Dental care needed for all citizens

SALISBURY POST

Low-income parents seeking dental care for their children already know that it can be a struggle to find dentists who accept new Medicaid patients. But a UNC-Chapel Hill study shows that the obstacles to good care don’t necessarily evaporate once you get through the dentist’s door.

Medicaid patients in North Carolina may face longer waiting-room stays than other dental patients, demeaning behavior from front-office personnel, policies that restrict visits, lack of transportation to the doctor’s office and language barriers, especially for Hispanics.

The study, published in the January issue of the American Journal of Public Health, analyzed 11 focus groups of Medicaid recipients who were seeking dental care. It adds yet more evidence that North Carolina’s poor children face daunting odds in taking care of their teeth, especially at an age early enough to prevent them from having serious dental problems later in life.

It’s estimated that 672,000 children in North Carolina have no access to dental services, primarily because relatively few dentists accept Medicaid patients. North Carolina ranks 44th in Medicaid participation by dentists, and in 40 counties no private dentists take Medicaid patients, according to the study.

Children’s advocates and many dentists have long contended that the state’s Medicaid reimbursement rate — which covers about 62 percent of a dentist’s regular charges — is inadequate to cover the costs of care. It’s a serious problem even in cities that have many dentists and dental clinics — and even more serious in areas such as Rowan County, which has fewer dentists in relation to its population than the national average. That makes it even harder for low-income families to find good dental care.

In addition to reinforcing the need to raise the Medicaid reimbursement rate, the study also underscores the importance of low-cost clinics such as the Smile Center, which the Rowan County Health Department established to serve children, and the Community Care Clinic, which depends on volunteer doctors and other medical professionals to provide services to children as well as adults.

Beyond those well-known barriers, however, the study also points to less obvious obstacles that stand between low-income families and adequate dental care. Subtle messages from doctors or their staffs can make Medicaid patients feel less than welcome — and less inclined to seek the services that their children need. It would be a distortion to generalize too broadly from the study’s small, anecdotal samples. The Rowan dentists who serve Medicaid patients and volunteer their time to work in community clinics are concerned about low-income children and working to expand their access to good care. But the study offers evidence that there are others who need to brush up on their office etiquette and make sure they aren’t worsening the pain of Medicaid patients by treating them like second-class citizens.