Montrose - Daily Press

MONTROSE  — Maria Suavez lives in Olathe and has three young children. She learned about the Community Dental Clinic (CMC) in Montrose though the schools.

Wednesday, she sat in the dentist's chair for her regular checkup. Her visit is being paid for through Farm Workers Health Care.

Suavez's three kids also take their turn in the chair. Dental hygienist Sarah Pandelos has them hold up a mirror while she explains how to properly brush their teeth. The children's visit is paid through Medicaid.

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The Suavez family is blessed in that their care is covered. Suavez can feel confident her kids can learn in school because they're not distracted by pain in their mouth. She can feel confident that her children's baby teeth are providing the appropriate spacing for their adult teeth. She knows her children's mouths are disease-free. She can see their smiles beam self-assurance because they're healthy.

Not all mothers have the same confidence in their child's oral health. Poor oral health is a component of poverty. There are many reasons: lack of knowledge on the importance of oral health, lack of insurance to pay for care, lack of understanding of state benefits for oral health and limited access in the community for low-income families.

As our country looks to address its poverty issues, some community members have decided to take smaller bites out of the problem by addressing dental hygiene.

Tooth decay is the leading chronic infectious disease affecting children, according the Colorado Health Report Card. By the time they're 11, an estimated 50 percent of all children will have experienced tooth decay, and by the age of 19, 68 percent will have decay in their permanent teeth.

Only half of children living in households below the poverty level received preventive dental care in Colorado in 2003, while more than 80 percent living in higher income households received such care, according to the report card.

"This (addressing oral health) is just one piece of a very large pie, but it's in existence and is under-utilized," said Richard Harding, interim executive director and board president for Painted Sky, a local resource conservation and development council.

Oral diseases are almost 100 percent preventable. However, lack of care results in extensive treatments instead of preventative practice. By this time, the cost is even higher.

Educating the community on the importance of oral health and the options for care is something that can be done, Harding said.

Providing assistance

Medicaid is available to certain low-income individuals and families. Guidelines regarding eligibility and services are set by the state. The person must be a U.S. citizen or lawfully admitted immigrant. Eligibility for children is based on the child's status, not the parent's.

CHP+ (aka State Children's Health Insurance Program) is also administered by the state. It is designed to provide coverage to "targeted low-income children" who reside in a family with income below 200 percent of the Federal Poverty Level or whose family has an income 50 percent higher than the state's Medicaid eligibility threshold, according to Health and Human Services.

"It's designed to catch those children caught in no man's land," said Dr. Ben Wilson, a dentist and owner of Smiles 4 Kids in Montrose. "It's another under-utilized program in dentistry. ... The money is a little tighter, but sometimes it's enough to get kids healthy and keep them healthy."

Medicaid covers 100 percent of costs, said Bill Sale, executive director of CMC. CHP+ also covers dental but has a limit of $600 per year.

"The truth of the matter is only one-third of the community eligible for Medicaid, takes advantage of it," said Peg Mewes, director of Montrose County Health and Human Services.

Of that population, only one-third uses their dental coverage and sees a dentist on an annual basis, said Linda Reiner, director of planning and evaluation at Caring for Colorado Foundation, a large monetary backer of dental programs throughout the state.

Addressing oral health

"I think it's an education problem," Sale said. "This is where we need to start, simply educating people on what is available and educating people on the necessity of dental care."

In October 2007, the Northside Child Health Center opened on the Northside Elementary campus.

Jennifer Danielson, the center's pediatric nurse practitioner, sees kids ages 3 to 12, many who are underinsured or uninsured.

Medicaid information is provided to every child who enrolls, and from the time the clinic opened until July 2008, Danielson said it helped in 38 applications.

Lack of dental care is sometimes the result of priorities.

"The challenge is that about half our kids don't have insurance, they pick and choose (care) with the budget they have," she said. Oral health is put at the end of the list.

But grants have moved it to the front of the line.

Last week, students from Olathe Elementary School received free dental screenings and fluoride treatments. Each student whose parent signed the permission slip was sent home with toothpaste, toothbrush, floss and the proper instructions for caring for their teeth.

Ten-year-old Taylor Carter had never been to the dentist and received her first treatment Wednesday. Though Carter brushes twice daily, Pandelos, who helped with the program, recommended her for fillings.

Earlier in the year, Northside offered the same program. In 2009, Johnson Elementary will see the same program.

It was free, but only about 25 percent of the schools' populations participated. The program makes a return visit to the schools in six months to perform follow-up treatments.

A prevalent issue

Oral health is becoming more prevalent at the state level as well.

Deborah Colburn, managing director of Oral Health Awareness Colorado, said last year the coalition was very successful bringing awareness to legislators on the importance of oral health. Several measures have arisen.

She said one measure is to increase provider rates to dentists who serve Medicaid kids. Many communities, such as Delta, don't have a dental clinic that takes Medicaid patients. Access for low-income families was evident in July when the Colorado Dental Association held a Mission of Mercy in Loveland, Colo.

More than 1,500 patients, some who slept on concrete to begin waiting at 8 p.m. the previous evening for a 5 a.m. opening, received dental care during the two-day program.

"It can be shocking that in the land of the free and the home of the brave — the most affluent country in the world — there are so many needy people," said event coordinator Dr. Jeff Stasch in a CBS interview.

Efforts to increase dental access to seniors are also underway, Colburn said.

There are measures to add adult dental to Medicaid and dental benefits for pregnant women on CHP+.

Gary Steinbach, preventive health administrator for the Telluride Foundation, a major funder of the current school programs, said bringing oral health into the school system is a perfect way to reach more children.

Colburn said dentists also need to change. She hopes that the push to increase Medicaid reimbursements may entice more dentists to join. However, dentists need to "get creative on how they address issues of poverty and what it means for their practice."

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