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Putting Teeth in Health-Care Reform: Advocates Pursue Dental Issues

A Lethal Infection

Deamonte, who had been living in a homeless shelter before moving into his grandparents' mobile home in Clinton, died from a dental infection that spread to his brain. A routine, $80 tooth extraction might have saved his life. As is the case with many poor families, transience as well as problems with transportation, phone service and mail delivery complicated the Drivers' search for care. The death spurred congressional hearings and gave lawmakers and the public new insights into failings within the Medicaid system charged with providing dental care to millions of poor children. The revelations led to reforms of the system in Maryland. Often invoking Deamonte's name, Cummings went on to help lead a successful fight for the inclusion of a dental entitlement for the children of the working poor under the reauthorization of the State Children's Health Insurance Program, or S-CHIP. The bill, vetoed twice by then-President George W. Bush, was signed into law this year by President Obama.

If there has been progress in getting dental care into the current debate, it has been built upon the events of the past two years, said Edelstein.

"The attention that oral health is getting is, I believe, a direct result of concerted, ongoing and persistent efforts by oral-health advocates and their technical advisers to keep the lessons learned by Deamonte Driver's death and in the [S-CHIP] reauthorization before policymakers during health-reform development," Edelstein said.

But the fact that dental care was not included as an entitlement for the first decade of the S-CHIP program is a reminder of the chasm between dental care and general health care.

Allen Finkelstein, chief dental officer for AmeriChoice, a UnitedHealth Group company, acknowledges that gap and said it must be closed to ensure better care.

"Care of the teeth needs to be integrated with care of the rest of the body," said Finkelstein, who advocates putting the delivery of both medical and dental services under a system of "health homes" and requiring children to visit a dentist annually before returning to school.

"Fundamentally, our health-care system and the laws and regulations that govern it must put dental prevention and care on par with the rest of our health," said Finkelstein.

And any reform must include a changed approach toward delivering dental care -- a move away from the old model of treating decay and disease and toward disease prevention and oral-health promotion, Finkelstein said.

For reform to be most effective, dentists and public-health experts must be active participants in the discussion, said Dushanka Kleinman, a dentist and associate dean for research and academic affairs at the University of Maryland School of Public Health.

"There is still time for this inclusion," Kleinman said, adding: "We must especially address the design of new programs to meet the needs of low-income and under-served populations."

The Americans who have the most at stake in dental health reform are the poor, agreed ADA president O'Loughlin. While most middle- and upper-class Americans have access to good dental care, national reform efforts should focus on bolstering the Medicaid and public-health systems, she said.

Ultimately, providing a system of preventive care to the poor could save money and head off more preventable deaths, she said. "If Deamonte Driver never had caries [dental cavities,] he never would have died," she says. "It was a preventable disease."

Support for reform came last week from the front lines of everyday oral-health care: dental hygienists. They foresee a bigger role for themselves in preventive care to the poor and under-served, said Karen Sealander, Washington counsel for the 150,000-member American Dental Hygienists' Association.

As she spoke last Wednesday, her army of lobbyists was converging on Capitol Hill. Hundreds of hygienists, nearly all women, armed with talking points and dazzling smiles, spent the day meeting with lawmakers and their staffs, asking about their own dental histories, discussing dental workforce development and emphasizing the urgency of preventive care.

They came from 39 states but they rallied under one slogan: "Put Teeth in Health Reform."


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