Health & Parenting

Dental Decay

The Politics of Early Care

Part of this problem relates to which services are covered. Some of the major government insurance programs pay only for restorative treatment, but not preventative care, says Ramos-Gomez. Put simply, Medicaid will pay for a filling, but not for the less-expensive checkup and cleaning that would have prevented that cavity. This approach often means that checkups are ignored and dental conditions that start with simple tooth decay can escalate, he says.

But for parents of limited income, even with government insurance programs, visiting the dentist can be a serious financial burden. In addition, even those with insurance can be burdened by the common requirement to pay the bill up front and receive reimbursement later.

As a result, many parents simply put off visiting the dentist, waiting until their children's dental problems become so advanced that they require emergency care. According to the American Academy of Pediatric Dentistry, several recent studies have shown that many parents use the emergency room to obtain primary dental care for their children, even though simple preventive checkups could have headed off the advanced problems often seen under those circumstances, making treatment much less expensive.

Lobbying for Change

To promote better dental health among the country's children, both the academy and the American Dental Association are lobbying Congress to modify government insurance programs to increase payments and cover more preventative work.

As is true in most other medical fields, Ramos-Gomez says many of the current plans have reimbursement levels that are far below the rates sought by dentists. Medicaid often pays only half of such fees, and some state plans pay as little 20%. As long as that remains the case, "there is no incentive whatsoever to take on these patients," he says.

The other side of this issue is educating people not only about the need for preventative care but also that help is available. "Some people don't seek care, even when they would be covered by some of these programs," Casamassimo says. "We have to let them know."

Now age 6, David's adult teeth are starting to grow in, finally filling the gaps left by the earlier removal of his baby teeth. Today he smiles, eats, and talks much like any other child. According to his mother, David's self-confidence has climbed thanks to the dental care he received. And that, she says, is definitely something to smile about.

Will Wade, a San Francisco-based writer, has a 5-year-old daughter and co-founded a monthly parenting magazine. His work has appeared in POV magazine, The San Francisco Examiner, and Salon.