Poor have few options in dental care

PHOTOGRAPHER: Kelly de la Rocha

When it comes down to a choice between putting food on the table and visiting the dentist, checkups, cleanings and fillings often go by the wayside.

According to Harris Interactive data released in May by the American Dental Association, nearly half of lower-income adults in the U.S. say they haven’t seen a dentist in a year or longer, while the vast majority of middle- and higher-income wage earners have.

The data also revealed that lower-income adults are more than twice as likely as middle- and higher-income adults to have had all of their teeth removed.

In Schenectady County, experts say dental issues are rampant in the poor, uninsured and under-insured population, young and old, and care options for those who don’t have the means to pay for treatment are extremely limited.

According to Mark Feldman, executive director of the New York State Dental Association, New York is one of very few states that provides both child and adult dental services under the state’s Medicaid program. The problem is, many local dentists do not accept Medicaid.

“A lot has to do with a lot of the paperwork that’s involved and not getting reimbursed for a considerable period of time after providing services, and the second thing is that reimbursement rates can be so low that sometimes practitioners are ending up producing less money than is necessary to cover their overhead,” explained Michael Breault, a periodontist who has a private practice in Schenectady and is also a teacher for the residency program at the Ellis Dental Health Center in Schenectady.

Medicaid does not cover periodontia, the treatment of diseases of the supporting structures of the teeth, he noted.

Historically, finding a private dental practice that accepts Medicaid has been an issue in the Capital Region, said Laura Leon, executive director of the New York State Dental Foundation, an organization that supports outreach to needy communities.

“People will call us all the time looking for a dentist that takes Medicaid and there isn’t really a list out there that says, ‘These are dentists that take Medicaid,’ ” she said.

Ellis Dental Health Center is one local institution that does accept Medicaid. Financial assistance is also available to help those who are uninsured.

Although preventive dental care is available, the majority of the patients seen at the center come for emergency visits, said Cassie Flanagan, director of physician practices for Ellis Medicine.

“I think most of the patients that we see are patients who have never seen a dentist, who are only coming to us because they have an immediate issue,” she said. “We have people in their 20s and 30s who need full mouth extractions. They’ve never had dental care. Their teeth are all just destroyed and we’re taking out all of their teeth and giving them dentures so that they can live without pain, they can eat and they look better.”

Over the past few years, there has been an increase in the number of younger people coming to the center with dental issues, Flanagan said. That increase could be attributed to a lack of education, she speculated.

“If your parents don’t take care of their teeth, they really don’t know how to show you to take care of them, and now we’re getting the younger generation who has never really learned how to care for themselves,” she said.

Many of the younger patients seen at the center have major dental problems, Flanagan noted.

“We have a waiting list for kids that need to go to the [operating room] because it’s stuff that we can’t do in the chair,” she said.

Hometown Health Center in Schenectady, which also provides dental services to the poor, performs dental outreach in the Schenectady school system. Children are offered not only education about oral hygiene, but also exams, cleanings and dental sealants to help prevent cavities.

“Sometimes children don’t get to the dentist for the first time before they’re 10, 11, 12 years old and that’s a real problem because by the time they make that first visit, there’s a whole host of problems they could have,” said Joe Gambino, CEO of Hometown Health.

The federally qualified center sees in excess of 20,000 patients annually, Gambino estimated. Medicaid is accepted there, and the center also offers a sliding-fee scale and payment plans.

Local pediatric dental care issues are confirmed by statistics from an Oral Health Survey conducted by the state Department of Health. The survey found that between 2009 and 2011, about 35 percent of low-income third-graders in New York state, excluding New York City, had untreated decay. That percentage dropped to about 14 percent for third-graders from higher-income families.

The instance of cavities during that same time period was about 62 percent for third-graders from low-income families. That percentage was cut approximately in half for those who came from more-affluent families.

Fluoridation of the public water supply has helped to significantly reduce tooth decay in a cost-effective way, and is a good way to help people who don’t have the finances to get dental care, Feldman said.

Schenectady’s water is fluoridated, but water fluoridation in other parts of the county is spotty, according to the Centers for Disease Control and Prevention.

Even with fluoridated water, a lack of proper oral care can have far-reaching consequences.

“If you have any type of health issues with cavities or periodontal issues, those affect the rest of your wellbeing,” said Leon. “There are strong linkages, for instance, between poor oral health and diabetes. If you have certain prevailing oral health conditions, you often can’t get the surgery that you need to treat, for instance, a heart condition.”

Dental problems can also make people uncomfortable about their appearance, which, in turn, could make them more hesitant to communicate or participate in class. Noticeably diseased teeth can also make it more difficult to secure a job, Leon noted.

“It’s so troubling because it is the most preventable disease out there; it’s entirely preventable,” she said.

Education is key to helping people maintain good oral health, and Flanagan said it must start with the pediatric population.

“If we can teach the younger generation how to take care of themselves, then it will roll over into the following generation,” she reasoned.

Feldman said the NYSDA is working to improve access to dental care by trying to get more private dentists to accept Medicaid.

“We are slowly but surely getting people to participate in these programs,” he said.

In June 2014, children and adults with have an opportunity to receive dental care free-of-charge at New York state’s first Mission of Mercy event, to be held at Hudson Valley Community College. According to Breault, the two-day event will include between 200 and 300 dentists, as well as auxiliary personnel, lab technicians and dental supply companies. If it’s a success, he said something similar will likely be held on an annual basis.