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  • Thema von rozenback im Forum USA

    ow reimbursements to dentists from Medicaid make getting dental care difficult for children and adolescents covered by the government health plan, new research suggests.

    Sandra L. Decker, senior service fellow in the division of health care statistics at the U.S. Centers for Disease Control and Prevention, found that in states with the highest Medicaid payments, children were more likely to get dental care, although they received care less often than children with private insurance.

    "This may be partly because a lot of dentists don't participate in the Medicaid program, so they don't treat children with Medicaid," Decker said.

    "In a lot of states, Medicaid dental fees are very low, so a dentist doesn't want to treat a Medicaid patient," she said. "So, low fees affect whether children on Medicaid get care."

    The good news is that in states that raised their Medicaid reimbursements more children were able to find dental care, Decker said. "Some of those children were receiving dental care at the same rate as privately insured children," she noted.

    But this progress may be in danger as states look for ways to cut costs. At a time when state budgets are being slashed, it is likely that reimbursements for dental care won't go up and may even be reduced, she added.

    The report was published in the July 13 issue of the Journal of the American Medical Association.

    Dr. Judy Schaechter, associate chair of pediatrics at the University of Miami Miller School of Medicine, said that "the relationship between type of insurance and visiting a dentist is well established."

    But, "what this paper adds is that it reveals the direct relationship between Medicaid fee and provision of care," she said.

    The reasons connecting fees to access are many, Schaechter said. "Among them are that fewer dentists will accept the lower fees, which hardly cover their costs for cleaning let alone their responsibility when they find severe dental disease," she said.

    A recent study showed that some dentists agree to participate in Medicaid, and then make it difficult for Medicaid patients to see them for dental care, Schaechter added.

    "From the patient perspective, if that happens enough, they think no one will see them. They give up trying to find a Medicaid dentist," she said. "Finally, with little to no financial incentives, neither dentists nor the Medicaid dental insurers are motivated to do sufficient outreach and educate families about coverage and the need to get preventive care at least every six months."

    States are obligated to provide children with the same access and quality of health care through Medicaid as they would get with private insurance, Schaechter said. "We simply can't do that if we are not willing to pay for it."

    For the latest study, Decker used data from the National Health Interview Survey from 2000-2001 on 33,657 children and adolescents, along with data on Medicaid dental fees in 2000 and 2008 in 42 states and the District of Columbia.

    She found that in 23 states, the 2008 Medicaid dental fees were lower than they were in 2000 (after adjusting for inflation). In 19 states and the District of Columbia, Medicaid fees were higher in 2008 than in 2000.

    In Connecticut, Indiana, Montana, New York, Texas and the District of Columbia, Medicaid payments to dentists increased by at least 50% between 2000 and 2008, Decker said.

    Whether a child or adolescent had seen a dentist in the past six months was dependent on the type of insurance they had, Decker found.

    In 2008 and 2009, children on Medicaid were less likely to see a dentist compared with children with private insurance (55% versus 68%, respectively) in the past six-month period. However, both groups were more likely to see a dentist than children without any coverage (27%), the study found.

    As payments for dental care increased, children on Medicaid were more likely to see a dentist, Decker said. For example, a $10 increase in Medicaid payments for a check-up, from $20 to $30 between 2000 and 2008, increased the likelihood that a child would see a dentist by 3.92%.

    More than one-third of children in the United States are covered by public health insurance, primarily Medicaid and the Children's Health Insurance Program. Covering dental care for children and adolescents is required by these programs.

    However, states can set payment rates for dentists, so these rates vary by state. In addition, dentists are not required to see Medicaid patients.

  • Thema von rozenback im Forum USA

    Dr. Fred Smith and dental assistant Kelly Yates prepare to work on Frank Dawson. The Dental Bus is visiting Winston-Salem this week through a sponsorship by Calvary Baptist Church. The bus, which has two dentist chairs, visited Samaritan Ministries on Monday, the Rescue Mission on Tuesday and the Salvation Army on Wednesday.

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    Travis Clark didn't have to go to the dentist this week — the dentist came to him.

    Clark is less than two weeks away from completing a yearlong anti-addiction program at The Rescue Mission.

    He was having some problems with his teeth but didn't have dental insurance or the money to see a private dentist. But he got the services he needed when the Dental Bus and its volunteer dental professionals came to assist residents of The Rescue Mission.

    "They did a great job," said Clark, who had a filling in one tooth and had another tooth extracted. "I was in real bad pain — sometimes it would come and go."

    The bus travels to service agencies across the state with a rotating crew of volunteer dental professionals to provide care to people who otherwise could not afford it. The bus is a ministry of N.C. Baptist Men.

    In 2009, the Dental Bus treated 4,886 patients statewide. The bus — which has two dentists chairs at opposite ends — is visiting Winston-Salem agencies this week through a sponsorship of Calvary Baptist Church. The bus visited Samaritan Ministries on Monday, the Rescue Mission on Tuesday and the Salvation Army on Wednesday.

    There will a different dentist each day. On Tuesday morning, Dr. Fred Smith — a dentist in private practice here who plans to retire next month — was taking care of patients such as Clark.

    Smith said he enjoys working with the people on the bus and likes the ministry aspect of reaching out to people in need.

    "They're people who feel like they don't have a place in this world," he said. "Hopefully this makes them feel valuable as people."

    Dan Parsons, executive director of The Rescue Mission, said people in shelters face barriers to going to the dentist, including a lack of money, lack of transportation and worry over their physical appearance. Some have never been to a dentist. Parsons said the bus eliminates those problems by bringing the free service to the residents.

    The Rescue Mission, at 710 N. Trade St., offers a free dental clinic on the second and fourth Thursdays of each month that is open to anyone who can't afford dental care. Parsons said the clinic does mostly extractions, while the bus offers expanded services, including fillings and cleanings.

    "It's exciting because it's another way we can show God's love to these men," he said. (336) 727-7327

  • Thema von rozenback im Forum USA

    Dr. John Sullivan was recently presented with an industry award for volunteer service.

    He received the "Give Back a Smile Volunteer Service Award" from the American Academy of Cosmetic Dentistry Charitable Foundation.

    The primary focus of the program is to help survivors of domestic violence by providing consultation and dental treatment to restore their smiles and their lives. Sullivan received the award for completing two or more Give Back a Smile cases in the past year.

    Survivors of domestic abuse who have suffered dental injuries are invited to contact Give Back a Smile at 1-800-773-4227 or

    Sullivan, owner of Smiles by Sullivan in Tulare, is president of the American Academy of Cosmetic Dentistry.

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