Nothing to smile about: Many toddlers lack dental insurance, proper dental care

Health experts recommend that children visit a dentist by their first birthdays or when their first teeth come in, yet a nationwide poll shows that many parents fail to heed that advice.

According to a poll conducted in May 2011 by C.S. Mott Children’s Hospital in Ann Arbor, Mich., only 23 percent of 1-year-olds and 44 percent of 2-year-olds had visited a dentist. Such statistics are troubling, experts say, as well as indicative of another troubling trend: Nearly half of Americans do not have dental insurance.

“Early assessment not only identifies children with decay but provides an opportunity for the parent or caregiver to get guidance on proper nutrition, oral hygiene and preventative care,” says Dr. Bill Kohn, vice president of dental science and policy for the Delta Dental Plans Association, a provider of dental insurance.

dental care toddler

Studies also show that parents who get their children early preventive dental care such as check-ups, cleanings, fluoride treatment and sealants can save on dental treatment costs down the road, Kohn says.

If children don’t get the dental care they need, they’ll be at increased risk of developing dental decay, says Dr. Rhea Haugseth, president of the American Academy of Pediatric Dentistry. Dental decay that goes untreated then can grow until it involves the pulp – the connective tissue that contains nerves and blood vessels, located in the center of a tooth. At that point, a painful abscess can develop “and then if that’s left untreated, you could be looking at more of a systemic infection throughout the whole body,” Haugseth says.

Worst-case scenario: An untreated systemic infection may lead to death.

Widespread problem

A number of studies show how pervasive a lack of proper dental care is. According to a study by the Pew Center on the States, about 17 million low-income children – one of every five kids – in the United States go without dental care every year.

“Many caregivers don’t understand how important their children’s baby teeth are to lifelong oral health,” says Kohn, the Delta Dental vice president. “They help children chew properly to maintain good nutrition, are involved in speech development and help maintain space for permanent teeth. We also know that children who have decay in their baby teeth are much more likely to also get decay in their permanent teeth.”

Children aren’t the only ones who are not visiting the dentist, though. Only 54 percent of adults had dental insurance in 2009, according to a report by the National Association of Dental Plans and Delta Dental. Of Americans without dental insurance, only 34 percent reported they regularly sought preventive care from a dentist. In total, more than 150 million Americans lack dental coverage, which is nearly three times the number of people who are medically uninsured.

Many factors contribute to the fact that parents aren’t getting children in to see a dentist by the first birthday.

• Some parents don’t know dental care is necessary that early. “Parents might believe in the myth that they’re only baby teeth, and they’re going to fall out,” Haugseth says.

• Other parents may think they can’t afford to pay for dental care. However, Medicaid and the Children’s Health Insurance Program each provide dental coverage for children.

• Some parents don't take their children to the dentist because the family doesn’t have dental insurance. According to the National Association of Dental Plans, Americans with dental insurance are more likely to take their children to the dentist.

In general, insufficient access to dental care is not unique to one geographic area, nor is it a problem only for low-income families, Haugseth says. “It is, unfortunately, an epidemic," she says. "It is everywhere. Nobody is excluded.”

Breaking down the costs

Several types of dental insurance are available for children and grown-ups.

Dental HMOs. These provide dental benefits with a contracted network of dentists.

Dental PPOs. Enrollees typically make a co-payment when using contracted providers and pay higher rates when they go outside that network.

Discount dental plans. Consumers pay an enrollment fee for access to a list of dental providers who will offer discounted services. This is a discount program, not insurance coverage.

According to the National Association of Dental Plans, most plans cover preventive care entirely, while consumers make a co-payment for other services. In the United States, the average monthly premium for a dental PPO is nearly $44 for an individual and almost $128 for a family. The average monthly premium for a dental HMO is about $14 for an individual and nearly $41 for a family. Discount dental plans can range from $10 to $12 a month for an individual to $20 to $30 a month for a family.

Low-cost options

For those who can’t afford to pay that much for dental insurance, there are low-cost options.

• Dental schools and dental hygiene schools often offer discounted services as a way for their students to "practice" on real patients.

• The U.S. Bureau of Primary Health Care provides funding for community health centers across the country that offer discounted services.

• Some state and local health departments offer programs. For example, Colorado offers a school-based program that provides dental sealants – thin coatings put onto the back teeth to prevent tooth decay -- to school-age children. Likewise, Georgia has a program that provides fluoride treatments and sealants to kids.

Changes on the horizon?

Some factors suggest that dental coverage could become more widespread:

• With 98 percent of dental plans coming through employers and group programs such as Medicaid, individual dental benefits plans have been somewhat limited in the past, according to the National Association of Dental Plans. However, more dental insurers now are focusing on individual offerings.

• 62 percent of employers consider dental coverage to be important to their benefits packages, up from 53 percent in 2005. Dental benefits typically are purchased separately from general health care benefits. In fact, among private group dental policies, only 3 percent were bundled with standard health insurance plans.

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