Dental care lags among many Rochester children

The following article appeared in Rochester’s Democrat and Chronicle on October 9, 2008.

Justina Wang
Staff writer

Thousands of Rochester-area children enrolled in Medicaid have not seen a dentist in years, and there’s no easy way to find the few pediatric dental offices that will accept them as patients.

The limited access has had an impact. According to a nationwide report released last month by the Government Accountability Office, children on Medicaid are nearly twice as likely as other youths to have dental disease, and one in eight has never seen a dentist. Locally, between 10 percent and 54 percent of children enrolled in the two Medicaid managed care plans that provide dental coverage in Monroe County — Excellus’ BlueCross BlueShield and Fidelis Care — have seen a dentist in the last year, according to state data.

“There is so much unmet need in these children,” said Dr. Cyril Meyerowitz, director of the University of Rochester Medical Center’s Eastman Dental Center. “You find very few children who don’t have (tooth) decay in that population, and it’s very alarming.”

In spite of the concern, low-income parents trying to find places to send their children for dental checkups cannot get a comprehensive list of dentists who accept Medicaid from any official resource: Not from the Monroe County health department, the state health department, the county department of human services and Medicaid office, the local division of the American Dental Association, or from either of the two managed care plans that provide Medicaid dental coverage in Monroe County.

And families that call every pediatric dental office individually to ask whether they’ll take their coverage will run into more barriers.

Of the 31 pediatric dentists listed in Monroe County by the New York State Dental Association, eight said they are accepting new Medicaid patients. Most of those offices are part of hospital- or community-based health clinics, like Eastman, which sees most of the area’s Medicaid patients.

“There are pediatric dentists in Rochester, a lot of them in the Yellow Pages,” said Dr. Meggy Kemshetti, pediatric dentist at the Anthony Jordan Health Center, which runs a dental clinic for low-income patients. “But it’s difficult to find one that will see a Medicaid patient.”

Monroe County has about 500 dentists, and the New York Medicaid helpline provides a list of 21 local general dentistry offices that supposedly accept the state-administered coverage. But when called, at least four of those offices said they do not take Medicaid, one was not accepting new patients, two had months-long wait lists, and seven of the listed phone numbers were wrong.

Issues of access

Rochester mother Melissa Parrish had always worried about dental care for her two sons, who are enrolled in Medicaid. She didn’t want them to have the cavities she had as a child, and wondered where to send them for their recommended six-month checkups. After a social worker referred her to the Eastman Dental Center several years ago, she took her 6- and 9-year-old boys for their first dentist visit and was distressed to find out that her younger son had already developed a cavity. “Early dental hygiene care is important to me,” she said. “I want to get a jump on stuff early.”

According to the Finger Lakes Health Systems Agency, there is one dentist who accepts Medicaid for every 6,744 people in the city’s low-income areas. Dentists say the Medicaid paperwork is overwhelming and that they wait months for reimbursement, which often doesn’t pay as well as private insurance companies.

“There’s a lot of paperwork, more so than your average insurance company,” said Dr. William Molak, a general dentist in Greece. “It’s a hindrance to a lot of dentists because they’re not being reimbursed fairly, and they don’t want any part of it.”

The problems of access gained renewed attention as a state law went into effect this fall, requiring schools to ask students in certain grades to provide certificates that indicate they have seen dentists.

In the Rochester School District, where 88 percent of students are low-income, officials said they have received very few of the certificates. Nurses have tried to refer families to dental offices, using a list of about 25 dentists in Monroe County who supposedly accept Medicaid, said Dr. Donna Hill, district student health coordinator. But the roster is old, and many of the offices no longer take the coverage or have wait lists.

Spurred by the new mandate, the Seventh District Dental Society, the local American Dental Association division, is working with the state health department to compile a list of dentists accepting Medicaid in Monroe County. But the task hasn’t been easy, said Seventh District executive director Lori Bowerman.

Several private dentists in the area say they would accept Medicaid for existing patients whose insurance changes, or for certain children, like those with developmental disabilities. But few agree to new patients, and many are reluctant to publicize that they take the coverage.

“The phones would be flooded,” said Dr. David Durr, of Greece Pediatric Dentistry, where Medicaid is accepted only for existing patients. “We’re not primarily Medicaid, but we’re trying to continue to help families that we have going through hard times.”

Local resources

While no roster of dentists accepting Medicaid is easily accessible, the state health department and the New York State Oral Health Technical Assistance Center offer a list of local dental clinics that treat low-income families. The Eastman Smilemobile also provides dental services to low-income children in a van parked outside local schools, and the Eastman Dental Center recently received a $3.9 million state grant to add six treatment rooms and an urgent-care clinic to take in more underserved patients.

