Recession affects dental care for youth from low-income families

July 13, 2009
A survey by FORBA indicates that low-income families must now choose between necessities such as food, housing, and transportation, or dental care for their children. The necessities win, and this is causing more problems with the dental health of children than were already being noted by dental professionals.

In the first survey conducted of its kind, FORBA--the nation’s largest dental practice management company focused on care for low-income children--wanted to see how families like those in their dental centers are being impacted by the nation’s financial crisis.

Is the crisis hindering their ability to provide their children with the dental care they need?

The answer is a resounding “yes.” Those surveyed indicated they must now choose between necessities such as food, housing, and transportation, or dental care for their children. The necessities win, and this is causing more problems with the dental health of children than were already being noted by dental professionals.

Dr. Steven Adair, a faculty member of the Medical College of Georgia and chief dental officer of FORBA, is one of the forces behind the survey.

“Every day, our dental centers see families who are struggling to make ends meet,” he said. “Since the onset of the economic crisis, families are increasingly turning to government programs, such as Medicaid and CHIP for assistance. There is an overwhelming need for dental care for economically disadvantaged children across the country. The surgeon general has called tooth decay among low-income children a silent epidemic.”

Dr. Adair oversees clinical and quality initiatives at FORBA’s nationwide associated network of Small Smiles dental centers, which has provided free screenings for nearly 10,000 children this year.

“The numbers in the survey are not surprising given the overall challenge the nation faces with regard to dental care for low-income children,” he said. “The information reinforces what many of us suspected about the impact of the economy.”

The national online poll surveyed 210 parents of young children in households with annual incomes of $35,000 or less. It revealed that one in five (20%) take their children to the dentist less than once a year, well below the American Dental Association’s recommendation of two annual check-ups. About 16% said their children are not insured, and more than 40% said their family receives government health assistance from programs, such as Medicaid and CHIP. Approximately 18% said they have trouble locating a dentist who will treat their children, a finding that reflects a national problem, Dr. Adair said.

“The two primary problems regarding dentists treating low income children are the low reimbursement rates provided by Medicaid and state children’s health care insurance programs (CHIP) for dental treatment, and the complicated administrative burdens that are all too often associated with government programs,” he said. “Often, the reimbursements do not cover the overhead costs of providing care in a private dental practice.”

Like his peers in pediatric dentistry, Dr. Adair chose the specialty because he loves children. “Being a pediatric dentist also offers me the opportunity to advocate for a group of patients who are often unheard and sometimes unable to advocate for themselves at the local, regional, and national level,” he said. “Being able to help educate parents and the public about the challenges that children from low-income families face with tooth decay is a gratifying aspect of my job.”

He and other Small Smiles participants work tirelessly to promote children’s dental health, and the results of the survey concern them.

“Children with poor oral health are often in pain,” Dr. Adair said. “As a result, they are not able to maintain a healthy diet and they do not sleep well. These factors can interfere with growth and learning, as well as physical and social development. These children may also miss time at school and in the classroom, may not be readily accepted by their peers, and may suffer from low self-esteem.

“It is important to help parents understand that good oral health is about more than just preventing cavities,” he continued. “It’s important that these messages are delivered in a caring, educational manner in an effort to enlist the caregivers as members of their child’s oral health care team. It is often difficult to get these important messages across to families who have limited access to dental care, so our doctors and dental staff are active in community outreach programs.

“Through events such as health fairs and free dental screenings at schools and day care centers, Small Smiles helps spread the message about the need for establishing an oral health routine to their community,” he continued. “As a profession, we can do a better job educating parents and children of all socioeconomic levels about the importance of good oral health and their options for receiving the dental care that they need.”

Without this education and a change in parental behavior, there will be an increase in dental treatment needs among adolescents and young adults in the coming years. Poor teeth in the young lead to poor teeth in adults.

There are numerous steps parents can take at home to help the situation, Dr. Adair stresses.

They can contact a local dental society and ask for a list of dentists in the community who treat children covered by Medicaid or CHIP. They should limit the number of sugary snacks their children consume, and make sure that their children brush their teeth twice a day with a fluoride-containing toothpaste. Parents should brush their preschool child’s teeth, and check to ensure that older children brush their teeth adequately. Children should drink tap water in fluoridated communities, not bottled water, so they receive the benefits of fluoride to help strengthen teeth.

But ultimately, the government and dental professionals must help with the situation.

“The long-term solution is to better educate our government officials about the importance of oral health as the debate over national health care reform progresses,” said Dr. Adair. “Inclusion of dental health care benefits for economically disadvantaged families is, in my opinion, critical.”

For more information, go to Dentistry IQ and Small Smiles USA.

To read more about this topic, go to FORBA survey.

To comment on this article, go to PennWell Dental Community site.