The state needs to spend about $40 million over the next two years to increase reimbursement rates to dentists who serve poor and uninsured children, according to a committee convened after a Prince George's County boy died this year of an untreated tooth infection.
It is the hope of the Dental Action Committee that a boost in reimbursement -- the state pays $9 for dental sealants, which cost dentists about $40 -- will encourage more dentists to participate in the state's Medicaid program, a federal-state initiative that covers health-care costs for low-income families with children, and other disadvantaged people.
The death of 12-year-old Deamonte Driver this year highlighted the state's lack of Medicaid dentists. His mother said she was unable to find a Medicaid dentist who could see him before an untreated tooth infection spread to his brain. The boy died Feb. 25.
The committee is expected to deliver its report to state Health Secretary John M. Colmers on Sept. 11. It will also recommend that pediatricians and nurses be allowed to give children fluoride varnishes, a step that significantly reduces the risk of cavities.
Even so, some dentists oppose the recommendation, in part because they say medical professionals lack the education to explain the purpose of the varnish, which is not a 100 percent guarantee against dental disease. Dentists say they would prefer to delay the action until after doctors and nurses receive some background in the procedure.
"Our major goal should be to start with education," said committee member Dr. Hakan O. Koymen, a pediatric dentist with Chesapeake Pediatric Dental Group in Perry Hall in Baltimore County.
The Maryland State Dental Association also objects to the recommendation, said Dr. Garner D. Morgan, the president-elect of the group and another member of the committee.
Nevertheless, a majority of committee members voted to uphold the recommendation -- as well as the large increase in reimbursement rates -- at a meeting in Baltimore this week.
While not all members agreed on the method, they were unanimous in their desire to improve dental care for uninsured children, they said.
Recommendations, which will require action by the state health department for implementation, include:
Development of a unified oral health message for use throughout the state to educate parents and caregivers of young children about oral health and the prevention of oral disease.
Incorporation of dental screenings with vision and hearing screenings for public school children or a requirement that children have such exams before they enter school.
Creation of a "dental home" or primary dental care provider for children in the state's Medicaid program to ensure regular check-ups.
It was Deamonte's death that forced Maryland officials to take a closer look at dental care for the poor. The tragedy laid bare problems with the state's Medicaid system, which can be difficult to navigate and has one of the worst reimbursement rates in the nation for basic dental procedures, according to a 2004 survey by the American Dental Association. Fewer than one in three children in the Medicaid program received dental service in 2005, the state reported.
Such facts startled many elected officials, some of whom have taken legislative action. U.S. Rep. Elijah E. Cummings, a Maryland Democrat, introduced "Deamonte's Law," which would increase dental services in community health centers and train more pediatric dentists. He has also worked to increase dental services through the Children's Health Insurance Program. That program was recently approved for reauthorization but is now under threat of veto by President Bush.