HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Improving the Oral Health of CSHCN through the lifespan

JAY BALZER: And I want to open it up now for discussion, but before anyone else gets a chance to talk, I want a little minute to say something.

My perspective comes as an MCH person, and as a dentist. I worked in the MCH unit and regional office for about eight years. And not necessarily as a dentist, but in the MCH program, being a dentist also, I have a very keen interest in this. And I just want to point out; I think Toni showed us the kinds of dental services that are covered within the special needs program in the state of Maine. And that’s probably a very typical kind of list. The real infrequent kinds of conditions like cleft lip, cleft palate, where a child is born with the condition and it affects the mouth. Now, cleft lip, cleft palate might affect one in a thousand births. Something like ectodermal dysplasia, which affects teeth, that’s also a very rare occurrence. But it affects the teeth directly. So we can understand why a state program for special needs children will cover conditions that directly affect the teeth. But these are the really rare, they’re costly to treat, yes, but it affects very few children.

The much more common kind of problem we kind of see with children with special needs is children that have garden variety kinds of conditions, very often behavioral issues, the kid is mentally compromised, or has uncontrolled movements and can’t cooperate in the dental chair. The dentist can’t handle it. So treatment cannot be done easily and it’s postponed, and postponed, and postponed and here you have a child that qualifies, has special needs, with an increasingly complex, difficult, dental problem, which starts to become disabling itself. Because it causes pain, problem eating, problem sleeping, problem concentrating, so, a child with special needs qualifies for the program because of the primary disability. But now, because of that disability has a secondary condition. A dental condition caused by the primary one.

What I’d like to suggest is that our state program that are serving these children be geared to producing, to assuring a healthy child. A child with a disability that’s healthy, including healthy mouth. And when that unhealthy mouth is a direct cause of the primary disability, I would like to see the dental care for that child covered to bring that child back up to a healthy situation so we don’t now have a child with the primary disability, mental retardation, now has a dental disability, which they never were born with and they’re really not predisposed to.

My suggestion is we don’t start saying we’re going to increase dental coverage for all children with special needs, because not all, just because you have a special need doesn’t really make you any more susceptible to dental decay. It’s certain behaviors. It’s certain complex medical conditions you know a bleeding disorder. That doesn’t make your teeth any more prone to decay, but it sure as hell makes the dentist a lot more reluctant to bring you into the office and work with you.

So what I’m suggesting is we start to think as dental problems, are they or are they not connected to the primary disability? And if so, let’s start thinking a little broader and get that kid covered so he’s not falling through the cracks and the payment for it might not necessarily have to come out of special needs program, it could be oral health program in the health department. So we start looking at bringing other programs together to collaborate bringing resources together, to get that child healthy. Because if you’re going to start adding coverage for dental care, where’s that money going to come from?