Posts Tagged ‘Pediatrics’

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: 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.”

Preschoolers in Surgery for a Mouthful of Cavities

Tuesday, March 6th, 2012

–excerpted from The New York Times, Health, March 6, 2012.

In the surgical wing of the Center for Pediatric Dentistry at Seattle Children’s Hospital, Devon Koester, 2 ½ years old, was resting last month in his mother’s arms as an anesthesiologist held a bubble-gum-scented mask over his face to put him under. The doctors then took X-rays, which showed that 11 of his 20 baby teeth had cavities. Then his pediatric dentist extracted two incisors, performed a root canal on a molar, and gave the rest fillings and crowns….

“We have had a huge increase in kids going to the operating room,” said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Me., and a spokesman for the American Dental Association. “We’re treating more kids more aggressively earlier.”

But such operations are largely preventable, he said. “I have parents tell me all the time, ‘No one told us when to go to the dentist, when we should start using fluoride toothpaste’ — all this basic information to combat the No. 1 chronic disease in children.” …

Click here to read the full article in The New York Times.

March 7th Presentation – Pediatric Oral Health Disparities

Sunday, March 4th, 2012

View Video Presentation: Pediatric Oral Health Disparities

COHI member Dr. Steven Chapman (Assistant Professor, Department of Pediatrics at Dartmouth Medical School, Medical Director, General Pediatrics Clinic Medical Director, Boyle Community Pediatrics Program, Children’s Hospital at Dartmouth, Dartmouth Hitchcock Medical Center) will be presenting “Pediatric Oral Health Disparities” at Pediatric Grand Rounds on Wednesday, March 7th from 8-9 a.m. in Auditorium E, Dartmouth-Hitchcock, Lebanon, New Hampshire. Dr. Chapman’s presentation will highlight both the unmet needs and role of pediatricians in addressing the oral health of children and families. The public is invited.

A Personal Story: Beyond Saving – Lori, Strafford

Wednesday, September 21st, 2011

Lori is a single mother of six, three of whom still live at home with her in Strafford, Vermont. Lori’s children have had dental insurance through Dr. Dynasaur from the time they were young but Lori has not. Although she always had a dentist, she could not afford routine maintenance, “and so I ended up losing seven of my adult chewing teeth—the big ones in the back—because they would just get cavities and they would just go so quickly that…there was no saving them. Even two of them, I went in and said, ‘I don’t care what it costs just save them,’ and they were just beyond saving.” Lori explains that her regular dental maintenance was just always one of the (many) things that was expendable at the end of the month, because her children’s care came first, “and it was expensive. Dental care is just so expensive.”

Lori has tried putting dental work on payment plans, but it usually ends up on a credit card where she ends up paying more for it in interest. “I finally said, I have two chewing teeth left, I cannot afford to loose these, because if I lose these I have nothing left to chew with. I believe now one is cracked and I need to get in there and I haven’t been able to go because there’s no money. (My ex-husband) has now quit paying child support completely.”

Seven years ago, Lori had a tooth abscess and ended up in the emergency room. At the time she did not have a primary care physician so she saw her kids’ pediatrician, who gave her a prescription: “I had no idea how dangerous it was to get a bad tooth infection.” Her face got extremely swollen, but the antibiotics got rid of the infection and then she was able to get the tooth extracted at a local dental clinic.

Lori is grateful for the care her children have received through Dr. Dynasaur: “I am so thankful and so appreciative that Dr. Dynasaur is out there for my children because I don’t know what would happen otherwise. I could not afford to take them for regular routine check-ups. I couldn’t. If they had to have a filling I would find a way but I know that those routine six month cleanings would not happen. And because of them not happening, I know that things would go undiagnosed and unseen.”

Illustration by Dennis Pacheco.

