U.S. Rep. Elijah Cummings, joined by U.S. Senators Barbara Mikulski and Benjamin Cardin, convened a forum Feb. 22 at the University of Maryland in Baltimore to discuss the progress in oral health care since the 2007 death of Deamonte Driver, 12, from Prince George's County.
The three legislators opened the forum with statements commemorating five years ago when the country and the world were shocked by the news that that Driver had died from complications of an abscessed tooth that should have been treated long before he was admitted to an emergency room.
Cummings said, "His tragic death, at the age of 12, opened our eyes to the crisis in dental care for low-income children. We are here to discuss the improvements we've made in the last five years and to talk frankly about what remains to be done."
In the aftermath of Driver's death, the University of Maryland School of Dentistry led a campaign to extend oral health care to underserved people across the state.
Cardin said new federal health care laws contain many new provisions that will help aid parents to gain access for childhood dental and oral hygiene care and access to education on the well-known link between oral health and overall health of an individual.
Burton Edelstein, DDS, MPH, founding director of the national nonprofit Children's Dental Health Project, asked Cardin to take the lead in implementing appropriate regulatory oversight of such new programs to make them efficient.
On the state government level, comprehensive legislation for improvement in oral health care has been mandated yearly since Driver's death. It also was the catalyst for the creation of the Dental Action Committee, which within three months of its formation in 2007 made seven recommendations that were then acted upon by the state legislature resulting in sweeping changes in the Medicaid dental reimbursement system. The Dental Action Committee has grown to become the Maryland Dental Action Coalition.
Harry Goodman, DMD, MPH, director of the Office of Oral Health for the Maryland Department of Health and Mental Hygiene, said that the seven recommendations translated into "significant Medicaid dental reforms, expansion of the public health dental safety net system, dental workforce expansion, training of medical and dental providers, school screenings and care coordination, and the need for an oral health literacy program aimed at the public."
In Baltimore, the Oral Health Impact Project is a successful "resilient" delivery system for children in the city's public schools that should be "propagated" throughout the state, reported Lawrence Caplin, DMD, CCHP, who is CEO of the project. "The snapshot of what we have seen in Baltimore is significant in providing comprehensive in-school care for at-risk students."
The project provides a "dental home" in the schools in partnership with community organizations, said Caplin. He said the children treated have avoided complications in dental care later in their childhood. "As a result, the problem surrounding emergency visits is eliminated. That cost goes away."
Maryland has been rated as the top state for dental care by the Pew Children's Dental Campaign, reported its director Shelly Gehshan, MPP. Maryland received an A grade in Pew reports for meeting or exceeding benchmarks in dental sealant programs, community water fluoridation, Medicaid reimbursement, and collection of data on children's dental health. "So I hope you [Maryland officials] can do more to show the way for other states," said Gehshan.
Edelstein said, "I want to talk about the glass that is still half empty. My appearance is bittersweet. Maryland yes, but across the country, there are states that need to be Maryland. Maryland is stellar. This is a disease that is overwhelmingly preventable. It is simply garden variety dental decay.
In many ways to insert oral health care into general health care is a little bit like fitting a round peg into a square hole. ý. [The idea is] to design the out-of-pocket protections to protect the families so that the dental care is not only affordable but understandable."
"But we have much more to do, much farther to go, much work ahead," offered William Bailey, DDS, MPH, assistant U.S. surgeon general and chief dental officer for the U.S. Public Health Service. Bailey told the national legislators that oral health is much more than fixing teeth-a physical problem. It is also a mental health, psychological, and educational problem, he said. He offered new Institute of Medicine reports as "new road maps for oral health." He added, "Now we have new bench marks for integrating oral health into overall health."
Caplin analyzed the dentist's dilemma on the issue. "Dr. Jones' dental office on the corner is not in a position to solve the problems we have today. The solution we came up with is to bring the care to the patient. We implemented a model if a child is not in school that day they are seen the next day. We make sure it is a pleasant experience. The barrier we face now is consent from the parent to see the child. We are then partnering with youth organizations like the YMCA," he said.
Goodman, former chair of the School of Dentistry's Clinical Operations Board, suggested that dentists need to be "guided to a true medical home, and we should provide care coordinators, almost navigators, to let them know. We are embarking on a major literacy campaign."
Much of the discussion focused on the value of very early examination of a child's oral cavity. Bailey said that a one-time application of a dental sealant reduces the risk of dental disease later for a child by 60 percent. Edelstein said "the disease is established before the age of 2." He said officials making new programs and regulations need to "look into early intervention programs where large numbers of children are being addressed."
Speakers spoke pessimistically about dental diseases nationally. Gehshan said limited access to dental care is a growing problem nationwide. More than 16 million American children went without dental care in 2009, according to the latest available data, and more than half of Maryland children on Medicaid did not receive a dental service. Grace Williams, parent of twins with autism, who told a tragic story of failing to find a dentist to treat her children, said, "This is a basic human rights issue."
Cummings summarized the University of Maryland forum by saying, "Our efforts must start now. We can overcome the barriers with education in our community. We must commit ourselves to closing the gaps that still exist so that we can mark another five years with similar gains."
Cardin added, "We should never be complacent about providing quality, affordable health care to everyone in our community. Since [Deamonte Driver's death] we have taken every opportunity to advance care. There is no health without oral health. It is not just to make coverage available. It is about getting parents to understand why it is important to get their children care."