…… U.S. GAO report concluded, referring to the federal/state health program for poor people.
… about 6.5 million children enrolled in Medicaid had untreated tooth decay in 2005 .
The GAO report was ordered after…Deamonte Driver, a 12-year-old boy…died last year in suburban Washington when an untreated infected tooth led to a brain infection.
http://www.cnn.com/2008/US/09/23/dentalcare.medicaid/ind Millions of poor American children have untreated tooth decay, some of them because they cannot find a dentist willing to treat them, a federal report issued Tuesday said. Only 1 in 3 children in Medicaid received any dental care over a year time span...
ABC News- March 6, 2009 Brandon had an astounding 16 baby root canals completed at one visit--nearly every tooth in his mouth. "He comes walking out of that door…and he had blood dripping from his mouth. And all I could see was silver shining through.“ [Mother] Hunter, another child who received the same treatment and was just starting pre-kindergarten, was teased by other children as a "metal mouth" and said "it just made me feel, like, bad." "I feel like they took my son's smile away." [Mother]
% parents reporting child dental problems or treatment affecting child or family “occasionally, often or very often” among parents of children with obvious caries experience (d 2 mfs>0) Impacts of Dental Disease 4 Smiling, talking 58 Both child and parent impacts 23 Work, finances 36 Upset, guilty 45 Parent overall impacts 16 Sleeping, irritable 17 Pain 26 Eating, drinking, talking, daycare 35 Child overall impacts Percent Impact
Physicians are being called upon to provide dental services
Surgeon General’s Report & Conference (2000)
ADA Future of Dentistry Report (2001)
AAP Policy Statements (2003, 2008)
Bright Futures Guidelines, 3 rd Ed., 2008
“ Maine has 2 DDS for every 2,300 people, compared to 1 MD for every 640. Nationally there is 1 DDS for every 1,600 people.” “ In Maine, training MDs in dentistry provides a dental safety net for the rural poor.” March 3, 2009 Short of Dentists, Maine Adds Teeth to Doctors’ Training Ronald Smart who had not been to a dentist in 5 years, came to Fairfield clinic to have an infected tooth pulled; he has had 3 pulled there before, and likely Will have more.
P riority O ral Health R isk Assessment & R eferral T ool (PORRT)
Percent Sleep with bottle Family has dental problems No fluoride in water Fluoride toothpaste not used Drink juice between meals Other oral condition Dental caries Enamel defects White spot lesions Visible plaque Behavioral Clinical Percent of Patients with Risk Factors n-=1,825; Not mutually exclusive categories
Referral Guidelines Cavitation or CSHCN White spot lesions Enamel defects Other concerns > 3 risk factors <3 risk factors Pediatric dentist General dentist Physician manages caries risk Yes (6%) No Yes (23%) No (72%)
73-2001. Resolved, that it be policy of the American Dental Association that topical application of fluoride varnish is a part of comprehensive dental care which requires an examination and supervision by a licensed dentist.
ADA Resolution: Application of Fluoride Varnish Trans.2001:430-432. ADA House of Delegates
Preventive Oral Health for Pediatricians. Pediatrics . 2008;122:1387-94.
Stage of Adoption of Medical Model by State Medicaid Programs Sams et al., 2009. = No Initiative in place; no plans for one (n=13) = Existing Program (n=28) = Plans to implement initiative in next 12 months (n=10) 3 states confirmed by telephone (Mississippi, Illinois, West Virginia) 1 state by guidelines (Wisconsin) RI TX FL NC CA OR WA AZ NM UT NV ID MT CO WY HI AK NE SD ND OK KS IA MO WI MN LA AR IL MI GA TN KY IN OH MS AL WV VA ME VT NH NY PA MD NJ DC MA CT SC Delaware
“ AAPD policy does not support the application of fluoride varnish absent a comprehensive dental exam. Current AAPD policy supports the delegation of fluoride application to auxiliary dental personnel or other trained allied health professionals, by prescription or order of a qualified dentist, after a comprehensive oral examination has been performed. Fluoride varnish interventions are not a substitute for the establishment of a dental home.”
AAPD perspective on physicians or other non-dental providers
applying fluoride varnish . Talking points . June 2006.
… coordination of preventive and treatment services among physicians, dentists and community programs will allow communities to manage and improve the oral health of all children so that they begin school with no untreated tooth decay…