A Personal Story: On COBRA for the Dental – Jen, Thetford

Tuesday, September 20th, 2011

Jen and her family had dental insurance until a few months ago when Jen lost her job. Fortunately, since they live in Vermont, Jen was able to get the family on VHAP and Dr. Dynasaur, but her daughter was seeing a pediatric dentist in New Hampshire. “My six year old had significant dental work that was needed and they had referred her to a specialist in Manchester, New Hampshire.” Because the regular family dentist refused to do the work, Jen was faced with the prospect of a seven hundred dollar to several thousand dollar dental bill for her daughter. “So I had to stay on COBRA which was $200 for our family for a month. It’s a lot since I’m totally on unemployment comp right now, which barely pays my mortgage. I’m not sure how I’m going to do next month but I have to do COBRA because I’ve got to stay with this specialist, because now she needs an extraction of four teeth. She just had three significant decays filled. I’m trying to find a Vermont dentist that eventually can take over the kids and I’m not sure what I’ll find.”

A Personal Story: Limits of a Limited Budget – Jessica, Chelsea

Wednesday, August 31st, 2011

Jessica is the mother of three young children living in Chelsea, Vermont. As a single mom, her family is on a limited budget, although she and her children have some dental insurance through VHAP and Dr. Dynasaur. Jessica had a hard time finding a dentist who will take Dr. Dynasaur, but she finally found one in Norwich. She has been satisfied with the situation until the past year or so when gas prices have gotten so high that the drive is becoming a financial hardship.

Jessica tries hard to limit the amount of driving her family does in order to save money—sometimes she’ll drive the kids halfway to meet their father who will take them the rest of the way for their appointments. She says she’s seen a mobile dental clinic bus in Chelsea, but has not been able to find any information about the dates and times it’s open. Jessica herself has not had her teeth cleaned in two years because she can’t afford it, but she’s committed to keeping her kids’ regular cleaning appointments: “When you’ve got small children, you’ve got to be on top of that.”

Illustration by Dennis Pacheco.

A Personal Story: Trapped, No Options – Nancy and Kate, Thetford

Wednesday, August 31st, 2011

Nancy and her family live in Thetford, Vermont. Nancy, her husband, and their three children all have dental insurance through her husband’s job. Nancy’s middle daughter, Kate, has been going to the dentist since she was two, having regular cleanings every six months. When Kate was three, their family dentist told them that she had cavities that would need to get filled in a year or so, before they started getting painful. Because Kate is so young, she needed to see a pediatric dentist. Nancy started looking and was surprised to find her options were very limited, with only one local pediatric dentist and just a few within driving distance.

Once she had an appointment, even with dental insurance, Nancy had to pay $110 before the pediatric dentist would even look at Kate. The initial exam revealed that Kate had six cavities which would need to be filled in three separate visits. Because of her age, Kate would need nitrous oxide for the procedure, which was not covered by insurance. Completing those six fillings would cost a total of $565. Although it would delay the procedures, Nancy would need to schedule each visit three months apart because, “we don’t have that kind of cash flow.”

At Kate’s first scheduled visit to get two of her cavities filled, Nancy was not comfortable with how the pediatric dentist interacted with her four year old. Ultimately, Kate pitched a fit, and the dentist couldn’t get the procedure done. He charged $67 for ten minutes. He was now recommending Kate have her cavities filled by him under general anesthesia. Nancy is not at all comfortable with this dentist, does not want her daughter under general anesthesia, but doesn’t feel like she has a choice: “I feel trapped. I don’t feel like I have any other option. I just don’t know where to turn.”

Illustration by Dennis Pacheco.

A Personal Story: Pediatric Care – Kate and Eva, Lyme

Wednesday, August 31st, 2011

When Kate’s daughter, Eva, was six, the family dentist saw that she had six cavities in between her molars that needed filling. Because of her age, the fact that her teeth were close together, and the number of cavities, the family dentist did not want to do the work. The pediatric dentist he recommended was in Manchester, New Hampshire. Kate looked for one closer, but could not find one she was comfortable with. She and her daughter made the 2 ½ hour round trip drive at least four times during the year Eva was in Kindergarten. The dentist would only schedule young children in the morning, so every trip meant that Eva had to miss a full day of school. By the end of the school year, her teacher was concerned about the number of school days she was missing. With the extra time and the expense of paying for gas, Kate said, “It definitely was not convenient,” but on the up side, “(Eva) is still positive about the whole thing.”

Illustration by Dennis Pacheco.