Louisiana’s Children in Crisis: Too Few Louisiana Children Receive Necessary Dental Care

A few years ago, a bowl of seafood gumbo did me in! I cracked a tooth all the way into the root on a piece of sand hidden in the gumbo. The tooth required a root canal.

Because of an allergy to local anesthetics a dentist referred me to an allergist. The soonest the allergist could see me was in two weeks. My jaw ached the entire time. The morning after the allergist determined septocaine is a safe anesthetic for me, an endodontist performed the root canal.

You may not believe this next statement. That root canal was the most relaxing experience of my life!

After a dozen shots of septocaine, I felt good again. The relief felt life changing! The procedure itself was simple and afterwards my pain was gone.

Pain Interferes With Life

During those two long weeks, I learned how very distressing and distracting tooth pain can be. Pain makes it difficult to pay attention to details. Pain interrupts sleep. Experiencing unrelieved pain makes one grumpy and it changes a person’s responses to others.

While it is difficult for adults to be pleasant when we feel persistent pain, it is even more difficult for children. Pain makes it impossible for children to pay attention in school. It interferes with self-control. It prevents a child from giving attention to teachers. Pain causes stress, impacts appetite (especially tooth pain), and interferes with childhood joy. Chronic pain destroys health.

Too Many of Louisiana’s Poorest Children Receive No Dental Care

Memories of my cracked tooth returned recently as I read a report by The United States Office of the Inspector General (OIG). According to the OIG report, 26% of Louisiana’s poorest children received NO dental services during the year of the OIG’s review. 55% received only some required dental care. According to the OIG, only 19% (less than 1 out of 5) of Louisiana’s children whose medical care is covered by Medicaid received all their required dental care.

(These numbers appear to hold true for foster children, too. All of our children in our children’s homes receive a dental exam after admission. Without telling her of the OIG report, I asked our Director of Nursing at Louisiana Methodist Children’s Home in Ruston how many children go to their admission dental exam and learn they require corrective care for cavities, extractions, etc. She replied, “about 80%”.)

The implications of the OIG report stun me. While the funds for these services are available, the majority of Louisiana’s poorest children are not receiving sufficient dental care!

According to the OIG report, “Medicaid provides dental services to children through the Early and Periodic Screening, Diagnostic, and Treatment program. Under this program, States are required to cover all medically necessary dental services and these services must be provided at the intervals specified in States’ pediatric dental periodicity schedules.”

States are expected to monitor the Medicaid-funded dental care children receive. However, according to the OIG investigation, Louisiana “reported that they do not routinely track whether children are receiving all the required services.”

We all know Louisiana has numerous barriers to child well-being. Just as there are reasons Louisiana ranks only 49th in the nation for child well-being, there are reasons Louisiana’s children are not receiving dental care.

Among those reasons are the rural nature our state which creates access and transportation problems. Some Louisiana children live in communities with no dental services. Region-wide public transportation is typically unavailable. Louisiana also has too few dentists who are willing to provide Medicaid-funded services because of the low reimbursement rates compared to commercial insurance.

Barriers to Dental Care Are Not Insurmountable

That there are barriers to sufficient dental care does not mean these barriers are excuses! That other poor, Southern states ensure their children receive dental care means Louisiana can, too. Ranked at 49th for child well-being, we can learn what other states are doing to care for children.

Mobile dentistry as broadly implemented in other states is one way around access barriers. Providing dental services in public schools is another. (My friend Mr. James Wagley, LCSW, and former Supervisor of Student Support Services for Sabine Parish Schools, once told me school buses are the best public transportation system available for child welfare. “Every day they bring children to the same place. Every day.”)

Requiring mandatory dental screenings in public schools would quickly identify children who have unmet dental needs. Broadening the scope of practice for dental hygienists – as other states have done – would allow them to conduct these dental screenings in schools. Several years of statewide, preventive dental care provided in schools may do more to improve Louisiana’s education system than anyone can imagine!

Summary

Louisiana is failing to monitor the federally required dental services for our state’s poorest children. Only 19% of children whose care is funded by Medicaid receive adequate dental care. While there are barriers to routine dental care, we know they are not insurmountable because other states provide sound dental care to children.

Louisiana’s children are in crisis. This OIG report documents another example of how we are failing our children today and, consequently, crippling our state’s future.

Rick Wheat
President and Chief Executive Officer
Louisiana United Methodist Children and Family Services

Learn more by reading: Most Children with Medicaid in Four States Are Not Receiving Required Dental Services, January 2016, OEI-02-14-00490, by Suzanne Murrin, Deputy Inspector General for Evaluation and Inspections, Department of Health and Human Services https://oig.hhs.gov/oei/reports/oei-02-14-00490.pdf