Article/Column

Children in pain

by Congressman Elijah E. Cummings

Millions of American children are living with pain – and, for far too many, the suffering is so intense that they will find it hard to concentrate on their studies today or even to go to sleep this evening.

The cause of their pain is dental decay, and a concerted, more-effective national effort to better protect our children's teeth is long overdue.

Consider these facts.

The Centers for Disease Control and Prevention tell us that dental decay is the most prevalent chronic disease that our children face, affecting more than one-fourth of all American children ages 2-5 and one-half of those in the 12-15 age range.

Children from lower-income and minority families experience an even higher incidence of untreated decay; and the resulting pain is affecting their ability to eat or go to school.

Studies have found that American children suffering from oral diseases will miss more than 50 million hours from school this year.  All too often, moreover, these infections can spread, causing critical complications like blindness and even death.

This, tragically, is what happened in February, 2007, to a 12-year-old Maryland boy named Deamonte Driver.  An untreated tooth infection spread to his brain.

An $80 dental treatment could have saved Deamonte Driver's life, but he never received that care.  I was so appalled that I made it my personal mission to do everything within my power to ensure that no other family ever endures such a tragedy.

I appealed to my colleagues in both Washington and Annapolis for constructive action; and last month, I was deeply gratified by the federal response in the State Children's Health Insurance Program Reauthorization Act of 2009 that we enacted.

 "SCHIP" ("MCHIP" here in Maryland) is a partnership between the federal government and the states that provides health coverage for the children of families who do not qualify for Medicaid but cannot afford the cost of commercial insurance.

Our reauthorization of this federal-state partnership makes a down payment on our national goal of affordable, high quality dental care for every child.

We must address the fact that 20 million American children currently have no dental insurance.  That failing, combined with the high cost of dental care, is one of the primary reasons that so many children are suffering from dental decay and pain.

It is important to note that the Children's Health Insurance Program now guarantees a dental benefit that includes preventive – as well as restorative and emergency – dental care.  Modern dentistry can often prevent tooth decay before it occurs, saving both scarce public health funds and personal anguish.

For example, applying dental sealants - plastic coatings - to the chewing surfaces of back teeth where most decay occurs is a safe, effective way to prevent cavities.  Yet, although lower-income children suffer far more often from tooth decay than their more affluent neighbors, these same lower-income children are far less likely to receive dental sealant protection.

Parents of new-born and younger children should be informed about how important (and less costly) this preventive dental care can be.  The new SCHIP legislation will help states to bridge that gap.

SCHIP will also help these families pay for more effective protection for their children.  In addition, the new federal law allows federally qualified community health centers to contract with private dentists so that more children insured by Medicaid and SCHIP can be served in convenient neighborhood settings.

Taken together, these reforms can represent an important first step in what must become a national movement to restore all of our children to dental health. Yet, candor demands that we acknowledge the full extent of the challenges that remain.

Last September, Chairman Dennis Kucinich [D-OH] of the House Domestic Policy Subcommittee on which I serve held another in a series of hearings on the current state of children's dental health.  The compelling issue before us was the revelation that at least 25 percent of the children enrolled in Medicaid nationally received absolutely no dental services between 2003 and 2006.

The most significant reasons advanced for this astounding and unacceptable failure were eye-opening: a shortage of pediatric dentists, low Medicaid reimbursement rates for dental care, unduly difficult insurance practices, and parents who are not taking full advantage of the services that are available to their children (often as a result of inadequate information or outreach).

I was encouraged, however, by the testimony to our Subcommittee by Executive Director Susan Tucker of the Maryland Office of Health Services.

In addition to contracting with Doral Dental in an effort to improve the administration of Medicaid dental services, Governor Martin O'Malley and our State Legislature are committed to a three-year effort to increase Medicaid's dental payments to a level where more dentists will be able to participate.

On this and a wide range of other measures critically important to improving the dental care available to Maryland's children, Governor O'Malley has demonstrated solid leadership, especially during these difficult economic times.  I am hopeful that the expanded federal funding for Medicaid that we included in the federal government's "economic stimulus" legislation will allow Maryland to do even more to sustain our progress.
 
For example, the new Children's Health Insurance legislation includes language that encourages states to provide "wrap around" dental benefits to children who are eligible for SCHIP but have private medical insurance that does not include dental care.  Taking advantage of this option could make a major difference in the lives of many Maryland children who are still living with pain.

None of these healthcare reforms will be sufficient, however, unless parents also do what we must to protect the children in our care.  Whatever a family's financial circumstances may be, dental prevention for our children today is far less costly than later restorative care.

We all have important roles to play in protecting the children of our community.  In an affluent and moral society, no child should have to live in pain.

- The Honorable Elijah E. Cummings represents the 7th Congressional District of Maryland in the United States House of Representatives.