Some Dentists Bad-Mouth Anti-Cavity Bill

Some pediatric dentists are bad-mouthing a bill that would allow mobile dental clinics to be paid by Medicaid for sealing the teeth of low-income kids at school — a cavity-prevention measure these dentists fear would keep children and their parents from seeking more comprehensive oral care.

Mobile dental units, many of them affiliated with non-profits or public health clinics, already travel from campus to campus in many of the state’s low-income communities, providing free sealants to prevent cavities in kids at the highest risk for them. But unless a parent or guardian visits the mobile clinic with a child, the clinic can’t bill Medicaid for the procedure and must cover the cost itself, reducing the number of procedures it can provide.

Rep. Mike Villarreal’s bill, HB 1248, aims to expand the number of kids who can have their molars sealed by letting mobile providers operated by government entities — public health departments and university dental schools — get reimbursed by Medicaid for it. Under the measure, which is pending in the House Public Health Committee, only campuses where the majority of students come from low-income households would qualify, and kids would have to present signed waivers from their parents.

A representative for the Texas Dental Association acknowledged in testimony this week that sealants are a particularly effective piece of the oral health equation. (A 2001 community study found that school sealant programs reduced the incidence of cavities by 60 percent in kids ages 6 to 17.) But the organization, which declined to comment for this article, argues that oral care should instead be provided in a so-called “dental home” — an established dental practice where the child and the parent have a relationship with a practitioner, and have access to everything from x-rays to fillings.

“The school-based sealant program is counterproductive to the state’s goal of having all services coordinated through a child’s dental home,” Dr. Rita Cammarata, a pediatric dentist from Houston who serves on the dental association’s board of directors, said at a House hearing this week.

Villarreal said while a dental home is preferable in theory, the reality is the closest many low-income kids get to the dentist is a mobile clinic. Children living below the federal poverty line are almost twice as likely to have cavities in their permanent teeth as are children from better-off families. A 2009 report in the Journal of the American Dental Association shows just 20 percent of kids ages 6 to 11 from low-income families have sealants.

“While I think [a dental home] is a laudable goal, while I think that is an ideal that we should pursue, we should not let it get in our way of taking away pain from children,” Villarreal said.

Jason Sabo, senior vice president for the United Ways of Texas, said the rule that parents must accompany kids to get a Medicaid reimbursement creates an artificial barrier for low-income, working families. “It’s saying, if you want access to dental care, if you want your kids to get sealants, I guess you have to quit your job,” he said. “We live in a world where kids’ teeth are rotting out of their head while they’re trying to take a TAKS test.”

At this week’s hearing, House Public Health Chair Lois Kolkhorst, R-Brenham, seemed skeptical about opponents’ opposition too, questioning, “I’m wondering, is it better to have this being done at the schools versus maybe nothing being done at all?”

Cammarata, the pediatric dentist, answered: “I’m not real sure.”

“If you’re just putting something on, and that child is going away, and never being followed up, I don’t necessarily see that as the right thing to be done for that child,” she said. “…You’re getting one small procedure done, but you’re missing the big picture.” Asked by lawmakers what she charges for a seal, Cammarata said $65 a tooth.

Dr. Jennifer Bankler, dental health coordinator with the San Antonio Metropolitan Health District, said the goal isn’t to tear kids away from private practices — it’s to get them the help they need. Seven to 10 percent of the children her mobile unit sees have urgent dental needs, she said; many are sitting in class suffering. “These kids are uninsured, underinsured,” she said. “We’re trying to reach those kids that don’t have a dental home, to work with families to help them find a dental home.”