July 21, 2004
She eventually got her son to a nonprofit clinic, but a year had passed. Dying nerves and an abscess in the bone beneath Angelito's baby teeth were threatening the development of his permanent teeth.
After a six-month wait, a surgical team at Children's Hospital and Regional Medical Center in Seattle sealed, capped and filled as many of his teeth as they could, but had to send the talkative little boy home to SeaTac earlier this month without any front teeth.
``It's heartbreaking to face the same difficulties in family after family. This is a really complex way to manage dental disease. If kids were getting routine dental care, we could avoid this,'' pediatric dentist Barbara Sheller said.
About 3.1 million people in Washington have no dental insurance or rely on Medicaid, the low-paying government insurance for the poor that only one in three practicing dentists in Washington will accept.
For families like the Haneys, that means dental care comes only after the rent is paid and food is on the table - and often only when tooth pain becomes unbearable.
Nationwide, more than 108 million people lack dental insurance, according to a 2003 report by the U.S. Department of Health and Human Services. The U.S. surgeon general has called the growing lack of dental access a ``silent epidemic.''
Faced with budget shortfalls and rising health care costs, state lawmakers cut dental coverage for low-income adults by 25 percent in 2003. Nearly 30,000 undocumented children also lost their state dental coverage in Washington in 2002.
As a result, dentists are finding more cavities and pulling more teeth, said Dr. Marty Lieberman, dental director at Puget Sound Neighborhood Health Centers, which serves about 15,000 mostly uninsured patients a year in five Seattle-area clinics.
Experts blame widespread dental decay in part on the relative lack of fluoridation of public water systems.
The federal Centers for Disease Control and Prevention considers fluoridation one of the 20th century's top-10 public health achievements. But just 57 percent of Washington's systems are fluoridated.
Another problem: There aren't enough dentists in many parts of the state.
In 2003, portions of 35 of Washington's 39 counties were federally designated as dental health professional shortage areas, either because not enough of the dentists there would see poor or migrant clients or because there were too few dentists to serve even those with private insurance.
Harborview Medical Center in Seattle has become one of the few places in the state where adults without insurance can get dental surgery, because the hospital sees anyone, regardless of their ability to pay.
Activist dentists and public health programs have worked to improve access in recent years. Since 1993, the percentage of Medicaid children seeing a dentist in a given year has increased from 27 percent to 40 percent.
In Spokane, Bremerton, Yakima and south King County, efforts are under way to train pediatricians to check children for dental decay and provide a fluoride varnish for kids at high risk for cavities.
A big part of the problem is that private dentists believe they cannot keep their small businesses afloat if they see significant numbers of patients covered by Medicaid or nothing at all.
David Hemion, assistant executive director of the Washington State Dental Association, said state Medicaid reimbursement rates cover about 35 percent of a dentist's typical office fee for an adult and 65 percent for a child.
He predicted that access for poor people will remain limited ``unless the reimbursement programs funded by public dollars come closer to market rates.''
Some activists, like Dr. Peter Milgrom, director of the University of Washington's Northwest and Alaska Center to Reduce Dental Disparities, are pushing for the creation of a new type of dental nurse that could deliver dental services at lower costs.