Struggling to pay for dental care

Lack of access for low-income families a problem across the country

So, the Germantown boy’s parents sought help from their health care provider, which serves low-income patients.

Jeffrey Chan needed to see an endodontist, a dentist specializing in root canals, so that his permanent teeth would not be damaged, the boy’s father, Peter Chan, said in an e-mail to The Gazette. The family contacted Jeffrey’s insurance company, which at first referred them to primary care dentists.

While the company searched for an endodontist, two of Jeffrey’s adult teeth turned gray and black, Chan said.

An endodontist outside of the insurance company’s network performed a pre-root canal treatment for young patients on Sept. 7. The family paid $2,000.

‘‘It’s very disappointing,” Chan said. ‘‘We called every day because we knew the teeth would die very soon.”

Jeffrey’s situation is not unique. Access to dental care is a problem for uninsured and underinsured people across the region, tragically illustrated by the February death of Deamonte Driver, the 12-year-old Medicaid patient from Prince George’s.

His death spurred dental care inquiries in the U.S. Senate and the Maryland General Assembly and shattered misconceptions that oral health care is optional.

‘‘If you have an infection in your mouth, it sits right over the heart and lungs and right under the brain,” said Kathy Lyter, manager of oral health services for Montgomery County’s Department of Health and Human Services. Montgomery provides basic and restorative care to select residents who are uninsured, underinsured or not eligible for Medicaid. Montgomery is the only county in the state that provides dental care for the elderly and adults besides pregnant women, she said, but it is also home to more people in need of care.

Lyter estimates that 110,600 adults, pregnant women, seniors and children are eligible for care in the county, which has the budget and space to serve 4,200.

Though the program increased its capacity after receiving long overdue expansion funding from the county two years ago, it still cannot accommodate everyone eligible for services, Lyter said.

Many patients seek care from other organizations and only a small fraction of those eligible for county services actually apply. The county is trying to resolve some of those issues by increasing coordination between its dental and medical programs, Lyter said.

‘‘We’re working from a hodge-podge of non-profits who have all been doing great things, but now we have to streamline the network,” she said.

The county is the last resort for people who have otherwise been unable to access care, she said.

‘‘Like everyone else in the American health care system, we’re subject to the same problems with available care,” said Kent Jenkins, a spokesman for the Chans’ health insurance company, Virginia Beach-based AMERIGROUP, which provides coverage for low-income patients.

Though he would not comment specifically on the Chan case, he said that in situations such as Jeffrey’s, the company sets up a one-time agreement with a doctor outside its network and pays the fees.

Dentists, particularly those who accept Medicaid patients, are in short supply in the county, Jenkins said, and specialists are even scarcer. AMERIGROUP has about 100 dentists, including dental specialists, in its Montgomery County network, he said.

Few dentists are willing to accept new low-income patients because of high costs and low reimbursement rates that have not kept up with inflation, said Sharon Zalewski, director of the Center for Health Care Access with the nonprofit Primary Care Coalition of Montgomery County. The cost of dental care per client – usually between $300 and $400 per year — is nearly twice as much as general medical care because of expensive equipment, supplies and facilities, she said.

‘‘You can’t do a 15-minute dental appointment,” she said. Zalewski estimated that 100,000 people in the county are uninsured, but more may be without oral health care because dentist visits are not always insured.

The situation may get worse in the future as the number of retiring professionals surpasses the number of new dentists entering the field, Lyter said.

Some area dentists are trying to help meet the demand. Staff at the Germantown Dental and Cosmetic Clinic recently provided a day of free dental care to 32 patients, financial coordinator Carol Brannum said.

‘‘There’s certainly a lack of access to dental care,” Dr. Arpana Verma said, adding that prospective patients began to line up outside the clinic well before it opened on the free care day on Sept. 13. The practice accepts Medicaid patients.

In 2005, 34 percent of children eligible for Medicaid in the U.S. received dental care services, according to a May report from the U.S. Oversight and Government Reform Committee. Tooth decay is the most common childhood disease — five times as common as asthma — and low-income children are twice as likely to be sufferers.

Medicaid patients ‘‘really don’t have anywhere else to go. There are very few private dentists that take them,” said Golnar Jahanmir, a pediatric dentist with a practice in Rockville. ‘‘There are some dentists that participate, but it’s still a big problem.”