However stark the problems in Rochester, most local dentists agree that the issues are even more troubling in surrounding rural counties where children on Medicaid have fewer resources.

Linda Voith drives two hours from her home in Allegany County every time her 15-year-old daughter has an appointment at Eastman — it’s the only office she could find that would accept Medicaid and handle the complexities of her teen’s dental care.

“I have to drive here,” she said. “I called just about everybody I could think of and nobody would take Medicaid.”

Dr. Charles Forte of Unity Dental Group in Penfield sees Medicaid patients from Wayne, Livingston, Seneca and other counties. “Rochester’s actually fortunate in the fact that it’s probably got more Medicaid providers than a lot of those areas.”

The new state law regarding dental certificates in schools has “caused near chaos in Wayne County because there’s no way to do this” in an area where so few dentists take Medicaid, said Emilie Sisson, program manager of the Wayne County Rural Health Network. The county recently opened its first dental clinic, which will offer free screenings one day a week for the uninsured and underinsured. But besides the clinic, only one small dental office in the county is accepting new Medicaid patients, Sisson said.

Other problems

In spite of some efforts in Monroe County to offer care to low-income children, dentists say problems persist because access isn’t the only issue. Although the Smilemobile van offers dental checkups outside 19 of 39 city elementary schools, Meyerowitz estimates the program only reaches 30 percent of eligible children because parents don’t sign permission slips.

Immigrant families from cultures that don’t emphasize dental care or poor parents who have grown up with few dentist visits often have many concerns that come before oral health, experts say.

“Poverty discourages going to the dentist,” Hill said. “The first need in a family is not going to be dental care if there’s still a need for food and shelter.”

Among the needs that most directly hinder dental care is the lack of transportation.

“If you don’t have a working car and you’re miles away from where your kids have an appointment, you have to find a way to get there,” said Dr. Lynne Halik, a pediatric dentist in Bushnell’s Basin. “Taking public transportation can take the whole day to get to an appointment. It can be overwhelming.”

Because of that, Medicaid patients often miss appointments, another factor that has discouraged some dentists from accepting them, Halik said.

For children who don’t receive regular dental checkups, dentist visits are reserved for when severe problems develop. Dentists say they often see Medicaid children too late, when decay could have been prevented, teeth saved from extraction and chronic infections avoided. Loss of baby teeth means fewer spaces for permanent teeth, and children who don’t have proper dental care have poorer oral hygiene and are less likely to visit dentists as adults.

“You set a pattern for a lifetime,” said Dr. Richard Speisman, chief of Rochester General Hospital’s department of dentistry. Because of some efforts by local clinic workers to reach out to families at health fairs and through city schools, more low-income children are coming in for preventive care, Speisman said. “But it’s not as quick or as rapid a change as we like to see.”

And in spite of some improvement, tooth decay has become more prevalent in children about 2 to 8 years old — a sign that complex issues have not been fully addressed, Meyerowitz said.

“We’ve looked at this for many, many years, and we still don’t have a clear answer,” Meyerowitz said. “It could be that parents don’t see this as a high priority … it could be whole other social barriers in terms of people trying to access care. But it’s a cascading series of problems that most of us wouldn’t want for our children.”

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3 Responses to Dental care lags among many Rochester children

  1. LaDene Naujokas says:

    I am a dental hygienist. What about extending hygiene services like in other states? Also, an “at school “location for check and treatment points. This has been done in the past and I would love to be a part of that type of program. Of couse, I understand that there are legal issues that have to be reviewed, and changed. I think it is worth changing. I see this as an issue on the rise ,due to unemployment rates increasing and the nations finacial crisis worsening. Some health concerns are related to our oral health and the lower income sector can not afford dental care.They can not afford to take time off of work to seek needed treatment, let alone prevenative treatment. Some can not transport themselves, or their families to have treatment. There are families that do not qualify for mecaid, becase they are just above the poverty line, and these families can not afford any care. I would love to be part of the solution, for I think it is apparent that we have a problem.
    Sincerly, LaDene

  2. I think parents should be more aware about the dental health of their children. The schools should also organize regular dental checkup camps for students.The state govt. should also support for organizing such camps.

  3. john d says:

    It is quite sad to hear about the deteriorating condition of the dental health care in the young kids of Rochester children I think parents need to be more aware about the dental health of their children. The schools should also organize regular dental checkup camps for students.The state govt. should also support for organizing such camps.The person who are poor needs to have proper medical aid .You can check out the dentists in Athens they are nice ( check out their page you will get a solution to the problem.

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