vermont. “We decided just to go [to Burlington] because we could think of more fun things to do on Lake Champlain than in Concord, New Hampshire.” When she finally was able to get their son’s teeth safely x-rayed, Heather found out that he had eight cavities. The extraction, a space maintainer, and the fillings, took a total of four trips over the course of a summer to complete.

Luckily, Heather and her family do their cleanings locally, and because her kids are under twelve, they get their dental cleanings reimbursed by the family’s health insurance. If they got dental insurance for their kids, it would only pay up to $1,200 a year, maximum, and it would only cover 50% of each procedure, so for Heather’s family it made more sense to pay out of pocket, about $2,000 for all of her son’s work. But the extensive travel Heather and her son need to make takes a toll. If he can’t get his teeth x-rayed at his next local cleaning, they’ll need to go back up to Burlington in six months for x-rays. Heather and her husband both had braces, so they’re anticipating a future of extensive dental care for their children: “It doesn’t bode well.”

A Personal Story: Can’t Find Affordable Local Dentist – Amy, Chelsea

Thursday, March 22nd, 2012

Amy and her family moved to Vermont eight years ago, and had three children at the time. “We had private insurance, and it did not include dental. We did not qualify for state dental insurance. We were private-paying for all of our dental work.” Then Amy’s husband lost his job and they could no longer afford $1,500 a month for private health insurance. After this happened they qualified for Dr. Dynasaur for their children. Amy started looking for dentists and found one who took her children on as patients. They saw him for a year and then got a letter saying he no longer accepted Medicaid. Amy found it very difficult to find a new dentist who would take her children, but did eventually find one in the Upper Valley, and most recently she has made use of the mobile dental van that visits local schools. “I do feel like even though it’s difficult to find dental care for my children it’s doable: difficult but doable.”

“As an adult, on the other hand, it’s practically impossible.” Amy couldn’t afford to pay out-of-pocket for her own dental care, so when she qualified for Dr. Dynasaur during her last two pregnancies, she figured she’d use the coverage to address her own dental needs. “I needed two extractions over a four year period. For my initial visit, I had to travel to Plainfield [nearly an hour's drive] … and my first visit took four months to get in.” When Amy had some chronic pain that she needed addressed immediately, she called her former dentist who made an exception and saw her. “I basically begged and pleaded. He did take my Dr. Dynasaur and he was really nice, but it was really clear that it was the only time.”

“The other piece that’s hard for us right now is we have a fourteen year old who needs braces…. I took her to an orthodontist and he said, compared to what she needs, the Medicaid was not going to pay for a lot of it, because it’s partially a cosmetic thing…. I have this fourteen-year old, and she’s going into high school, and I can’t afford braces for her and she needs them.”

“The cost of private dental care is high–prohibitive for me–I am now a single mother. My children and myself, we are covered by state Medicaid. There’s nothing that’s covered for me for dental right now. I need a cleaning, I need dental work done, and I don’t know when I’m going to be able to have that taken care of.” Amy sees dental care accessibility as a nationwide problem that is particularly acute in Vermont. “At one point, when I was the most frustrated, I did call the VT Department of Dentists, and I did explain the situation, that I couldn’t find a provider for my children or for me that was within fifty miles. There was really no help on the other end, other than, ‘Oh well, bring more dentists to Vermont.’

Amy believes compensation for dentists from Medicaid is a big problem. “Obviously, they’re not getting it. And obviously they can’t afford [to treat patients on Medicaid]…. I would guess that more than fifty percent of their customers would come from Medicaid, and if they’re getting paid fifty percent of their costs, I don’t blame them. They can’t volunteer all their efforts. But at the same time, there’s lots of people that are going without.”