What you can do about the longest local dental care waits for the poorest children

What you can do about the longest local dental care waits for the poorest children

Sacramento : CA : USA | Feb 12, 2012 at 6:39 PM PST
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Why does Sacramento have the worse dental care rate in California for kids on Medi-Cal, according to reports and interviews mentioned in the February 12, 2012 Sacramento Bee article by Jocelyn Wiener and Phillip Reese, "Model' dental program proves painful for kids"? Also check out the Sacramento Bee articles, "Children forced to wait months for county dental care," and "Autistic boy has dental surgery after suffering for years."

If you'd like to check out more research and statistics, the information in the Sacramento Bee article also came from a partnership between the Sacramento Bee and the California HealthCare Foundation Center for Health Reporting, an independent news organization devoted to reporting about health care issues. You also can check out data on dental care in California from the University of Southern California's Annenberg School for Communication & Journalism, and the nonprofit, nonpartisan California HealthCare Foundation.

How many people does it take to get changes? How many kids fall into the cracks of having to wait months or even years to get their teeth fixed or extracted if they're on Medi-Cal or otherwise have families not able to pay for dental care in Sacramento?

The problem now focuses on two views: the critics and those who are not criticizing the system as it stands. But nearly 20 years ago Sacramento County became the state's testing ground for a new model of dental care for the poorest children.

Is this managed care system working? And how does it stand up against fee-for-service dental care when state data show that the county has consistently produced one of California's worst records for care?

Critics – including local dentists, county officials, school nurses and family members – contend that Sacramento's special model of care forces many children to wait months or even years before receiving needed treatment, even if they have broken or rotting teeth, or are in so much pain that they can't chew. What would you do when your child has a dental emergency and no one can help you when you want to stop the pain with something other than painkillers or only antibiotics--such as taking out the infected tooth?

The Sacramento Bee article cites examples of children who had to wait long periods of time to see a dentist and get their dental problems treated. But is there a nutritional solution to preventing some of the dental problems? And once the pain starts, who will provide children with dental care to fix the problem and stop the pain?

Poor people with no insurance who are on Medi-Cal aren't likely to get permanent bridges made with gold inside of tooth-colored crowns or implants or false teeth or extractions or root canals when they need them and are in pain. Or can they get their teeth fixed without waiting months or years for help? Is there a solution? Maybe it's time to look for help and check out sites that accept Medi-Cal dental and medical patients, such as The Effort Dental Care.

Why should kids have to wait months or years before getting their teeth fixed while their parents beg dental offices to pull out the bad tooth or teeth or otherwise fix severe decay? The article reports on a 4-year old with finally had 20 root canals done on his baby teeth.

Check out the article to see all the examples cited. One one hand, you have the state was paying dental plans a monthly fee to treat the children. On the other hand, between 2010 and 2011, only 30.6 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office.

Now, if you read the Sacramento Bee article, you can find excellent examples of the issue from the side of the parents, children, dentists, county, and the state. What the problem is is that plans are paid a monthly fee to the dentist, right now about $12 for each Medi-Cal kid assigned to each dentist.

Ask yourself why that amount paid is the same whether or not the child sees a dentist? And the main complaint of parents is that their children aren't being seen. So what will it bee for Sacramento, the managed care model which is what Sacramento has now? Or the fee-for-service model in cities outside of Sacramento, elsewhere in California, where dentists bill the state for each Medi-Cal visit from a patient.

Under managed care, kids in Sacramento are supposed to be guaranteed a provider. But the state doesn't promise any guarantee under the fee-for service program in other California cities outside of Sacramento. With a lot of paperwork, you have numerous Sacramento dentists who don't even take Medi-Cal patients. Dentists complain about low reimbursement rates and delays before getting paid.

Some Sacramento dentists even make patients pay upfront and have their insurance companies reimburse them for what they're allowed weeks later. Some insurance companies have a yearly maximum of what they'll pay for dental work. And some only pay a fraction of what the dentist charges for specific work. So if you're not insured, you either pay out of pocket or if you're qualified by income and poor, you apply for Medi-Cal.

Not many dentists will perform procedures on Medi-Cal patients. Some are told they have to have their teeth extracted rather than have root canal or a procedure other than a filling. It varies by dentists. But why has Sacramento been the experiment for so many years?

Are thre problems with managed care? Or are the poorest of parents not being told how to keep their kids from having so much tooth decay from sensitivity to grains, sugar, falling asleep with a bottle of milk or juice in their mouth, and starchy fillers. Some mothers still practice putting sugar and water in baby bottles to lull their babies into sleep.

Did dental care for the poorest children become worse when managed care came to Sacramento? You can check out studies from the Sacramento Community Services Planning Council. Read the 2010 report raising concerns about dental care for poor children in the county titled "[PDF] Sacramento Children Deserve Better.

Families have too many obstacles if they complain. Try getting dental appointments and care when you have to sit for hours only to be told your child can't be examined. Do you need to switch health plans?

