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Attention to dental coverage lacking in health-care debate

TAMPA — Flo Turner's teeth are falling out.

One by one, she collects the rotten remnants in an old orange prescription bottle.

The 48-year-old has 17 teeth left, including a few slivers. They have all painfully yellowed and browned, on their way to turning into little black rocks.

She has called 62 dentists in eight counties for help. Turner, who has been disabled for 22 years and also receives Medicaid, hasn't found relief through the state either.

In Florida, adults on Medicaid can see a dentist only for emergency services. But few doctors work with the program and even fewer take new patients who need the kind of specialty work Turner requires.

The lack of access to dental services for low-income patients isn't just a problem in Florida, patient advocates say. It has caught the attention of lawmakers around the country, sparked by the death of a 12-year-old boy from an infected tooth.

And as legislators vigorously debate health care reform, provisions for dental care have largely been left out of the discussion.

"It is important," said Dr. Ervin Cerveny, a dentist at the Suncoast Community Health Centers in eastern Hillsborough. "For too long, the oral cavity has been treated as separate from the rest of the body. ...Oral disease is the most common disease, and unless included in the discussion of health care, will remain so with all its systemic effects."

• • •

A family of four with an income of $40,000 typically spends 8 percent of that on routine dental care, said Frank Catalanotto, professor of community dentistry at the University of Florida. That's three-fourths of what that family should typically spend on overall health care, he said.

While some in the industry are trying to figure out less expensive models to provide basic, preventative dental care to low- and middle-income families, there aren't any immediate answers, he said.

The tone of disconnect between the mouth and the rest of the body was set in the 1960s when dentists opted out of public health programs being created, Catalanotto explained.

As the importance of dental health and its link to the rest of the body has become more evident over the years, the mouth has become much more important.

Poor dental health has been linked to heart disease, stroke, diabetes, low weight births and respiratory diseases.

Currently, more than 100 million Americans do not have dental insurance, said Liz Rogers, spokeswoman for Oral Health America, a Chicago nonprofit that promotes health care reform that includes dental coverage. For every person without medical coverage, there are two people who have no dental insurance.

She said the group sees glimmers of hope with mentions of dental-care provisions in recently proposed legislation.

"Do the health care reform bills provide universal access to health care including dental benefits for all ages?" Rogers asked. "No, they don't. But we know the administration and Congress are looking at oral health in a new way."

• • •

Turner, who has been trying to get her mouth taken care of since 2003 when she moved to Tampa, says her teeth have always been bad.

She traces some of her problems to genetics. Bad teeth, it seems, run in her family. Several years of drug and alcohol abuse, around the time she was diagnosed as bipolar, sped up decay.

When she arrived in Tampa, her front tooth cracked and eventually fell out. She struggled to find a dentist through Medicaid. In the last year and a half, the infection in her mouth dramatically worsened.

"This whole time, I've been going through the (Medicaid) lists and calling any dentist I come across in the phone book for help," Turner said. "But the Medicaid doctors aren't taking new patients. And the other dentists don't really seem to care."

Even discount clinics, some of which charge by the tooth, are too expensive for Turner. And they don't offer sedation, which she knows she'll need to have what's left of her teeth removed.

One dentist, Turner said, offered to remove her teeth and make her dentures for $10,500.

"Where am I going to get that kind of money?" she asked, wiping away tears.

In January, Dr. Jeri Norman, an internist, warned Turner that she needed to see a dentist. The doctor feared the infection in Turner's teeth could spread to her blood with fatal complications. She wrote Turner a prescription for antibiotics.

"Unfortunately, people with no money end up losing their teeth," Norman said. "They don't get preventative care. It's lousy the way the system's set up."

• • •

As with other states, Florida has historically underfunded reimbursement rates for dental services, patient advocates say.

Low rates have led to a deficit in providers who take patients on public programs, unlike the 75 percent of physicians who accept patients on programs such as Medicaid for medical services, said Catalanotto the UF professor.

"Only 10 percent of Florida dentists participate in Medicaid in any meaningful way," he said. "It's notoriously bad for pediatric dental care. And adults can't expect to get any preventative or restorative care."

A report last year by the Centers for Medicare and Medicaid concluded that Florida's rates for dental services are among the "poorest in the country" and have remained "stagnant" over the last five years.

The Agency for Health Care Administration, which administers Medicaid in Florida, will head to court in December along with other state agencies over a class action suit. State pediatric groups sued the bureaucracy in 2005 for failing to meet federal mandates to provide low-income children with medical and dental checkups and corresponding care.

Agency officials dispute allegations in the lawsuit, and note that the state's Medicaid program pays for "a comprehensive array of medical services for children," that exceed some private insurance plans.

Officials also said the agency has a provider network that meets federal and state requirements, and it constantly looks for ways to expand access to care.

Still, lack of access to dental care goes beyond Medicaid, said Catalanotto, who is also an Oral Health America board member. It's a festering problem that's spreading to those who used to be able to afford seeing a dentist.

"Yes, it's true that some patients need to make better choices of how they spend their money and when to prioritize health care," Catalanotto said. "But when your priority is living paycheck to paycheck, I don't want to hear about these 'choices.' "

• • •

Two years ago, a 12-year-old boy in Maryland died when an infection from a bad tooth spread to his brain.

Earlier this month in Michigan, a 76-year-old woman died after being denied Medicaid coverage for surgery to remove infected teeth.

Turner doesn't want to be added to the list.

What's even more painful than her always-throbbing mouth is the thought of her only child's wedding in December.

She doesn't want to show up or pose for any pictures looking the way she does.

Turner fights to believe it will all somehow work out. In the meantime, she keeps her orange bottle handy for the rest of her teeth.

Times news researcher John Martin contributed to this report. Chandra Broadwater can be reached at or (813) 661-2454.

Attention to dental coverage lacking in health-care debate 10/30/09 [Last modified: Monday, November 2, 2009 12:48pm]
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