For the past several years, Ellis Health Center in Schenectady has been expanding and improving its dental health center, moving it from the basement to the first floor and increasing the number of dental chairs from seven to 12.
Now the hospital is poised to open a new oral surgery clinic. Ellis has always provided some oral surgery, but when the clinic opens on March 19, it will have two rooms dedicated solely to the service. And it will provide dental care to anyone who needs it.
“When you go to an oral surgeon, they expect the money up front,” said Cassie Andriano, practice administrator of the dental health center at Ellis. “Many patients cannot pay up front. Here, they will not have to produce thousands of dollars to get help.”
Since 2009, Ellis has seen a 20 percent increase in patients seeking help for dental problems. Experts say that access to dental care remains a huge problem for the poor and low-income, and that even middle class families can find paying for dental care a struggle, particularly if their employers do not provide insurance. They say that many people still fail to understand the effects of poor oral hygiene and that parents, in particular, need to be educated about the importance of caring for their children’s teeth. Dental disease, they note, is the most common chronic illness among children.
“Some families don’t understand the significance of dental disease,” said Bridget Walsh, a senior policy associate at the Schuyler Center for Analysis and Advocacy in Albany. Some parents, she said, mistakenly believe that a child’s baby teeth do not need to be taken care of because eventually they’ll fall out. But children with poor baby teeth are likely to have poor secondary teeth.
“It’s really sad when you hear stories of kids who need to have all their teeth pulled out,” Walsh said.
A 2011 report on the state of children’s dental health gave New York a B, an improvement from a C grade. The report, which was put together by the Pew Center on the States, found that the percentage of low-income children receiving dental services in New York has steadily increased, from 27.3 percent in 2000, to 38.4 percent in 2009.
“New York is well ahead of other states, but there are still a lot of improvements that can be done,” said Mark Feldman, executive director of the New York State Dental Association.
The report notes that tens of millions of children in the U.S. have dental coverage either through private insurance or a public program, but that, “unfortunately, for many kids, this does not translate into actual care. In 2009, for example, only 12.9 million (44 percent) of the more than 29 million Medicaid-enrolled children received any dental services.” The report adds, “Research shows that kids who do not receive needed dental care miss a significant number of school days, use expensive emergency room services more often and face worsened job prospects as adults compared with their peers who do receive care.”
At Ellis, the hospital’s dental program is trying to educate patients about the importance of preventive care, such as regular cleanings. Many of these people are in pain when they arrive and need immediate help. Andriano said that the dental program’s phones open at 8:30 a.m., and that by 9:30 all of the emergency appointments are filled. The hospital sees about 275 dental patients each week.
“People are coming in with teeth so blown out and painful that they can’t take it anymore,” Andriano said.
In New York, children can receive dental care if they are on Medicaid or Child Health Plus.
But experts say that there is a shortage of dentists, and that this shortage is felt more acutely in rural and inner city areas. And many providers, they said, refuse to see Medicaid patients because the reimbursement rate is lower than that of private insurance and because demand for services so high, there’s no reason to accept lower-paying patients.
Kevin Jobin-Davis, executive director of the Healthy Capital District Initiative, estimated that less than 3 percent of dental providers in the Capital Region accept Medicaid.
“There are so few dentists in relation to demand,” Jobin-Davis said. “It’s much worse for Medicaid folks.” He described the new oral surgery clinic at Ellis as one of the “biggest new opportunities” for improving dental access in the Capital Region that he’d seen in a long time.
Feldman said the real problem is not a lack of dentists, but rather the distribution of them. The state has plenty of providers, he said, but they tend to set up practice in more affluent areas. He noted that many dentists graduate with more than $100,000 in debt, and that serving a low-income population makes it more difficult to repay student loans. “Many dentists who practice in under-served areas can barely cover their costs,” he said.
But Feldman said that the state is taking steps to address the issue.
Gov. Andrew Cuomo’s budget for 2012-2013 would expand the state’s Doctors Across New York loan repayment program to include dentists and hygienists. The goal of the program is to get young primary care physicians to move to under-served areas by providing up to $150,000 in loan repayment in exchange for a five-year service obligation.
