Lack of dental care leaves poor in agony

Leslie Storer gets free dental coverage through Medicaid, the government health plan for the poor. In reality, the Tumwater resident has paid for it with her teeth.

When Storer, a former special-education teacher, had three decayed molars, root canals likely would have saved them. But Medicaid quit paying for such procedures for adults after budget cuts in 2003.

So for Storer, who survived polio and lives on $625 a month in disability payments, the only alternative was to have the teeth extracted.

"I cried," said Storer, 61. "I had a vision of these old ladies with toothless mouths."

Even as improving the nation's health-insurance system gains traction in Congress and in state capitols, dentists and advocates for the poor complain that dental care remains a neglected stepchild among health priorities. In Washington, Gov. Christine Gregoire, while promoting universal health coverage for all children, has not proposed any increase in money for dental care for the poor.

The disparity leaves dentists warning the governor and the state Legislature that poor and uninsured people will face an increasingly tough time getting decent dental care. And advocates note that poor oral health is the root of a host of life-threatening and expensive medical problems that contribute to an overloaded health-care system.

Even those who qualify for government assistance are finding it tougher to get help. For the first time, a majority of the 3,800 active dentists in Washington won't accept Medicaid, saying it doesn't pay enough and poses too many paperwork hassles.

That leaves a long wait, or a trip to a community dental clinic. Either way, the treatment is usually simple.

"They'll pull the tooth," says Tony Lee of Solid Ground, a Seattle anti-poverty and anti-racism group that is fighting for more Medicaid dental funding. "That's the treatment."

"Urgent care" clinic

It was another weekly "urgent care" day last week at the Community Dental Center in Auburn, one of four dental clinics operated by the nonprofit Community Health Centers of King County. Patients nursing swollen mouths, abscessed teeth and other dental woes had lined up since before 7 a.m. for one of the first-come, first-served dental exams. Patients are asked to show up with $40, but not all do.

Michael Coates of Auburn was grimacing in pain. He had four inflamed, infected wisdom teeth — and no dental insurance.

As he waited, Coates held an empty juice jug in one hand and a pitcher of ice water in the other. To dull his toothache, he sipped the ice water through an oversized straw, held it in his mouth, then spat the tepid water into the jug. Then he would do it all again.

After finally reaching the dental chair and calming down, Coates was given a shot of anesthetic. But what he really needed was oral surgery, and the Auburn clinic isn't equipped to handle that.

He was given a list of oral surgeons, including the University of Washington's dental program, which treats many poor patients but has a long waiting list. There are simply too many people who need free care and not enough places that will do it.

Coates, who delivers furniture and does other odd jobs and doesn't qualify for Medicaid, has heard it all before. He hasn't been able to find an oral surgeon to extract his throbbing molars for little or no money. "This is no way to live," Coates moaned.

Dr. John Caron, dental director for Community Health Centers, says delays in getting treatment often turn simple dental problems into expensive crises. For example, the experts at the Auburn clinic noted that Coates' ordeal might have been avoided had he been able to get help before his teeth became infected.

Lee, of Solid Ground, says there's an even larger issue at stake: Oral infections lead to health problems as serious as heart attacks and strokes. Having missing teeth interferes with chewing and contributes to a poor diet or malnutrition. And it affects a person's speech and appearance, which makes it harder to find a good job.

"You can't separate the mouth from the rest of the body," Lee says.

A dental-health crisis

Washington actually has one of the more generous Medicaid dental benefits in the nation. Half of all states provide no dental coverage at all or limit coverage to cases of severe pain or trauma.

Nationally, a third of Americans have no dental insurance, and about half of all dental procedures are paid for out-of-pocket, according to the federal government's 2004 Medical Expenditure Panel Survey.

Most Washington adults who qualify for Medicaid can get some free dental care, including checkups, cleaning and fillings. But it's not as comprehensive as it used to be: In 2003, the state Legislature cut the biennial Medicaid adult dental budget by 26 percent, from $88.7 million to $65.9 million.

Unlike with children, states do not have to provide Medicaid dental coverage for adults. The savings came largely from eliminating coverage for many root canals and crowns.

But the main problem is that Medicaid pays dentists 30 percent or less of what private insurers pay for same procedures, said Dr. John Davis, the director of the state's Medicaid dental program.

"It costs us money to see those patients," said Dr. Rhonda Savage, a Gig Harbor dentist who is president of the Washington State Dental Association. Dentists, she said, "are just a small part of this enormous problem."

The result, says Davis: "We're on a slippery slope of private practices" dropping out of Medicaid. "At what point are community clinics not going to absorb it any longer?"

Pushing for change

To try to stem the exodus, the dental association is pushing state lawmakers to partially restore the cuts in the Medicaid dental program and boost reimbursement rates for dentists. It would cost about $22 million over two years, a 9 percent increase over the governor's current proposal.

But even that might not be enough. Some patients regard being on Medicaid as worse than having no insurance at all.

Lisa Scott, a Queen Anne resident who lives on disability benefits, had to scour phone books before finding a dentist in the University District who was willing to take Medicaid.

The dentist cracked Scott's tooth while touching up a filling, she said. Then Scott couldn't reach the dentist the next day and couldn't find another dentist to treat her pain.

Finally, she went to a hospital emergency room. "If I had better coverage, I would have gone to another dentist instead," she said.

"The reality is that there really is no dental coverage with Medicaid," she says. "It's a nightmare out there."

Kyung Song: 206-464-2423. Seattle Times staff photographer John Lok contributed to this report.