Wednesday, May 25, 2011

Pew Center: The State of Children's Dental Health - California's Report Card

A grade of "C" from the Pew Center on the States.
California meets half of the eight policy benchmarks for improving children s dental health, but children in the state still face significant barriers to accessing care. A recent study by Children Now revealed that one in five California children under age 12 had never seen a dentist. To help alleviate this problem, stakeholders in the state are exploring innovative ways to expand the dental workforce. Pew is supporting a campaign in California to authorize a new type of dental provider who can offer primary care.

Although the state does not yet meet the benchmark for water fluoridation, it has improved significantly since 2006, with over half of the state now receiving the benefits of fluoridated water.
I have some problems with the criteria the Pew Center uses to judge the state of children's dental health and really see little correlation between each of the categories to judge an overall state of health.

Let me take them one at a time.

Share of high-risk schools with sealant programs

Pew is assuming that more dental sealants mean better dental health. Over the 30 years of placing and evaluating dental sealants, I have seen little reason why having a school program in high-risk disadvanatged area would correlate to better dental health. Just because there is a program and sealants are placed, does this mean less decayed and missing teeth as adults? I would like to see a current model and study.

Hygienists can place sealants without a dentist's prior exam:

What does this have to do with children's dental health? Some states allow this and some don't - big deal. How difficult is it for a school or public health based clinic to have a retired licensed dentist or dentist volunteers to at least examine the children. Or, does hygienist placement of sealants without a dentist examination mean a better outcome? This is hard to believe.

Share of residents on fluoridated community water supplies:

You might expect better dental health with fluoridation. But, what abut the communities that have naturally fluoridated water? And, isn't this really a political decision by the local communities and not the states?

Share of Medicaid-enrolled children getting dental care:

More Medicaid children seeing a dentist probably means better dental health. But, what type of treatment are they receiving? Extractions, restorations or regular preventive care? Do the patients return on a regular basis? And, do the states really want to promote utilization of their resources to Medicaid recipients by marketing? I would guess not.

Share of dentists' median retail fees reimbursed by Medicaid:

Dentists receiving more of their regular fee for treating Medicaid children might mean more dentists treating more children, right? Yes and No. Some dentists don't participate in Medicaid regardless of the fees paid, because of the needless bureaucracy and ever present/relentless federal audits which might send them to prison for making billing errors. Some dentists just don't like the federal government intruding on their private business decisions. So, increasing the fees for Medicaid might reward some dentists, but probably would not increase the numbers of dentists providing Medicaid treatment - unless of course, the fees approached 80-85% of their UCR. But, what states and which taxpayers will be able to afford that?

Pays medical providers for early preventive dental health care:

I cannot imagine seeing general/family practice physicians, pediatricians or PA's sitting down in a Medicaid environment either providing dietary advice, dental sealants, or oral hygiene instructions. Just because physicians can, does not mean most M.D.'s will. I would like to see a study as to which states have a goodly number of M.D.'s providing these type of services.

Authorizes new primary care dental providers:

This is, of course, the hidden agenda question for the Pew Organization who has been at the forefront in promoting the new dental therapist as an alternative to the dentist. This category has no relevance to children's dental health, since there is no evidence that having dental therapists equates to better dental health. Most of the USA is not Alaska, remote and rural. I don't think most private practice dentists are going to hire dental therapists, so they can see more Medicaid patients with a reimbursement of around 40% of their regular fees. Remember the "invisible hand?"
Tracks data on children's dental health:

More government bureaucracy reporting to the federal government really equates to better dental health.

As you can see, I am not too fond of this report. But, Pew is a large, well-funded organization and one with an agenda to promote dental therapists as a way to improve access to dental care for underserved populations. This report must be viewed with this in mind.

Here is the last graph on California's report card:

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