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Dental Care – A Function of Economic Class?

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Dental Care – A Function of Economic Class?

Dental Care – A Function of Economic Class?

October 24, 2005
By: Jean Johnson for Dental1

The eight-year-old girl has on white anklets and a black pair of Mary Jane’s buckled just so. The photograph from the Portland Oregonian only shows Rubi Reyes’s feet resting on a dental chair while she waits for her first exam. Indeed, what readers don’t see is what the article highlights – the young girl’s teeth. Instead it’s the headline that alerts: “Root of dental disparity – decay and infection are rising for Oregon youths in families without insurance in an era when many kids escape toothaches.”
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Start your child on the path to good dental health:

Your child should have a dental check up at least twice per year.

Some children require more frequent visits due to tooth decay risk or poor oral hygiene.

Encourage your child to brush twice a day and floss once per day.

Do not allow your child to snack frequently between meals.

Talk to your child’s dentist about fluoride to ensure your child is receiving the proper amount from drinking water, fluoride products or supplements.

To encourage your child to brush, print out a chart they can color in to keep track of their brushing and flossing: Timmy the Tooth and Ms. Floss Brushing Adventure!

Statistics indicate that oral health in the U.S. has improved over the last half-century. In August 2005 the Centers for Disease Control and Prevention (CDC) reported the number of children that have never had a cavity has increased over the past 10 years. Still the U.S. Surgeon General's Report on the Oral Health of the Nation from 2000 described a significant dental disparity gap. “There is a ‘silent epidemic’ of oral disease affecting poor children, the elderly and many members of racial and ethnic minorities,” the Surgeon General wrote.

In short, despite regimes of sealants and fluorides aimed at countering poor oral hygiene habits and diets high in sugary foods and drinks, children in lower economic classes are still slipping through the cracks. “It’s a known fact that if parents don’t have dental insurance, they don’t’ take the kids in,” said health services administrator in Portland’s county health department, Gayle Pizzuto.

Like many major metropolitan areas, the city works in a number of ways to serve the underprivileged. One of Portland’s elementary schools runs a dental clinic that sees students who qualify for free or reduced school lunches. “We could have two dentists busy all the time,” said Susan Bitter of the charitable Assistance League that finances the clinic. Bitter points out that the League’s resources are limited, though, and that the city’s larger dental community also works to meet needs of the underserved with grant and government-funded programs.

But it isn’t enough, says chairman of the pediatric dentistry program at the Oregon Health & Science University School of Dentistry, Prashant Gagneja, D.D.S., M.S. “At least two children a week are hospitalized because they require general anesthesia to have 12 or 14 teeth fixed at a time, and we are booked through January,” said Gagneja. “Hundreds of kids walk through, and we are helpless. This should not be happening in the United States.”

The CDC which is the federal government’s research arm in Atlanta, pointed out that barriers to effective oral health care in underserved communities can stem from a lack of education or what the organization terms “limited oral literacy.” Not only do people not make adequate connections between eating habits and healthy teeth and gums when they are not well-educated on the subject of oral health. Also, sometimes they are simply afraid to go to the dentist.

One way to begin resolving this problem, conclude CDC experts, is for more people from minority groups to enter the practice of dentistry. “Of the 16,926 undergraduate dental students enrolled in U.S. dental schools in 1996-97, fewer than 1,000 were African American, and fewer than 1,000 were Hispanic.”

Toward this end in 2005, Delta Dental of Massachusetts, a company that provides group benefits for organizations ranging in size from five to 30,000 or more employees, has awarded a $4 million grant to Boston University School of Dental Medicine (BUSDM) to create the Delta Dental of Massachusetts Scholars Program. According to a university statement, “the gift establishes the largest endowment in the nation for dental scholarships for low income and minority students.”

“The mission of Delta Dental of Massachusetts is to improve oral health,” says president and CEO of Delta Dental of Massachusetts, Kathy O'Loughlin, M.D. “In one of the wealthiest nations on earth, the documented and increasing disparity in oral health status due to income or race is a serious public health dilemma. This is an exciting opportunity – all Massachusetts residents deserve access to optimum oral health, and I believe through partnerships such as this that it is achievable in our lifetime.”

Progressive, forward-thinking insurance companies in Massachusetts, of course, are not the only ones trying to address dental disparities associated with economic class. In 2002, a research center based at the University of Washington School of Dentistry was established to investigate dental disparity associated with both income and racial groups.

"This new center was created by faculty who already have a long track record of identifying the reasons for dental health disparities, and what can realistically be done about them. We're very excited about the prospects of focused research in an area that can prevent so much pain and so many health problems in our children," said principal investigator of the center and professor in the Department of Dental Public Health Sciences, Peter Milgrom, M.D.

Indeed, Milgrom noted that children ages one to two who are from poor families have three times the rate of cavities found in other children – and that the problems of diverse groups in the Northwest mirror national trends. "The knowledge and the technology exist to prevent painful and expensive problems that will dog someone into adulthood and can hurt their health throughout their life," Milgrom says. "The challenge facing everyone in dentistry is to translate our knowledge into means of care that will work in culturally appropriate and effective ways."

The Robert Wood Johnson Foundation of Princeton, New Jersey agrees and has established a foundation initiative called the Pipeline Profession & Practice: Community-Based Dental Education. Like the Massachusetts program, this five-year grant program is aimed at increasing the number of dentists from underrepresented minority and low-income student populations. In 2002 the foundation awarded $1.5 million to 10 dental schools throughout the nation for the purposes of training dentists who will be in good positions to give back to their own communities and thus decrease the current level of disparity in dental care.

So it’s abundantly clear that social welfare experts are focusing attention on the problem. From charities to the federal government to insurance companies to university researchers to foundations, community and national leaders are increasingly concerned enough to spend serious time and money. With any luck children presently coming through the ranks may have better chances of establishing a solid foundation for good oral health. As a society, we can only hope this will be the case, and that young ones dependent on the greater social good will emerge with confident smiles intact, ready to participate in the future.

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