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Published: Sunday, 1/20/2008

A gap that needs to be filled: Dentists for Medicaid kids

BY JULIE M. McKINNON
BLADE STAFF WRITER
Patient James Maynard, 12, travels 60 miles from Paulding, Ohio, to Bowling Green to see his dentist, Jack Whittaker. Here, hygienist Tammy Rogowski cleans his teeth. Patient James Maynard, 12, travels 60 miles from Paulding, Ohio, to Bowling Green to see his dentist, Jack Whittaker. Here, hygienist Tammy Rogowski cleans his teeth.
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BOWLING GREEN - Ever since James Maynard was a toddler, the Paulding boy, now 12, has made the roughly 120-mile round-trip to Bowling Green at least twice a year.

That's the best way for James, who has spina bifida and is insured by Medicaid, to get his teeth cleaned, filled, and otherwise treated. No local dentist would do more than clean the boy's teeth.

Bowling Green pediatric dentist Jack Whittaker is one of a few private practitioners in northwest Ohio routinely taking Medicaid patients, who account for 40 to 50 percent of his practice.

Like James, more than half of the children he treats are from outside Bowling Green, including other far-flung places like Bryan and Van Wert.

"He was nice enough to take us," said James' aunt Florence Goings of Paulding, who drives her nephew and sister, Jackie Hardman, to and from their dental appointments. "No one else in the area would."

For at least twice as long as James has shuttled between Paulding and Bowling Green to see him, Dr. Whittaker has railed at the lack of dentists nationwide taking children covered by Medicaid programs.

Low reimbursement rates are chief among the reasons why dentists don't routinely accept disabled or poor children covered by Medicaid. Programs in Ohio, for example, pay about 51 cents on the dollar, while Medicaid reimbursements in Michigan are even less and vary by plan, dentists and others handling claims say.

That isn't much, especially because dentists getting established have about $200,000 in school debt along with high overhead for their equipment-

heavy practices, said Dr. Whittaker and others.

Dentist Jack Whittaker of Bowling Green checks Amber Heiss, 6, of Northwood as her father, Karl, holds her hand. Amber has Rett Syndrome. She uses expressions to communicate. Dentist Jack Whittaker of Bowling Green checks Amber Heiss, 6, of Northwood as her father, Karl, holds her hand. Amber has Rett Syndrome. She uses expressions to communicate.
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"A lot of dentists can't afford to take Medicaid," said Dr. Paul Casamassimo, a past president of the American Academy of Pediatric Dentistry. "It costs them money to take care of the kids."

Dr. Whittaker, Dr. Casamassimo, and other dentists treating Medicaid recipients commonly see emergency cases where children have infections from abscessed teeth because they don't get routine dental care. In rare cases, such infections - as with a 12-year-old Maryland boy last year who had no dental insurance at all - are fatal.

"It's not fair to the kids," said Dr. Whittaker, who spends two Fridays a month at St. Vincent Mercy Medical Center in Toledo and the other two at Wood County Hospital in Bowling Green.

"The children are the ones who suffer."

The move to Medicaid managed-care programs in recent years in Ohio and Michigan has helped increase the percentage of children seeing dentists, statistics show.

Ohio, for example, has had a 20 percent hike in the number of Medicaid-covered children getting help over the last five years, with about half of those aged 4 to 21 having a dental visit in the fiscal year ending June 30, 2006, according to the Ohio Department of Job and Family Services.

The need for such treatment is growing, dental and medical doctors say.

Roughly half of Ohio first graders now have tooth decay, and typically those who don't have access to dental care are the ones who need it most, experts say. Poor children often have unhealthy diets, do not adequately care for their teeth, and do not see dentists, said Dr. Casamassimo.

"The disease is probably the most common childhood illness we have in this country," added Dr. Casamassimo, the chairman of pediatric dentistry at Ohio State University and chief of dentistry at Nationwide Children's Hospital in Columbus.

Tooth decay can linger in baby teeth, causing problems with permanent teeth, Dr. Casamassimo said. It is believed the bacteria strain is virulent, he said.

Dental disease in adults is associated with diabetes, heart disease, and even preterm birth, said Dr. David Krol, chairman of the pediatrics department at the University of Toledo College of Medicine, formerly the Medical College of Ohio.

Low Medicaid reimbursements aren't the only barrier to getting access to preventive dental care to prevent emergencies such as painful abscesses Dr. Whittaker routinely handles, dentists and others said.

It's difficult, for example, for general dentists to treat young children, who are advised to have their first dental visit at 1 year old, and there are few pediatric dentists nationwide. No-show rates among Medicaid recipients are high because of a lack of transportation or other issues, so dentists don't want to book them for fear they will lose money by having unfilled appointment times.

Parents with children on Medicaid have their own concerns.

Tami and Karl Heiss of Northwood take all five of their children to Dr. Whittaker after a doctor recommended him for their now 6-year-old daughter, Amber, who has Rett Syndrome, a neurodevelopmental disorder.

"I would be very uneasy taking her to a dentist who didn't specialize with handicapped kids," Mrs. Heiss said.

Plus, Amber, who doesn't walk or talk but communicates with expressions, likes Dr. Whittaker.

"We like the doctor, the people," Mr. Heiss said.

"It takes a special person - there's people who are a lot more severe [disabled] than Amber here,'' he said.

There are efforts under way in the Toledo area to try to ease the dental access problem for children.

Most recently, the UT college of medicine added a pediatric dentistry residency program at the Health Science Campus, both to help ease the shortage of pediatric dentists and to treat more children. The program started in July. In the following six months, the two residents saw 2,000 patients, 85 percent to 90 percent of whom were covered by Medicaid.

Two years ago, Small Smiles opened a dental center in Toledo. About 95 percent of its patients are Ohio children on Medicaid. The dental center, which is managed by a for-profit company with 66 facilities in 20 states, treated 9,175 children last year and is at more than two-thirds capacity, said Todd Cruse, senior vice president for FORBA of Nashville.

"We still get new patients every day calling," he said.

The Toledo-Lucas County Department of Health has a pediatric-dentistry program open every weekday that accepts Medicaid and has a sliding-fee scale for those without insurance.

Health department dentistry employees also visit Lucas County schools, and some children receive fluoride sealants on their teeth to help prevent cavities.

Dental Center of Northwest Ohio in Toledo is another place where children with Medicaid or no insurance can receive treatment.

On Feb. 1, local dentists such as Dr. Brett Pelok, president of the Toledo Dental Society, will volunteer for the annual Give Kids A Smile Day from 8 a.m. to 4 p.m. at the center. Such efforts in the last half dozen years have helped fill the gap in service, and he and other dentists continue treating some patients in their own practices, he said.

More can be done, dentists and others agreed.

Pediatricians, for example, should lend a hand by being more aware of oral problems with their young patients, said Dr. Krol, who added that 70 percent of the patients at their practice at UT are on Medicaid.

"It's all about prevention. It's not about filling the hole in the tooth," he said.

State governments need to raise Medicaid reimbursements, said Dr. Whittaker, the Bowling Green pediatric dentist. And maybe, to be licensed in Ohio, dentists should be required to have, say, 10 percent of their patient load be Medicaid recipients, he said.

"Dentistry should just start doing more," he said.

Contact Julie M. McKinnon at: jmckinnon@theblade.com or 419-724-6087.



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