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

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.

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.

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Thu, 05/02/2013 - 10:31pm
Why is that the answer always turns to money from the government first rather than starting with what the care could look like, who and how people could get involved, even about how dental care starts with the person whose oral hygiene we want to see improved? Since Michigan has a model for others to follow, why can't we hear about how that model works, what is successful about it, what ideal oral health should be, what Michigan's model isn't addressing, and even open up to asking the public for ideas of how they might see the needs being addressed and how they would like to get engaged. No, all we get from Norman Palm is ways to spend more of other people's money. I learned early in career that a cultural mindset can narrow the view of experts, they can get into a group think. In this case it seems what we are being told is that more treatment is needed, nothing about prevention, and to provide more treatment the professional society wants money. I was taught to start with the desired results rather then start with your solution for most times focusing on the desired results opens up the possiblities of better (more effective, even more efficient) means and methods for achieving those results. The dentists, the whole dental profession has changed and improved the quality and extend of care to an unbelievable level. My dentist and staff keeping telling me about prevention being important to good oral health, Norman Palm only seems to see treatment and money (other people's) as the answer to better oral health. Maybe the creative thinking of many of the minds who have help make successful companies in Michigan could be ask to help apply their knowledge and skills to this issue. For I can assure Norman Palm that different prespectives from well thinking people can instigate creativity that those closest to the problem aren't seeing. It is disappointing that Norman Palm can only see those outside of his profession as sources of money and can see that they maybe sources of ideas or means and methods to help deliver the oral health we all want for the people in Michigan.
Peter Parker
Thu, 10/22/2015 - 12:46pm
Duane, THE simple thing of making good complete TEETH cleanings every 6 months, like $10 from ANY Dentist (paid for by medicaid, care, or their insurance and required to be offered by ALL -- so one Dentist would not get all the low income) would solve a majority of issues as this is the basis of having your teeth for LIFE --- but many, err, most low income cannot fork out $100-$200 for a cleaning twice a year, so guess what -- they forgo them sometimes for decades and seek help when "it hurts" -- by then the tooth is lost (and probably much more by gum disease).... How bout a law making all dentist do this ? Peter Parker
John S.
Wed, 07/10/2019 - 6:08pm

It is easier to find a snowball in hell than an oral surgeon who will take a Medicaid patient. Try navigating the insurance cobweb to learn what a health care plan covers in terms of dental benefits. Then try finding out what insurance an oral surgeon accepts or doesn't accept. A program for the poor is going to be a poor program. Sorry about your teeth, but my teeth are just fine.