Better Dental Health Needed for Maryland’s Poor Children, Dentists Say

Maryland's "poor" children have an "extraordinarily poor level of oral health," Drs. Norman Tinanoff and Richard Ranney of the University of Maryland Dental School write in a Baltimore Sun op-ed, urging the state to make several changes in its Medical Assistance program. Although federal regulations require children receiving medical assistance to have at least one dental visit each year, only about 19% of poor Maryland children receive dental services, mostly due to a prolonged "lack of funding for dental services," the authors write. In the mid-1990s, dental care represented one-quarter of 1% of the $1 billion Medicaid budget. According to a 1994 survey of 3,500 Maryland school children, 60% of participants had decayed, missing or filled teeth, compared to 45% nationally. Furthermore, 70% of poor children had untreated decay, while 45% of children with private insurance did. In another, "just- completed" survey of children in the state's Head Start program, 53% of children had dental decay, while 15% of those had tooth pain and 9% "have cried because of a toothache." Tinanoff and Ranney note that "lack of oral health care results in severe pain, impaired eating ability, speech difficulties and problems associated with chronic infection." The authors discuss several recommendations made during the Sept. 22 "Oral Health Care for Maryland Kids Summit," including funding increases for dental services in Maryland's Medicaid managed care program, expansion of community and school-based dental services and attraction and retention of dentists for the Medicaid managed care program. Other suggestions include creating a case management system and partnerships between local health departments and practicing dentists, finding new preventive approaches for dental cavities and promoting "more active advocacy" for children's oral health needs. The authors conclude, "We need to keep this critical care need on the radar screen of all elected and appointed officials" (Tinanoff/Ranney, Baltimore Sun, 11/7).