Gail Rosenblum: Budget cuts leave a hole in kids' dental care

Phrases such as "on the doorstep" and "final compromise" popped up a lot last week about our nation's health care overhaul. Hallelujahs notwithstanding, I move that we quickly put teeth into the next big health care debate. Literally.

I'm talking about dental care. While the dismal state of affairs for some Minnesota adults deserves its own column (such as a man who landed in Hennepin County Medical Center's hyperbaric chamber after a tooth infection went untreated), it's our kids who need us most at this pivotal and troubling moment.

In 10 weeks the financial underpinning of the dental safety net, the "Critical Access Dental Provider" program, will disappear as part of Gov. Tim Pawlenty's unallotment measures. CADP provides special payments to safety-net dental clinics with high numbers of uninsured and low-income patients.

Its disappearance will reverberate throughout clinics that have made impressive gains in combatting childhood tooth decay. Those gains already have translated into happier, healthier kids, more productive parents and a whopping cost savings for the rest of us.

To wit: Sealants and fluoride treatments cost about $250 a year. General anesthesia in a hospital when cavities rage out of control? As much as $10,000.

"The dental talk is where we need to go," said Sharon Oswald, community impact manager for Greater Twin Cities United Way's Bright Smiles program. The program, in Ramsey, Dakota and Hennepin counties, provides nearly 11,000 low-income children up to age 5, and more than 2,000 pregnant women, with essential preventive and dental treatment.

"We need to incorporate oral health into the overall health discussion," Oswald said, "so there is no longer this legacy of separation between dental care and medical care."

"Children who bear the burden [of dental disease] are those who can least afford to miss school, or have their parents miss work," Oswald said.

School outreach is "pretty inconsistent," Oswald said, and other barriers loom: cost, language, transportation and a dearth of pediatric dentists.

Those working in the trenches try not to point fingers. "We are asking dentists to be exceptionally altruistic," acknowledged Sarah Wovcha, executive director of Children's Dental Services, whose northeast Minneapolis headquarters serves 300 clients weekly, speaking 15 languages, including Vietnamese, Spanish, Hindi, Russian and Chinese.

Some dentists do pro bono work, but the lion's share of care is done in community clinics, where many are in a panic. Vacharee Peterson, a dentist and CEO of Community Dental Care, said Critical Access allows her clinic to provide dental care for thousands of under-served patients. The clinic has increased patient visits by 10,000 annually, treated urgent-care patients who otherwise would end up in emergency rooms and provided outreach to more than 8,000 parents and children. Her clinic faces a loss of up to $1.4 million annually.

Part of the state's budget solution

Patricia Tarren, a pediatric dentist at HCMC, also is part of the solution. In February, she'll speak to emergency department medical residents about how to recognize "raging problems" in children's mouths. "They're my eyes and ears in the field," Tarren said. "If you can catch it when it's just starting, it's so much easier for the regular dentist to take care of it."

Wovcha's 100 clinics, located throughout Minnesota, serve 20,000 low-income clients annually, mostly from birth to 21. But one focus is on pregnant women of all ages, teaching them good dental habits they can pass down, such as not putting baby to bed with juice or milk, which wreaks sugary havoc on teeth.

On Thursday, 3-year-old Sheryln Diaz-Saldivar was looking not-too-happy during her follow-up checkup. Three weeks ago, Sheryln had four cavity-filled teeth treated at a surgical center under general anesthesia. Through Spanish-speaking interpreter Julia Peasley, Sheryln's mother, Edilberta Saldivar, 29, said she is determined to turn things around. Cut the juice, beef up the toothbrushing.

Saldivar also said she appreciates this clinic. We all should. Dental disease is nearly 100 percent preventable. We just need to get to kids before it's too late.

"We're going to take it on faith that we'll figure this out," Wovcha said. "We'll leverage resources, beg, whatever we need to do to keep it afloat."