IN MARYLAND, poor children have a critical health-care problem with dental cavities and lack of access to dental care.
Oral health is inseparable from overall health. Every day in Maryland, the lack of oral health care results in severe pain, impaired eating ability, speech difficulties and problems associated with chronic infection.
It has an adverse impact on social and financial well-being because of poor appearance and the inability to concentrate because of suffering and pain.
There is evidence that schoolchildren with dental pain have increased numbers of missed school days and have a reduced capacity to succeed academically.
A 1994 survey in Maryland of 3,500 school-age children found that 60 percent of these kids had decayed, missing or filled teeth, compared with 45 percent nationally. Even more alarming was the finding that 70 percent of poor children had untreated decay, compared with 45 percent for those with private insurance.
Additionally, a just-completed study of Maryland's Head Start children (ages 3 to 5) found that 53 percent of them had dental decay. Of these children, 15 percent complained of tooth pain and 9 percent have cried because of a toothache.
This extraordinarily poor level of oral health for Maryland children is due, in large part, to a long history of underfunding for dental services under the Maryland Medical Assistance program.
In the mid-1990s, the dental care portion of the overall Medicaid budget under the previous state-operated, fee-for-service program represented only one-quarter of 1 percent of the budget of more than $1 billion.
Federal regulations require at least one dental visit a year for children receiving medical assistance. Because of the lack of funding for dental services for so long, only about 19 percent of poor Maryland children are receiving dental services.
Solutions
At an "Oral Health Care for Maryland Kids Summit" Sept. 22, advocates from around the state recommended the following:
Ensuring that proposed increases in funding for dental services in Maryland's Health Choice program result in realistic reimbursement rates to cover the costs of the dental services provided to poor children.
Expanding community and school-based dental clinics to include dental services.
Finding ways of attracting dentists for the Health Choice program and retaining them.
