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Orlando Sentinel
November 10, 2002
Poor kids' dental care nothing to smile about
By David Damron
Sentinel Staff Writer
Nov. 10--Three-year-old Raul Rodriguez clutches
the wall, smiling warily as older kids bounce surgical-glove balloons off
each other's heads in the dentist office.
Bashful, but no easy scare, Raul made his first solo ride in a dentist chair
at the Osceola County Health Department Dental Office that same day last
month -- after just two visits with Mom in tow.
"They have patience with him," Raul's mother, Patricia Rodriguez, 36, said of the office staff. "He likes it. I like everything about this place."
They like everything but the 35-minute drive from Poinciana. Rodriguez's sister knows a great dentist who works closer to home, but he doesn't accept Medicaid patients.
Almost six out of seven of Florida's 10,387 dentists don't.
That leaves poor kids and children of the struggling working class with twice as many cavities as their peers, recent studies show.
At a time when more people than ever are free of cavities -- fluoridated water and hygiene education work -- poor children are still far more likely to hide a smile: The poorest quarter of American school-age children carry 75 percent of all cavities, according to the advocacy group Oral Health America.
Parental neglect -- in any economic class -- is partially to blame, but uninsured and under-insured children suffer most. Untreated, cavities hamper children's growth and learning as they miss school or deal with painful distractions. Dental problems can also tear down a child's self-esteem.
Since the problem mirrors poverty levels, minority children face the worst odds in getting quality dental care, a problem especially acute in Central Florida where Hispanic migration has exploded to 13 percent of the overall local population.
For instance, Mexican-American 5- to 17-year olds are almost four times more likely to have untreated decay in permanent teeth, compared with whites, according to a recent Children's Dental Health Project study.
Black kids are more than twice as likely to suffer the same fate than white peers.
In Central Florida, meeting the dental needs of a growing low-wage service economy is a huge challenge, dentists say. What will help is the opening this week of the new Terra Cotta Orange County dental clinic at Hoffner Avenue and State Road 436, said Maria Demas, the Orange County Health Department's Dental Clinic executive director.
But it will probably just make a dent in the problem, she said.
Waiting lists at county clinics can top two months.
"This is Third World oral health right here in one of the most affluent countries in the world," said dentist J. Michael Allen, who directs the Osceola County dental clinic he helped form. Allen also volunteers in an Orlando homeless dental clinic.
Lack of money is the main culprit behind poor dental care, Allen and others say.
Even many middle-class Americans can't afford dental insurance. Roughly 23 million American children, or about a third, now go without it, according to a 2001 Grantmakers in Health study.
So, typically the working poor rely on Medicaid, the federal medical program that reimburses dentists and allows patients to secure free care.
Frustrated dentists
Historically, Medicaid has repaid dentists at rates that often amount to 10 to 30 cents on the dollar of what they normally might charge. Recent cuts in Medicaid have made it even harder to provide services, many dentists say.
"The biggest problem is that they [the Medicaid program] don't pay a damn," said Oscar Sistrunk, a 73-year-old dentist who still devotes 10 percent of his regular practice hours to Medicaid patients.
For instance, Sistrunk charges about $90 at his Winter Park practice to examine and clean the teeth of a child. But Medicaid reimburses him $28 to provide the same service to a poor child.
"Medicaid patients looking for care in Orange County are going to be pretty stressed to find it," Sistrunk said.
Budget cuts reduced care
Since July, because of Medicaid budget cuts pushed by Florida's Republican-led Legislature and Gov. Jeb Bush, adults older than 21 in Florida can't get anything but emergency dental care. All other adult dental Medicaid programs were eliminated.
Even those younger than 21 on Medicaid took a hit this year. The $81 million spent in state and federal funds on dental care in fiscal year 2001 has been trimmed by $19 million, amounting to a nearly 25 percent hit, according to the state Agency for Health Care Administration figures.
With so few dentists taking Medicaid patients, parents have to hunt for providers, deal with long waiting lists, or make long trips across town to get children's care. Some give up or don't even try.
There were 1,512,874 children eligible for Medicaid dental care in Florida in fiscal 2002, but only 18 percent received it, state records show.
That's down slightly from 19 percent the year before.
"The system is not working," said Frank Rosario, 48, a pest-control worker who moved to Central Florida from the Netherlands, which has higher taxes but a much stronger state medical safety net.
Rosario and his wife make too much money in Florida to qualify for Medicaid for themselves, but they can't afford to buy health care or dental insurance. And although their children qualify for federal aid, state officials recently informed them that they may no longer.
So the Rosario children probably will shift to a state aid plan, Florida Kidcare. That means they also will have to switch to a new dentist, Rosario fears, one that may not allow him in the same room while his children are being treated, as the Osceola County dental clinic he goes to does now.
"I can bounce from one dentist to another," Rosario said. "But for my children, it's harder."
Mobile clinics can help
Area dentists argue that to improve dental care for poor children, more free mobile dental clinics, as Orange County has, are needed. For more than five years Orange's mobile clinic has traveled to schools that have large numbers of uninsured or under-insured children. This relieves the travel problems that many parents face.
Kissimmee dentist Denise T. Orlando is convinced that aid programs should pay for more sealant procedures to be performed on children. Widespread use of the teeth-coating procedure would mean less decay, costs and pain later in life, she said.
Too much soda, candy
Other experts point to broadly improving hygiene education, especially in schools. Keeping soda and candy machines off school campuses would help, too, dentists say.
Updating or adding fluoridation systems in municipal water supplies -- as Orange County did in recent years -- would help more than 100 million Americans, according to a National Center for Education in Maternal and Child Health.
Until all those changes are made, though, county health departments and a handful of private dentists are going to struggle to provide enough care.
"We will have no problem filling chairs," Orange executive director Demas said of the county's free dental clinics.