Must Poor Kids have Bad Teeth?

• Author: Tobler, Laura

For many poor children, a trip to the dentist isn't a source of terror; it's an unknown experience. Although we have programs to care for children's dental needs, they aren't working for the poorest kids.

Toothaches. Just the thought makes even the most stouthearted flinch. The pulsating pain of dental disease sends us running to our dentist for relief and therapy. Now imagine this scenario without the dentist.

"Children are needlessly suffering from preventable dental disease that threatens their growth, early childhood development and their ability to function at home and in school," says Burton Edelstein, a dentist and director of the children's Dental Health Project. He says the amount of tooth decay in a child is inversely related to income.

"Eighty percent of dental disease is found in 25 percent of the poorest children," he says, "and about half of this disease goes untreated." For the most part, he is talking about children who are eligible for Medicaid and the State Children's Health Insurance Programs (SCHIP).

So why are children eligible for public programs missing school, being admitted to emergency rooms and suffering pain because of untreated dental disease? State legislatures are attempting to answer this complex question and create acceptable solutions. In 1999 more than 40 bills were introduced across the country to improve access to oral health services. Seventeen bills were enacted.

Connecticut Representative Vicki Orsini Nardello remembers that "five years ago you could not get a legislative discussion on oral health." She attributes this to our attitude toward dental health. "Because we look at teeth as expendable, we diminish the impact of the pain and the disease," she says. However, research showing the correlation between dental and cardiac diseases in adults, and poor nutrition and growth, low self-esteem, missed school days and other medical complications in children brought this public health issue to the legislative floor in many states.

MEDICAID, SCHIP AND ORAL HEALTH

Federal law entitles all children enrolled in Medicaid to comprehensive dental services. Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, the nation's primary source of well child care for low-income youths through age 20, must provide dental examinations and necessary treatment or services to correct or ameliorate defects.

Children who do not qualify for Medicaid because of their parents' income may be eligible...