Report: Access to dental care lags in N.D., Minnesota

North Dakota and Minnesota are among the two-thirds of the states failing to ensure that disadvantaged children get the dental health care they need, according to a new report from the Pew Center on the States.

The Pew study found that 17 million children in low-income families lack access to dental care, leading to lost school time, impaired nutrition and diminished future job prospects.

"In the midst of the array of complex health care issues confounding the nation, ensuring that children have access to dental care should be non-controversial," the reports' authors state. Proven solutions exist and are relatively inexpensive.

"Yet millions of low-income children -- one out of five children overall -- cannot get access to care. The problems resulting from a 'simple cavity' can snowball well into adulthood" and waste resources on expensive treatments.

Dr. Steve Erlandson, a Grand Forks dentist and president-elect of the North Dakota Dental Association, agreed that "an access problem" exists for disadvantaged children in the state, primarily because of low reimbursement rates.

"A lot of us are private practitioners," he said, working with more overhead than is borne by doctors affiliated with a clinic or hospital. The state medical assistance program reimburses dentists about 55 percent of what are considered standard fees, about 20 percent less than what the dentists need to break even.

"Other states at 75 percent reimbursement have seen a huge increase in dentists willing to take medical assistance patients," Erlandson said.

Another problem, however, is making sure that disadvantaged children keep dental appointments once the financial arrangements have been made.

"It's not the kids' fault," he said. "Parents have the responsibility to see they show up."

A matter of dollars

Dr. James McDonald, a Fargo dentist and current president of the state association, said the Legislature has been reluctant to increase the portion of dental fees covered by Medicaid.

"It's been a source of frustration for the dental community for a long time," he said. "We try to rally our members to serve not just children but indigents generally, but it boils down to dollars."

Despite the financial margins, a pediatric dentist in Bismarck "should be made a saint because he will see anybody," McDonald said, while volunteer dentists in Fargo put together an indigent care clinic every Tuesday night and Friday. In Grand Forks, dentists Grant Korsmo and Robert Remmick have "done some amazing things" with the Valley Community Health Center's clinic, which opened in late 2007.

"The bottom line is that dentists collectively and individually are doing the best we can to help this situation," McDonald said. "But it's a huge problem."

'Silent epidemic'

In 2000, a report issued by the U.S. Surgeon General called dental disease a "silent epidemic," and little has changed in the 10 years since then, the Pew report states.

The good news, it says, is that the problems can be solved.

"At a time when state budgets are strapped, children's dental health presents a rare opportunity for policymakers to make meaningful reforms without breaking the bank."

Pew recommends four fixes:

n Sealants, or protective coatings applied to the teeth by a dentist or hygienist, cost a third as much as filling a cavity and have been shown to prevent 60 percent of cavities. School-based programs are a cost-effective way to provide sealants to disadvantaged children.

"It's the best thing as a preventive since fluoride came along," McDonald said.

Joe Cichy, executive director of the state dental group, said the state Department of Health has done three pilot sealant programs in recent months with third graders in Bismarck and Richardton, N.D.

"They hope to initiate a broader sealant program if they get funding from the Legislature," he said.

n The Centers for Disease Control and Prevention has called water fluoridation one of the 10 great public health achievements of the 20th century, as fluoridated water has been shown to counteract tooth decay and strengthen teeth. But about 30 percent of the population on community water systems nationally does not yet receive fluoridated water.

"The fortunate thing in North Dakota is we have a lot of natural fluoride," McDonald said.

n Medicaid programs could motivate more dentists to treat low-income children. Only 38 percent of Medicaid-eligible children received dental care in 2007, largely because too few dentists are willing to treat them, according to the Pew study.

n More dental care providers are needed, especially in areas with larger numbers of at-risk children.

McDonald and Erlandson said the problem in North Dakota has more to do with the distribution of dentists.

"Attracting a young person coming out of school with debt to a rural area can be a problem," McDonald said. "We did some things years ago to recruit more dentists into underserved areas, but everybody flocked to Grand Forks, Fargo and Bismarck."

Only six states merited a grade of A in the Pew study. Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina met at least six of eight benchmarks set by the Pew Center. South Carolina was tops.

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com .