Hometown Health Centers in Schenectady provides general dentistry and services such as pediatric root canals, crowns, dentures and fillings, to low-income patients. A visit costs $40, and patients can pay for services on a sliding fee schedule or installment plan, which can make the more expensive procedures easier to afford. For example, if a service costs $500, a patient could pay for it in five installments.
“We do a lot of full mouth extractions,” said Justin Hurlbut, the dental director at Hometown Health.
Hurlbut said that 65 percent of his patients are on Medicaid, and that the dental services the clinic provides run the gamut. “We see some people who are very regular, who come in every six months for cleanings,” he said. “They keep up with their teeth pretty well. We see some who just got Medicaid and need something taken care of. We see a very low dental IQ population. We see people who only come when something hurts them. We see children with severe dental decay. We’ve seen people in their 20s getting all of their teeth pulled out. We see people who most likely don’t own a toothbrush.”
To educate children about the need to take care of their teeth, Hometown Health sends teams of hygienists and hygienists assistants into schools in Schenectady County to do screenings and cleanings and provide fluoride and sealants, thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth to protect them from tooth decay. This program is expanding, thanks to a grant from the New York State Health Department, from two teams to three.
“If we can get the kids started when they’re young, if we can teach them to take care of their teeth now, they’re not going to have some of these problems later on,” said Hurlbut, who is a dentist. “Kids are the ones, unfortunately, who bear the brunt of some adult mistakes.”
‘Seal a smile’
The Healthy Capital District Initiative helps low-income Capital Region residents obtain health care, often by enrolling them in free or low-cost insurance. The organization also runs a program, called Seal a Smile, that provides about 3,200 schoolchildren in Albany and Troy with dental screenings, cleanings, fluoride and sealants, and tries to educate parents about the importance of taking care of one’s teeth. Launched in 2005, Seal a Smile targets low-income youth, providing services in schools where at least 35 percent of the population participates in the federal school lunch program.
Jobin-Davis said that dental care has always been treated as a separate area of health care, which contributes to access problems. The vast majority of adults with dental insurance receive it through their employer, but many employers have dropped this benefit as insurance costs have continued to grow.
“Since dental health coverage is carved out of health coverage in general, adult oral health is a big problem,” Jobin-Davis said. “There’s a real gap in the insurance market when it comes to oral health care for adults.”
Jobin-Davis said that he and other health advocates would like to see dental care considered part of primary care, and that research has established that dental health is connected to a person’s overall health.
“I don’t know why your eyes, your mind, your teeth and your feet are all separate areas of health care,” he said. “Until dental care is considered a necessary part of health care, just like any other part of your body, it will continue to be a problem for consumers.”
“We’ve got to find ways to get people to think of dentistry as a public health issue,” she said.
One of New York’s Healthy People 2010 objectives was to reduce the percentage of adults over the age of 65 who have lost all of their teeth to 20 percent. According to DOH, the state has met this goal, as only about 17 percent of New York’s seniors had lost all their permanent teeth.
The state has been less successful at meeting another of its Healthy People 2010 goals: reducing the percentage of third grade children with tooth decay to 42 percent. Right now, approximately 53 percent of the state’s third-grade children have experienced tooth decay. “Furthermore, the disparity between higher and lower income children are noticeable,” the state notes in a summary of progress.
Healthy People 2010 was a set of health goals established in 2000 in areas such as obesity, tobacco use and mental health.
Ellis’ dental program is part of the hospital’s “medical home,” which opened in 2009 with the goal of providing comprehensive primary care services, making the health care system easier to navigate and diverting people from the emergency room and connecting them with doctors and specialists. The medical home is open to everyone, but the focus is on helping the poor.
Kellie Valenti, vice president of strategic planning and program development at Ellis, said that the medical home emphasizes comprehensive care and wellness, and that it makes sense to include dental care.
The new oral surgery clinic will be run in partnership with Saratoga County Oral & Maxillofacial Surgery Associates, PLLC.