Decay in utilization as well as teeth

By MARALINE KUBIK
VINDICATOR STAFF WRITER
YOUNGSTOWN -- You can open a dental clinic, but you can't make people take their children to see the dentist.
At all three free and low-cost clinics in Youngstown, dentists say most children they see are there to have a problem treated, not for regular dental checkups.
Access to dental care isn't a problem in the Mahoning Valley, explained Dr. Charles Yourstowsky. Education is.
A recent report by the surgeon general indicates a nationwide epidemic of oral diseases among the country's poorest children, many of whom cannot get dental health care.
But the availability -- as in the Youngstown area -- doesn't guarantee the use of dental services.
The Youngstown clinics offer a sliding fee schedule that makes dental care affordable to everyone, Yourstowsky said. Unlike many dentists in private practice, the clinics accept Medicaid and other government-issued medical cards.
Dental clinics at St. Elizabeth Health Center, Forum Health's Northside Medical Center and Youngstown Community Health Center all provide primary dental care -- exams, cleanings, fluoride treatments, fillings and other repairs.
Several options: The hospital clinics also provide more extensive secondary care services such as surgery, prosthetic devices and special services for challenged patients. In addition, the Youngstown Health Department provides screenings and dental sealants for children in Youngstown city schools and Youngstown State University's dental clinic provides free screenings, cleanings and fluoride treatments to anyone who schedules an appointment.
At St. E's, there were 5,115 patient visits last year, said Dr. Andrew M. Wojtkowski, director of the organization's general practice dental residency program. Of those, 20 percent were children under age 18, and 48 percent had medical cards.
Most came in with a problem -- something hurt or was broken -- Wojtkowski said. The percentage of patients, including juvenile patients, who visit the clinic for routine exams "is fairly low, maybe 10 percent," he noted. That is largely because parents don't understand the impact of good oral health on their children's overall health, he continued.
Once adult patients visit the clinic, he said, "we try to establish a doctor-patient relationship," educate them about the importance of good dental care for themselves and their children and establish a routine of regular dental visits. Afterward, he said, "many of the parents we see who have problems bring their kids in."
Forum Health's dental clinic experiences between 7,000 and 8,000 visits a year, almost half of whom are children, said Dr. Patrick C. Thomas.
The majority of Forum's dental patients -- 40 percent -- are on Medicaid, 20 percent are insurance based and the rest are self pay, and, like the clinic at St. E's, most initial visits are prompted by a problem, "usually pretty severe," Thomas said.
Follow-through: The biggest challenge with pediatric patients, he said, is parental compliance. Children can be taught about good oral hygiene and the importance of dental exams at school and through outreach programs, but it's up to the parents to see that the children get to the dentist.
Children from low-income families are at greatest risk, he said, because their parents are more likely to have transportation problems; to move from one residence to another making it difficult for dental care providers to contact them, and are often young and unknowledgeable. "That's a big part of it. There are a lot of children having children and they don't have any good role models on how to take care of themselves," he said.
Baby teeth lost: Many of the children who visit Forum's clinic suffer from "nursing bottle decay," a condition that develops as the result of babies being put to sleep with a bottle of milk, juice or other sugary beverage. Thomas said the incidence of nursing bottle decay, which is 20 percent higher in the Youngstown area than in much of the country, is directly linked to the inexperience of the children's parents. As a result of nursing bottle decay, he said, patients as young as 3 years old have had up to 20 teeth pulled.
Ron Dwinnells, chief executive officer, Youngstown Community Health Center, also recognizes a need to educate parents about the importance of dental care for their children.
In 1999, the health center experienced 1,829 visits for dental care. Between 35 and 40 percent of those were children, Dwinnells said. Last year, those numbers increased substantially because the center began working with Head Start. "We probably saw 500 kids" from that program, he said. "All the kids need at least one dental evaluation before they start school."
Once a child visits the center for dental care, Dwinnells said, "We strive to have them come back every six months for cleanings. It works very well. The parents are very good [about bringing the children back] if you sit down and talk to them about why it's important."
Additional help: Many children from low-income families are eligible for dental care under Healthy Start, a program Dwinnells described as "an expanded version of Medicaid." Under Healthy Start, children from families earning up to 200 percent of the federal poverty level are eligible for care from birth to age 18, he said. Accessing care under that program, however, may be difficult, he said, because few dentists in private practice accept the medical card. Dentists in private practice, he explained, are deterred by the low reimbursement rates.
While three clinics in Youngstown accept medical cards, not all communities are as fortunate. According to the Health Resources and Services Administration in the U.S. Department of Health and Human Services, fewer than 60 percent of community health centers throughout the country offer dental care. Consequently, "low-income children suffer a disproportionately higher share of disease and disproportionately lower share of dental visits, even though they have the highest rates of dental coverage because of Medicaid." Some 80 percent of tooth decay occurs in 25 percent of children, most of whom are from low-income families, HRSA reported.
The disparity in care, however, is not entirely due to lack of providers, Yourstowsky stressed. Of those who are covered by traditional insurance plans and could visit almost any dentist, he said, only 50 percent visit a dentist regularly.