HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Improving the Oral Health of CSHCN through the lifespan

MAUREEN MITCHELL: Well, Toni mentioned a lot of things that I was going to say, so this should move a little more quickly. Yeah, I think we’re certainly in agreement as parents. We see the same things you all see.

My name’s Maureen Mitchell, I’m the parent of four daughters. All born prematurely, and Bridget, my oldest, when she was born three months premature, she was very ill, of course, and was put on a respirator and lots of medications. And certainly our main concern was, we focused on the primary health care issues. And oral health dental care wasn’t even mentioned for many, many years. But we noticed when her teeth grew in, they were all brown and misshaped and they looked like they were pointy and things like that and really strange looking. And I was never told that that might happen, wasn’t even a possibility, never in the vocabulary that that could be a possibility, but we were very surprised. And the primary care doctor said, “Hmm, gee, no, I don’t know. Are you sure you’re not giving her,” I said, “They’re just growing in, how can it be baby bottle tooth decay?” Which was a fairly new concept back then, by the way. But, so I asked around, checked around, this and that. And they go, “Oh, that’s probably because the medication she was on.” So it goes to show you the lack of awareness, the lack of knowledge, and the lack of information and interest that we have as families, as parents.

I also got a lot of; I endured years of those strange looks and questions. “Are you putting your baby to bed with a bottle?” I said, “She doesn’t even drink from a bottle. She doesn’t suck.” “Well, you keep her away from sugar now, look at her teeth.” I said. “That’s from her medicine.” Anyway, it was hard to convince some people I think. But again, I think working in partnership and educating me and have a conversation with me. Just don’t look at me and make assumptions about her.

Anyway, we don’t’ have access to clear, accurate information about oral health and you know, for those in Head Start, may be eligible for Title V services, and WIC services, and things like that, yes, you do get some information and it’s certainly much better than it was when my children were younger, but for others who aren’t connected to those services, or who don’t speak English, or English isn’t their primary language. You get even less, if not zero information. Remember the days when children received periodic check ups in schools and different variety of places, primarily in schools. You’d get the fluoride rinse and swish. My kids, when they’re younger, have that today. I think it’s very rare to see. Those programs have all been cut for the most part, I would imagine.

And where do families receive information? Maybe it’s from a pamphlet in a doctor’s office somewhere or another parent, relative, mom, neighbor, but most families have no formal way of receiving information or support. Again, if you don’t have access to the internet, or if you’re busy caught up with so many other issues in your life, it’s not really primary. I know I get questions. I’m a grandmother, too. I have two lovely grandchildren, four and a one year old. And I remember my daughter asking me, “Mom, he swallows the toothpaste, isn’t that bad for him?” And just really basic questions. Where do you go to get those kinds of questions answered? I guess to your mom or grandmother or someone like that.

But there are lots of barriers to access. There are 3.6 million children between the ages of 1 and 17 years old that do not receive all the routine preventative dental care that’s needed, that would include check ups, screenings, sealants, things like that. So that’s a lot of children in America, 3.6 million that are not receiving any routine preventative dental care.

We know there’s a lack of providers, I won’t get into that, but there’s a major shortage. And if you have Medicaid, it’s even more difficult. We all know about providers that say, “We’re not taking new Medicaid patients,” or as you mentioned one hour a month they might see a few extras, but, and then if your Child with Special Health Care Needs. The shortage is even greater, because there’s 10 percent maybe of the providers that are knowledgable and able to and experienced even in taking care of our children with those very unique needs and the special accommodations needed. They won’t open their month, they need anesthesia and how many dentists will say, “I don’t do anesthesia, I’m not taking the responsibility, no liability, etc.” And then if you have Medicaid and a child with special health care needs, good luck. It’s a horrible experience out there and it’s very difficult. I won’t go on with barriers, there’s financial, out of pocket expenses for families, there’s 23 percent that would be 16.2 million children, with no, without any, with health insurance that doesn’t have dental coverage in it. So needless to say, a family often can’t afford out of pocket and I’m preaching to the choir here, I know you all know about physical accessibility. I know my own situation, we had a dentist actually come out to the car, it was my kids’ orthodontist that came out to my van and looked inside my daughter’s mouth. He said, “You’ve got this thing here and there, looks like an abscess,” which it was, and so on. So he came out because he wasn’t accessible, I couldn’t get the wheelchair into his office, it was very nice for him to come out, too.

So lots of barriers, I won’t get into all of them, you probably know all of them anyway, so, us parents are. You know what; it’s very heartbreaking for a parent. You’re, probably most of you are parents out there, and you know that when your kid needs something, you’re going to like kill to get it, right? You do without to give your kids whatever they need. But some families, you just can’t find, if you don’t have a car and the nearest dentist is 50 miles away, it breaks your heart as a family knowing that he needs it and you have no way of giving it to them. It’s very heart breaking, it’s going to make me start to cry, I’m going to stop right there now.

Anyway, let me turn my page, and see. There are a few small steps that we can take now to improve access to oral health, I’m thinking and some of my colleagues that Title V may be could take a more active role and insisting that medical homes, I know that’s a strong word, that medical homes would include coordination of oral health as well. That physicians should take a more active role in knowing the providers. This was touched on earlier with Toni’s presentation, what they’re doing in Maine. But physicians should refer to the dentist. I know if there are shortages, but there are alternatives that they should know about and maybe we need the Title V public health system to go into and nurture or give them that information and nurture partnerships in the communities. And partner with others, Family Voices and others, too, in those efforts. I know there is no one looking after oral health needs and we really need the local health community to help us make it through and help us with that type of coordination and give us the information we need. And websites, if you have a computer, that’s great, too. One of the next steps, we feel, is to encourage State Title V, CSHCN, to identify key stakeholders and to build partnerships, committees, you know, advisory teams, and so on, to address these issues. Reimbursement rates were discussed, very low provider shortage training, an experienced; one thing that was mentioned is to do with the debt forgiveness. Get more focus interested in becoming dentists and make it affordable for them to receive that type of education and the experience needed.

We can do so much, I think public health too, to partner, and get dentists to understand special needs and to get the experience they need in working on their children. Lord knows we have a lot of kids without it. Take some of those some students and partner them, or pair them up with the families who need dental care, and they can care a lot. Anyway, there’s those kind of things that should be happening. Encourage medical homes to include coordination of oral health needs and to increase information and supports given to families, youth and individuals. I think that Bright Futures is a step in that direction. We need more of that, even another thought we be in doctor’s offices, more information about oral health. Maybe a video that shows, or some of those materials routinely there that families can watch a video and I noticed with my own daughter, too. Oral health was something that she wasn’t all that knowledgeable about. Of course, I shared as much as I know about teeth with her. Primary care doctor, always 10 minutes, you’ve got to get out the door to the next patient. So they don’t have the extra time, they’re busy with the basic immunizations and such. But I noticed that she took on a job as a dental assistant. And now you should see how she’s got the toothbrushes, the floss, she’s got her four-year old flossing his teeth, and boy, I’m so proud of that.

So, but see it took information and a real knowledge on her part, wow, this is important. And she has instilled, “I don’t want to brush my teeth,” “You’re going to brush your teeth.” And a parent has control and authority, they can make their kid do stuff. And she has taken it on as an important issue and I’m very happy about that.

So thank you very much, there’s my contact information, I’ll turn it over to our next speaker.