Put Back The Teeth? Why We Separate Dental And Medical Care

Some patients are concerned by a lack of communication between their dentist and primary care physician. (Herry Lawford/Flickr Creative Commons)

Some patients are concerned by a lack of communication between their dentist and primary care physician. (Herry Lawford/Flickr)

My colleague Stef Kotsonis stops me in the hall at work every few weeks with a new pearl of health care wisdom. Last week, it began with the story of three teeth that had to come out.

“I’m getting implants put in, dental implants,” Kotsonis explains, an index finger pulling back his lower lip. “Two down here, bottom left, and one up here.”

He pauses to grin.

“So when they tell you to chew on the other side, it’s a much more subtle dance than that.” Kotsonis is giggling now. “There’s a foxtrot going on at meal time.”

Paying to fix the problem is no laughing matter.

“Our dental plans are awful compared to our health plans,” Kotsonis says. “I’m paying thousands of dollars for these [implants]. It’s, boy, it’s breaking the family bank.”

Should dental health be treated separately from the rest of the body? (US Army Africa/Flickr Creative Commons)

Should dental health be treated separately from the rest of the body? (U.S. Army Africa/Flickr)

Kotsonis is also worried about the lack of coordination between his primary care physician and dentist.

“My own doctor has no idea what’s going on in my dentist’s office,” Kotsonis says. “She doesn’t know if I’m having implants, she doesn’t know if I’m being given these antibiotics, she doesn’t know if these antibiotics clash with anything else she’s doing. And it just seems to me that this is exactly the sort of thing, in this information age, that should be shared.”

How did this happen, this decision to treat the teeth and gums separate from the rest of the body? There is lots of proof that poor oral health is tied to heart disease, diabetes, HIV and can lead to death. So why, in this era of integrated medicine, do we continue to carve out the teeth? And is anyone trying to put them back?

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Better Dental Care For Kids

Eleven years ago when lawyer Clare D. McGorrian and others filed a class action lawsuit — Health Care For All v. Romney — against the state for providing inadequate dental care for kids on Medicaid, only about one-third of eligible children in Massachusetts were being treated by a dentist. That’s right: only 30 percent.

At a trial in October 2004, parents testified to months-long waits to get dental care for their children. MassHealth dental providers corroborated the parents’ testimony. State officials acknowledged that the program received thousands of complaints each month.

In July 2005, U.S. District Court Judge Rya W. Zobel ruled that the MassHealth dental program violated federal Medicaid law. Judge Zobel wrote that the children encountered “extraordinary difficulty” in obtaining timely dental care.

Now, after five years of court-ordered oversight and sometimes tense negotiations, the dental program is free to function without a guardian. And McGorrian, now in private practice, concludes that the Medicaid dental program is in far better shape than it used to be. For one thing, about half of eligible kids now get dental care.

On the Health Care for All website today, she blogs about the history of the case and its final chapter.

Among the improvements brought about by the legal action, McGorrian cites these as most critical:

First, she says, there is now a Medicaid dental director, Brent Martin, a dentist, leading the program, where previously there was none. “It puts dental on the same equal footing as medical,” McGorrian said.

Second, Medicaid hired a company, Delta Dental, to run the claims process. “I’m not a big privatization person,” she said, “but it became clear that the state couldn’t give priority to dental, and it needed to be addressed by a specialized company.”

Third, reimbursement rates to dentists — which had been low compared to commercial insurers were increased as part of the legal judgement.

Finally, McGorrian said, new dental prevention programs are starting to take hold. For instance, a school-based program that puts sealants on kids teeth is now in place. And MassHealth is now paying pediatricians and nurse practitioners to integrate prevention into primary care for children.

“We haven’t solved the problem yet,” McGorrian said. “But it’s a lot better.”

Dental Misery: MassHealth Cuts Take Toll

Massachusetts led the way toward getting more people covered by health insurance, but recently it took a notable step in the other direction.

As of July 1, about 700,000 poor adults statewide lost their dental coverage through MassHealth, the public health insurance program, as a result of budget cuts. CommonHealth asked Christine Keeves of the advocacy group Health Care For All how the cuts were playing out.

Q:What are you seeing as a result?

A:  Health Care For All has a HelpLine that can answer general insurance questions, tell folks what free and lower-cost programs they may be eligible for, and help them to apply all in quick and easy telephone call. They have experienced a spike in calls now that the cut has been made. Our Helpline counselors have already collected stories from every corner of the state from MassHealth members who are in pain, unable to eat, sleep, or work because of dental pain, and who are getting sicker and sicker while they try to find care.

· A Worcester woman, pregnant and on disability, needs two root canals that she cannot get because the procedure is no longer covered, which is endangering the health of her and her unborn child.

· A Mattapan man who has had 8 extractions cannot get the dentures he needs not only to go on job interviews (which we all know is incredibly important, especially in the current economic climate), but also for such basic functions as eating and speaking.

· Our Helpline counselors are in the process of assisting a Springfield woman who is mentally ill and diabetic. She had to have all of her teeth pulled in June. In light of this cut she is unable to get dentures. Her doctor warns that she will die without the dentures. Continue reading