The repercussions aren’t limited to problems with teeth. Neglecting teeth, besides causing pain, can have a variety of negative effects on health, ranging from malnutrition to a risk of respiratory infections among the elderly. Dental decay is also exacerbated by certain common diseases. Diabetes, for example, is linked to increased incidence of periodontal disease, infections of the gum that can lead to tooth loss, according to the American Dental Association. Medications can also affect oral health. Some prescription drugs that many seniors are taking can cause dry mouth, which promotes tooth decay.
Marge Gagnon, a registered nurse at Kingston Hospital who also works under contract with Ulster County, said the gap in dental care is a huge issue in the region. Among those most at risk are children from low-income families and seniors on fixed incomes. Many middle-class people who are trying to survive on reduced incomes are also neglecting to get the oral care they need because it’s so expensive, according to county health officials.
Seniors particularly at risk
Many seniors are in a bind because Medicare does not include dental care. Anne Cardinale, director of the Ulster County Office for the Aging, hopes to change that. As a delegate from New York State to the American Nurses Association (ANA) House of Delegates, Cardinale wrote a resolution in 2008 to have preventive oral health care covered by Medicare. Her resolution, approved unanimously by the group, called for Medicare to include a free annual dental exam and provide a payment scale for dental services based on income.
According to Cardinale, a 2005 study of nursing-home patients found that pathogens from dental plaque had gotten into the lungs of some, causing serious respiratory infections. Nursing-home patients are particularly at risk of periodontal disease because many are unable to take care of their teeth. Tooth loss interferes with chewing and swallowing, potentially resulting in malnutrition and weight loss, she noted.
To help ensure seniors get the dental care they need, the Ulster County Office for Aging is in the process of partnering with a dental clinic in Troy that is affiliated with Hudson Valley Community College. By early July, Cardinale said she hopes to obtain health evaluation booklets from the clinic to be made available to seniors. Although the arrangement is not yet final, Cardinale plans to book appointments at the clinic for those who qualify, based on income. The Office for Aging plans to obtain a van to transport the seniors to the clinic twice a month in the fall. The dental screening would include a free cleaning and X-rays at greatly reduced cost.
Gap in care for low-income kids
According to the county health department, many low-income children are covered for routine dental care under the state’s insurance program, Child Health Plus, as well as under Medicaid, managed-care Medicaid programs, and several HMOs serving Ulster County. Still, many kids aren’t getting the dental care they need.
A 2003-04 study of third-grade children by the state health department’s Bureau of Dental Health was updated in 2009, with almost identical results. The percentage of kids who had cavities and untreated cavities was higher in Ulster County than the statewide average: 64.7 percent had cavities in Ulster County, compared to the 54.2 percent average state-wide, and 37.2 percent had untreated cavities, compared to 33.1 percent state-wide.
A major problem is the lack of dentists in the region who accept Child Health Plus and Medicaid. According to a phone survey by the county in 2008, only eleven dentists out of a total of 92 listed in the county phone book accepted Medicaid recipients.
Dentists who do accept Medicaid patients tend to do so sporadically, so consistent care is another problem, according to Stacy Kraft, public health education coordinator. She believes that only one clinic, Family Health Institute, now consistently accepts Medicaid recipients.
A special mobile clinic visits schools in southern Ulster County, providing various levels of free dental care. It’s operated by Prasad, an international charitable organization that is focusing on providing dental care for children in the United States. In the last five years, the clinic has visited schools in Ellenville, Kerhonkson, and the Rondout Valley, according to Cecilia Escarra, children’s dental health program administrator for the organization. (In Ellenville and Kerhonkson, full care has been offered, while at the Rondout Valley schools only screening and education are provided, she said.) Some parents also take their children to the clinic over the summer.
According to Escarra, dental disease, four to five times more common than asthma, is the number-one chronic disease for children. Some parents can’t provide even the transportation to the dentist. Although children are covered by Medicaid, they won’t get the benefit if their parents don’t apply for it.
Escarra said Prasad has secured a $200,000 federal grant through congressman Maurice Hinchey, but needs to raise $200,000 more to replace its twelve-year-old mobile clinic. Additional funds are needed for the clinic’s operation.
Money for mobile units
Tischler Dental in Woodstock launched the Tischler Dental Foundation last fall with the aim of raising money for Prasad. According to Judy Hinchey, clinical supervisor and coordinator, the foundation plans to donate money to Prasad CDHP for a second mobile unit, which would travel to schools in northern Ulster County. In addition, Tischler Dental hopes to raise money for its own mobile unit. Hinchey said the foundation was planning a major fundraiser on July 24. (The all-day event will have wine and beer tastings, music by live bands, and an art auction. Tickets cost $35. For information, visit www.tischlerdental.com.)
Research by the foundation indicates that children in Ulster County are missing 50,000 hours of elementary school a year due to tooth decay and pain. In addition to neglecting dental visits (which Hinchey said should start when kids are still toddlers), she noted that many parents also need to do a better job of promoting good brushing and good eating practices within the family.
Tischler Dental also does free check-ups of needy children for one day every February, according to Hinchey. This year it brought in 30 children from Head Start. However, Tischler does not accept Medicaid patients, so children who needed to have cavities filled were referred to a dentist’s office in Kingston, Hinchey said.
Healthy Ulster may help focus
The sugary, starchy diet and incessant soda intake of many kids is a major cause of tooth decay. As part of the Healthy Ulster initiative, the county’s health department is advocating for policy changes at schools and organizations such as municipal recreational centers and children’s summer camps, to promote healthier eating. It hopes to increase its educational outreach to children about how to care for their teeth, according to coordinator Stacy Kraft.
Kraft sits on the Healthy After-school Snacks committee of Healthy Kingston for Kids, a program of the Cornell Cooperative Extension (the health department is a partner) funded by a grant from the Robert Wood Johnson Foundation. The committee is currently assessing the wellness policies at schools to determine how they can be improved.
Kraft also participates on Healthy Ulster’s obesity prevention committee, which is beginning to research what schools are stocking in their beverage vending machines. Based on informal observations, she said, a number of schools in the county stock soda. The committee hopes to change that, with less sugary drinks such as natural juices and water replacing the soda. The American Dental Association fervently opposes the selling of soda in school vending machines.++