What if your child's teeth (or your teeth) are infected and painful? Your first step is to find out what plan to choose. If your child has special needs, how long will you wait under which health plan before seeing a specialist? Are you willing to wait more than a year? What happens when the pain makes it impossible for you to wait that long?

What happens when referrals expire before you can get a new appointment? Kids in Sacramento and families should not have to have these kind of complaints about waiting or instances of no records of children's visits when they are not seen but instead simply kept waiting in an outside office time after time with no records on them in any given dental office.

Sometimes parents are not complaining to their dental plans (or medical plans in the case of doctors). What happens when you need an emergency appointment but are told nothing is available for months ahead?

Who do you go to when you're in pain or your child is in pain? Sometimes a dentist will give you pain killers and/or antibiotics. But why do you have to wait months to get a painful tooth extracted or have other work done on it? If your child is in constant pain, wouldn't you want to have the tooth taken out or fixed without waiting months taking pain killers and anti-biotics for an infection such as an abscess?

People may not realize that when a nerve dies in a tooth, the tooth pulls away from the body to get rid of it, and a painful abscess forms. The tooth needs to be taken out or a root canal given. Nobody should be left waiting in pain and just handed some pain killers. There is too much confusion in Sacramento when someone doesn't have what it takes to have a painful tooth pulled out.

Some people can't afford the price of a root canal. So to extract a tooth, the price is cheaper and varies from dentist to dentist. What Sacramento needs are solutions to this problem of dental care for children and their parents when they are poor and are not insured or are on Medi-Cal. You can just hope there will be changes and look forward to it. In the meantime, find out whether your child's teeth respond to grains and sugars with decay.

You could research Medi-Cal Dental Services Division of the California Department of Health Care Services to see what changes are being planned. According to the Sacramento Bee article, the state is in the process of requesting applications for the next round of contracts, which in Sacramento will take effect Jan. 1, 2013.

You have a problem when these dental clinics subcontract with the managed care plans, receiving $3.43 a month per patient. They make up some of the difference with federal funds they receive for being a health center that serves the poor.

One alternative you have is to pay a non-Medi-Cal dentist to take out your child's tooth or do a root canal. Can you afford a crown? Do you have the thousand dollars or more it costs for a root canal and the price of the crown, several hundred dollars more perhaps ranging from $600 to $900 or more? Dental care is expensive for the uninsured. Without a job, how will you afford dental care for your family without insurance?

And why would a dentist do a root canal and not a provide a crown at the same time? It happens. Also what happens is a dental office not referring a kid to a specialist to extract the tooth. You'd think any dental office is qualified to extract a tooth.

After a root canal goes wrong, the tooth breaks, or it gets infected with inflammatory points, if you can't pay to fix it, the tooth gets pulled. However, many times it's a complicated extraction if the tooth is brittle and breaks in pieces. For parents who are not told how to navigate the system, it's stressful not knowing what to do or where to go.

Dental offices treat thousands of children, and when they accept Medi-Cal patients, the number of kids on Medi-Cal can be in the thousands. You need to find a clinic that does do root canals and crowns which are covered by Medi-Cal.

You need to find out where you can get a referral to a specialist who does that type of dental work for Medi-Cal patients, for example, getting a painful broken tooth pulled. For example, check out The Effort since its website notes that they accept Medi-Cal patients for dental care as well as medical care.

For dental care see the site, The Effort Dental Care. For medical care, click on the appointments and eligibility site for The Effort Appointments and Eligibililty. You are supposed to get dental services when you have dental problems. Perhaps The Effort can help you.

The Effort is committed to providing optimal oral health for infants, children, adolescents, adults, and patients with special healthcare needs. It is essential that dental care begins at a very early age in order to provide children with the best possible opportunity for a healthy, beautiful smile that will last a lifetime.

Untreated tooth decay can cause pain and infection that can lead to problems with eating, speaking, and learning. Dental decay is an infectious disease and can be prevented with proper hygiene, nutrition, preventive treatment and anticipatory guidance.

The dental team at The Effort consists of dedicated professionals specially trained in serving infants, children, and adolescents of all ages, according to its website. Its goal is to offer high quality dental care in a fun and pleasant child/youth friendly environment in order to create a positive experience for your infant, child, or teenager. Also see the sites, Oak Park Community Health Center, North Highlands Multi-Service Center, and South Valley Community Health Center – coming soon.

Can you prevent tooth decay with nutritional changes?

When a nerve in a tooth dies an abscess soon forms and the tooth either needs to be pulled out or a root canal performed to get rid of the pain. But what about common tooth decay, can it be prevented by a diet different that the high-sugar, high-grain, high-starch diet so many children and adults have? Is there a nutrition-based way to help prevent tooth decay? The key is to improve your immune system but not so much as to create an auto-immune issue.

