Boston to launch battle against dental 'crisis'

Boston Globe

November 11, 1999

City to launch battle against dental 'crisis'

By Dolores Kong
Globe Staff

With a study estimating that the number of untreated cavities among Boston students greatly exceeds the national average, public health officials are about to launch an offensive against what they say is a growing dental crisis in the city.

Other signs of the crisis include a number of infants from Roxbury and Dorchester with baby-bottle tooth decay, frequent calls to the Mayor's Health Line from people looking for dental care, a decline in the number of dentists serving the neediest patients, and the recent closing of a neighborhood dental clinic.

Things have gotten so bad, public health officials and patient advocates plan to hold a community hearing next month on the oral health needs of Greater Boston, to raise awareness among state legislators and the public.

Already city health officials are considering adding new preventive dental care methods, including sealants to reduce cavities, to services available through a new 40-foot public health van that makes regular rounds in Boston.

While Boston's water supply has contained tooth-decay fighting fluoride since 1978, city officials say the scope of the problem reflects gaps in insurance coverage and access to dental-care providers.

''The lack of accessible dental care is a major health crisis for residents of the city,'' said John Auerbach, executive director of the Boston Public Health Commission. ''The problem is a complicated mix of people who are uninsured, people who are underinsured, a lack of providers who are willing to serve people who are on Medicaid, and inadequate reimbursement for health care providers.''

According to statistics cited in the city's latest annual health report, ''The Health of Boston 1999'':

Eighteen percent of children 4 years old and younger who were seen in the pediatric program at Tufts University School of Dental Medicine in 1995 had baby-bottle tooth decay, a painful condition that arises when a baby is given a bottle of juice or milk at bedtime. Treatment can cost up to $4,000 per child.

About 90 percent of 107 Boston high school students were found to need dental treatment, according to a 1996 unpublished study. That report also estimated that the city's students had four times more untreated cavities than the national average, although there were no details about whether that might be a result of differences in demographics, insurance coverage, or availability of dentists.

Dental care was the second most requested specific health service on the Mayor's Health Line, behind primary care, between 1995 and 1998. (Outpacing requests for specific health services like primary and dental care, however, were the phone calls from people seeking general health insurance coverage.)

Homeless children in Boston have a much higher rate of untreated tooth decay in permanent teeth than the New England average - nearly eight times higher, according to a 1994 survey of 114 homeless children, age 3 months to 17 years old.

In 1997, a screening of 88 elementary school students in Dorchester found that 44 percent had obvious tooth decay and 11 percent had gum disease. ''These are second-graders,'' said Emily Feinberg, a nurse practitioner at Dorchester House who coordinated the screening.

While many of these children had dental coverage through Medicaid, they may have been unable to find a provider who would take the insurance or get a timely appointment, she said. There is no school requirement for annual dental screenings and there are no dental clinics at Boston schools, according to Feinberg.

Despite this crisis, the number of dental-care providers serving the neediest in Boston and around the state is shrinking.

Just this summer, a Jamaica Plain dental clinic that served 3,000 patients a year closed as a result of too-low insurance reimbursement rates. The clinic, based at Martha Eliot Health Center, was getting at most 38 cents for every dollar charged.

And out of 4,700 dentists in Massachusetts, fewer than 800 take patients with Medicaid, now known as MassHealth, according to statistics cited by the Massachusetts League of Community Health Centers.

Other states, particularly Connecticut and New York, have begun to combat growing dental problems among young people by putting dental offices inside the schools.

All this evidence, plus testimony from patients, outreach workers, parents and providers, will be presented at a Dec. 7 hearing to address the crisis, beginning at 3 p.m. at Brookside Community Health Center in Jamaica Plain. The hearing is co-sponsored by health centers, the city public health commission, and the Boston-based consumer advocacy group Health Care for All.