An intramural argument has broken out between the dentistry profession
and those seeking expanded dental preventive care for children of poorer
families. But unless a larger question is resolved first, regardless of which side
gains the upper policy hand taxpayers will be the loser.
In the wild, wide world of Medicaid coverage, dentistry is an outlier
with federal law and regulation essentially making its provision optional.
Louisiana provides
some emergency care, although it recently had to drop
regular care for expectant mothers due to budget concerns. But what many
don’t realize is dental care is available to these children in one area, right
at their schools, where some perform sealant procedures on teeth, designed to
reduce the incidence of cavities that may prevent future access of Medicaid
emergency-based services.
In fact, as of the latest
statistics available, Louisiana is rife with such clinics, which were
encouraged to be established by the state by legislation in 1991 and now have
64, which ranks ninth highest in number but sixth-most per capita. Should a school establish one, they are not cheap; the state
Department of Health and Hospitals requires a
minimum of six different kinds of professionals mandating six broad areas of
performance.
One optional service, requiring an additional professional, is
dentistry. And on the heels of a report criticizing
the state (and many others) for lack of access to sealants in school-based
programs, has triggered a policy debate over Louisiana, and a handful of other
states, requiring prior dental examination for authorization of applying sealant,
which does not have to be done by a dentist and can be performed by a
specially-trained hygienist. The state’s dental profession argues trained
dentists should make the call on whether a sealant is appropriate (as something
more drastic like a filling may be better), while others, including the report’s
authors, say hygienists can be trained to do this.
We’ll leave it to the professionals in the field to debate what kind of
training is appropriate. Of greater concern is adding this to the extensive
menu already operating at school-based clinics, in part because of controversy
over the value of sealants themselves compared to a simple regiment of regular
brushing and flossing and the expertise in knowing when and if it is
appropriate to do it.
Sealants have no utility when basic, adequate oral hygiene care is
performed. They only have value when the process of decay has begun, in an
attempt to slow it. Unfortunately, it is used as a substitute for learning
these beneficial habits and having them provided free and willy-nilly in
school-based clinics only discourages acquisition of these habits and encourages
taxpayers footing the bill for a treatment unnecessary in almost all cases if
families would just take some personal responsibility.
It should be the job of government to promote this responsibility.
Thus, the real policy debate should be over whether to allow school-based
clinics, which already function far beyond immediate and emergency care by
provision of preventive services in other areas, even to offer this particular
service. The wisest course would be not.
Instead, the state should mandate, just like every year before
enrolling for the school year proof of certain vaccinations must be provided,
that all children have had a dental exam. If as a result of that parents wish
to have sealant for their child, they may go for it out of their own resources –
insurance, out of pocket, or by charity, with no government financing, just
like in paying for the exam. Denied the easy, taxpayer-financed option, this
will spur families to take dental care more seriously if faced with the
consequences of poor decision-making in this regard, lowering aggregate costs
systemwide. If school-based clinics wish to contribute, they can dispense toothbrushes
and floss and instructional materials on their use.
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