An abscess in a tooth doesn't always happen just when there's decay. They may also occur in people with underlying medical conditions such as autoimmune disorders (Sjögren's syndrome and similar conditions) or conditions that weaken the immune system (diabetes, post-radiation/chemotherapy cancer care). Dental abscesses can also be triggered by minor trauma in the oral cavity.

So if the nerve dies, an abscess forms, even when you have a crown on that tooth and you have no decay and took good care of the tooth for decades with flossing, brushing, and regular check-ups. It could be about your immune system that also may change with aging.

Are you taken anything that weakens your immune system? Are you sensitive to gluten in any supplement or gluten in your foods that could cause a weakening of your immune system as you age?

What a health trend for Sacramento dentists and their patients in need of care. Business for Sacramento and other California dentists dropped by as much as 25 to 30 percent in the past three years. What will happen in the future when new dental graduates seeking a job in Sacramento can't find work because the older dentists are not retiring because they can't afford to, having lost much of their retirement income in the economic downturn? More people can't pay for treatment in Sacramento because they're out of work, lack insurance, or are students.

Due to the jobless rate, many people are delaying going to the dentist unless they're in pain or have a serious gum disease. Many are turning to various dental self-sufficiency websites, and those without insurance insist on getting cleanings without getting x-rays, which add a few more hundred dollars to an average bill for cleaning of $135-$150.

If you don't have a steady job or insurance or are a student, you're not going to be able to afford a crown, root canal, or other work that totals two or three thousand dollars or about a thousand dollars or more per crown with many dentists.

What people want are holistic minimally-invasive dentists who will tell them how to avoid having to go frequently to the dentist and diets that promise to heal small cavities before they grow bigger. But holistic dentists are not easily found in a society of dentists, most whom have never heard of the book, Nutrition and Physical Degeneration by dentist, Weston A. Price, DDS, who wrote in the 1930s.

Worse yet are new dentists who are recent graduate who can't find jobs, just like all those pharmacists who also can't find jobs. There are too many dentists and not enough jobs for them. It's the double-digit unemployment rate in some cities, for example, in California.

Most dental practices are small businesses that are getting drilled by the economy, state budget cuts, and insurance plan increases or other changes. For example, look at Sacramento statistics, where business for dentists dropped by as much as 25 to 30 percent in the past three years.

Dentists battle lost retirement benefits or funds, losses in the stock market for some of their retirement investments, and a delay in retiring, unless they've made enough money to retire on or have invented a dental device that sells widely, such as various types of sports teeth protectors. It's very tough for young dentists to find jobs or move into practice, opening small businesses.

On top of that bite, cuts to Denti-Cal in California for poor people who can't afford dental insurance and the lack of free dental clinics chip away at dentist's income. Once a year Sacramento has free dental and medical services at the Cal Expo and thousands of people are lined up for the free service. Many also may be turned away, and some wait in line for hours or even all night to get the once a year free medical and dental help.

State budget shortfalls add to the woe and the poor economy point to more patients not going to the dentist for routine cleanings. And on top of that, most older people are tired of the frequent x-rays as radiation builds up. It's hard to find a dentist willing to give a cleaning without requiring an x-ray and charging for it up front, hundreds of dollars on top of the fee for cleaning.

Patients are hoping the can find dentists who will just give a yearly cleaning without all the other charges for x-rays if the patient has used dental self-sufficiency techniques to avoid cavities in areas dentists can't see, such as between back molar teeth.

Eight of 10 dentists in California are sole practitioners, according to the California Dental Association. The big bite on dentists in a downturn is their inability to find jobs once out of dental school. They graduate with bills and loans for dental school and have a tough time finding job.

Are there too many dentists and too few jobs? Or are people not able to afford the high cost of routine dental cleanings or other procedures they need?

As a result many people turn to the dental self-sufficiency sites such as Freedom from dental disease, Dental Self-Sufficiency - David Icke's Official Forums, and How to become dentally self-sufficient."

Also see the October 23, 2011 Sacramento Bee article by Anne Gonzales, "Dentists, Patients feel economy's bite - Sacramento Bee." On one hand you have the economy and jobless rate affecting dental practices. And on the other hand you see patients who want more dental self-sufficiency and who may not be able to afford routine dental care and may see a dentist only when they have an emergency, are in pain, or have a broken tooth. Some patients can't afford to get cavities filled, don't know how to heal small cavities, and have poor nutrition.

So when some patients do see dentists, it may be just to have the teeth extracted only to find it difficult to find food other than soups and smoothies because they can't chew the type of food they can afford. What jobless people need are dental plans they can afford or more free clinics that offer quality services when needed.

AnneHart is based in Sacramento, California, United States of America, and is an Anchor on Allvoices.
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  • 'Model' dental program proves painful for kids

      Sacramento Bee
    Model' dental program proves painful for kids Almost two decades ago, the state made Sacramento County the testing ground for a new model of delivering dental care to poor children. Officials envisioned a managed care system that would control costs...



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