State, citizens can’t treat dental care as a luxury

HEALTH POLICY: Michigan can’t continue to rely on an oral health policy built on charitable contributions from private dentists, argues Norm Palm. (courtesy photo/used under Creative Commons license)

Any serious effort to provide dental care to underserved people in Michigan must better incorporate private practice dentists in the plan.

A new survey released by the Michigan Dental Association provides ample evidence of that. Nine out of 10 dentists surveyed said their dental practices donate an average of about $62,000 each in care to disadvantaged adults and children annually. Most of the free or discounted care was for more costly restorative services such as crowns and fillings, which are needed when people wait too long to see a dentist.

But a dental safety net based on charity care is ultimately unsustainable. At some point, the underfunded Medicaid system must be addressed.

Norm Palm is a Grand Rapids oral surgeon and president of the Michigan Dental Association.

And there’s good reason to do so: Providing timely, appropriate dental treatment saves money and alleviates human suffering. Oral health is vital to overall health. Yet the American Dental Association calls oral disease “a silent epidemic affecting our most vulnerable citizens – children, the elderly, people with special needs, and adults who lack access to affordable dental care” – even though it almost entirely preventable. It costs us dearly to treat dental disease that could have been easily prevented or addressed but instead has been allowed to progress to chronic infection, lost gum and bone tissue, and tooth removal.

We have established nearly 50 community dental clinics in Michigan in the last 10 years, and we have an Oral Health Plan within the Michigan Department of Community Health. However, Michigan lacks a coordinated system that is adequately funded to serve our most vulnerable citizens.

Michigan already has a nationally recognized model for providing care to children in Medicaid-eligible families, the Healthy Kids Dental program. Gov. Rick Snyder wisely wants to expand the program, which currently reaches children in 75 of Michigan’s 83 counties. The program reimburses dentists at rates similar to those of private insurance. Eighty-one percent of dentists participate in Healthy Kids Dental, but less than a quarter participate in Medicaid, which fails to even cover costs.

The Michigan Legislature also has wisely voted to continue providing Medicaid adult dental benefits. That’s a money-saving move because otherwise adults end up in expensive hospital emergency rooms where only their pain can be treated. They still have to see a dentist for their dental problems.

The South Carolina Dental Association in 2011 outlined how costly that is for taxpayers. The cost to Medicaid of treating an abscessed tooth in the emergency room was $236, but that only covered antibiotics and pain medication, so recurrence was likely. In contrast, the cost to Medicaid for treating an abscessed tooth in the dental office was just $107.23, including extraction of the tooth, which solved the underlying problem.

Michigan’s dentists want to be part of the broad, comprehensive effort – involving government as well as the private and charitable sectors – needed to ensure all Michigan residents get the dental care they deserve.

Consider the Calhoun County Community Dental Access Initiative, started in 2007 when members of the local dental community realized that only by joining together could they address the dental needs of 68,000 disadvantaged people. The initiative requires low-income patients to provide community service in exchange for oral health education and dental care. The return on investment is impressive. It costs about $117,000 annually to fund the initiative, but the value of the services donated by dentists and patients totals nearly $600,000.

There are various pieces to the access puzzle that are unique for each underserved person seeking dental care. What’s needed now is a concerted effort to coordinate and fund them.