The tooth squad

THE LEGISLATURE and the governor are putting a commendable effort into a bill to cut the growing percentage of state residents who lack health insurance. But insurance coverage alone is no guarantee of adequate care. Proof of this is the deplorable state of oral health among low-income children who are covered by Medicaid but have no access to the small minority -- fewer than 15 percent -- of Massachusetts dentists who accept Medicaid patients.

According to a 2004 study by the state Department of Public Health, 28 percent of third-graders in the state have untreated tooth decay. In children, dental neglect can lead to infections, pain, and lost school time.

The Forsyth Institute of Boston is testing a new model for dental care of at-risk children by setting up clinics in schools, using its own dentists. The pilot program, begun in Hyannis and Lynn and then expanded to Boston, has had promising results. The 15-minute exams in the Hyannis and Lynn schools have produced a 50 percent reduction in cavities. According to Ellen Gould, a research hygienist and director of the Forsyth program, the shared experience of dental care in the schools takes much of the fear and loathing out of it for children. Also, families are spared the inconvenience of locating a dentist who accepts Medicaid (there is only one on all of Cape Cod) and then getting to an appointment after school hours.

School-based exams are just one way to improve children's access to oral health. Community health centers in many locations also provide this service. The Forsyth's CEO, Dr. Dominick DePaolo, suggests that in some communities public schools could partner with community health centers or with local dental practices.

One key to expanding access is increasing Medicaid reimbursement rates. Dentists are also deterred from accepting Medicaid patients by the requirement that, if they accept any, they cannot limit the total number in their practice. The state should monitor a pilot project in Central Massachusetts in which caseload caps will be permitted to see if, over time, this permission brings a significant increase of dentists into Medicaid.

Massachusetts is not alone in failing to ensure that children get proper dental care. The US Centers for Disease Control and Prevention reports that, between 1988 and 2002, there was a 15 percent increase in tooth decay among children age 2 to 5. According to the Forsyth Institute, for more than a quarter of American children, the first dental visit is for an emergency. Through school-based dental exams, community health center programs, and more public education, Massachusetts should take the lead in ensuring that growing up poor does not mean growing up with decayed teeth.