The Epidemic of Children's Dental Diseases: Putting Teeth into the Law
44 Pages Posted: 5 Jun 2012 Last revised: 2 Mar 2013
Date Written: 2011
Abstract
Health care reform often involves a search for interventions that have the greatest value, both in terms of outcome and cost. Preventive dental care for children is simple, low risk, affordable, and has benefits that exceed its cost, making it a sensible type of care for all children to receive. However, there is a literal epidemic of preventable tooth decay amongst children in this country, an epidemic that has proven resistant to many attempts to ameliorate it. This epidemic leads to pain, poor school performance, poor nutrition, infection, and increased risk of heart problems in adulthood. It also, at times, leads to children’s deaths. This Article argues that this pervasive, stubborn problem of preventable dental decay is structural, and requires legal reforms to create a system whereby all, or at least most, children receive the necessary preventive care in a timely manner.
This epidemic has highest rates of prevalence in children who have other significant stressors in their lives, such as lower socioeconomic status. Interestingly, those in families with relatively high incomes still have an appallingly low rate of compliance with recommended preventive care and so this does not appear to be a simple matter of increasing funding for Medicaid programs.
In light of the epidemic’s pervasiveness and complexity, this Article explores the attributes of the epidemic, gives examples of how the current system is incapable of addressing it and then makes substantive recommendations for legal changes that can help allow for a system that achieves better preventive care.
In brief, there are not enough dentists in this country to treat all children. Medicaid and dental insurance reimbursement rates are inadequate. Many parents cannot seem to manage to leave work and take children to necessary preventive care appointments. This Article recommends that dental therapists, a newer type of caregiver trained in pediatric preventive dental care, be used in schools to provide the basics of preventive care to all children. This proposal is based on the system currently being used in New Zealand, where it has achieved close to universal preventive care. The Article then explains some impediments to implementing this proposal, and suggests interim legal steps to improve children’s dental health.
Keywords: health disparities, dental care, children, medicaid, social justice, health care reform, health insurance
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