For the past 30 years, Dr. Fred Howard of Harlan has been seating patients in his blue dental chair and telling them to open up. When they do, he’s seen all kinds of scenarios, from toddlers whose teeth are already rotten from sucking on bottle filled with soft drinks to 20-year-old adults with no teeth at all. On some occasions, children walk in with such a severe abscess in their mouth their eyes are swollen shut.
Though the view can be grim, Howard said he has seen some improvements in his decades of practice, but with new changes in Medicaid managed care, the overwhelming prevalence of children and teens drinking soda pop and an embedded cultural belief in some areas that “teeth are just something to get rid of,” Howard concedes that making headway can feel like one step forward and two steps back.
Enter the newly re-established Kentucky Oral Health Coalition, a statewide force whose goal is to ensure Kentuckians have happy, healthy smiles.
Dozens of organizers and stakeholders met in March to discuss the coalition’s aims, and a membership drive is underway to build financial momentum. The coalition will promote oral health education, statewide partnerships and advocate oral-health legislation. “I think they will turn into the advocacy group for dental change,” said Julie McKee, dental director for the state Department of Public Health. “They’re working hard to come up with a plan. They’ve got their heads on straight.”
Howard (pictured with Gov. Steve Beshear at signing of the bill that requires dental exams for students starting school) favors the expansion, but doesn’t feel Kentucky’s oral-health problems can be solved just by putting more boots on the ground.
“The bottom line is: We can have twice as many dentists, have more dental hygienists, but if we don’t change the mindset, if we don’t provide the education, I don’t think we’re going to solve the problem,” he said.
To that end, the coalition is also investigating ways to expand school-based health and dental education, either by finding funding, collaborating with groups that are already in place or advocating legislation changes, Plummer said.
A recently enacted state law requires children to get a dental screening before entering kindergarten, but there is little else in the way of legislation that requires schools to offer services to help students with dental problems, Plummer said. “Kentucky law says that students’ health does affect their learning and schools should take steps to affect their learning but it’s fairly broad,” she said.
The administrative burden that comes with these patients has also gotten worse since Medicaid transitioned to managed care, Cecil said. “Everything they do has to be pre-authorized,” he said. “That delays approval, delays treatment, delays payment.”
Under managed care, Howard said, patients now need to come in twice to get a full complement of X-rays and radiographs done, which can not only make it hard on dental practices, but for patients as well. “The more times they have to come, that gives them more opportunities to miss appointments,” Howard said.
That gathering was not just made up of dentists, oral-health advocates and experts, Howard said. Members of the media were present, along with parents, health department officials, school nurses, students and educators. That made all the difference to Howard, who said he is inspired by what changes might occur and what education can take place. “When we have people from all these different venues, we have more of an opportunity to make a difference,” he said.