One of the easiest, and most inexpensive, ways of preventing cavities — applying plastic dental sealants to children’s teeth — is one that Florida is failing to provide to most of its neediest.
The Pew Centers for the States this month gave Florida and 14 other states a “D” for its shortage of school programs offering the treatment in its disproportionately low-income school districts.
One big reason: Fewer than a quarter of Florida schools with high numbers of students participating in the federal free and reduced-price lunch program have a dental sealant program, according to Pew. Sealants are commonly applied starting when children are 7 or 8 years old.
School-based sealant programs are often offered by a county’s health department or community health centers, although that is not the case in Lee County.
A pilot program in Collier offers in-school sealants this year to eight schools. That program, supported by grants to the Healthcare Network of Southwest Florida (formerly Collier Health Services), hopes to expand to 14 schools next year.
Dr. Bill Maas, a Maryland-based dentist and consultant to Pew, said the cost of applying sealants is about a third the cost of filling a cavity.
Dentists charge a median rate of about $44 for sealants, according to a 2009 American Dental Association rate survey. The median U.S. rate for fillings is $134.
Sealants commonly last at least several years.
“It is an upfront investment,” Haas said. “But it’s almost certain to save money in the long run.”
This gap in preventative dental care is a particular problem for a state in 2010 that saw about $89 million in unnecessary dental treatment in hospital emergency rooms, which are largely not equipped to treat these kinds of problems.
About $3.5 million of that was in Lee and Collier counties, according to a report last year from the Florida Public Health Institute. It counted 4,655 dental-related ER visits here in 2010, a 40 percent increase over the 3,369 in 2008.
Among the other Pew findings:
• In 2009, U.S. children made more than 49,000 visits to hospital ERs for dental problems, many of which likely would have been prevented with sealants.
• About three-quarters of U.S. children age 6 to 9 did not have dental sealants in 2009 and 2010.
• Florida is among 19 states, and the District of Columbia, that did not submit information to the National Oral Health Surveillance System, a database used to identify trends and assess the need for improvement.
This is hardly the first poor showing for Florida on Pew scorecards.
A 2011 study found that only a quarter of Florida children covered by Medicaid had adequate access to dental care, compared to the national average of 38 percent. That earned a state an “F.” It received the same grade in 2010.
Consider this sampling of statistics from Healthcare Network of Southwest Florida’s limited effort last year: More than 60 percent of 7- and 8-year-olds it visited showed signs of decayed teeth, problems that effected even their newly sprouted permanent teeth. Overall, 7 percent had urgent dental needs requiring immediate attention.
“The numbers are just ... they blow your mind,” said Kelley Johnson, dental director for the Healthcare Network of Southwest Florida. “It would be great in the next 10 years to start to see a shift in that.”
Report challenged
In a recent statement, the Florida Dental Association complained that the Pew report did not factor in recent improvements in the state’s dental care, including a variety programs aimed at adults and children in need.
Family Health Centers of Southwest Florida has an expanding dental program for the insured and under-insured in Lee County, though it does not have a in-school program, said spokesman Bob Johns. A statewide program, Project Dentists Care, connects needy adults and children to dental programs. And private providers commonly volunteer their time providing free dental care to area residents.
Even so, Florida Dental Association president-elect Terry Buckenheimer, a Tampa-based dentist, said the Pew study is not completely without merit.
“I guess, in a way, everyone’s been neglecting oral health issues,” Buckenheimer said. “That’s one thing we can thank Pew about — at least they’re increasing awareness.”
Collier's program
Back in the mobile dental vehicle in Collier County, Johnson will see roughly two dozen kids a day this school year.
On Monday, she was at Manatee Elementary in Naples, a school that had a 58 percent dental decay rate last year. Roughly 60 percent of these children are not covered by insurance. Many are part of migrant families, some undocumented immigrants. Poor dental habits are the norm, she said.
Many will only see dentists when their teeth are causing severe pain.
Johnson gave them the candy and brushing speech: Stay away from the chewy, sticky varieties of sweets. And always, she tells them, brush in the morning and before bed.
“Perfect job, angel,” Johnson told 8-year-old Aliyah Litteral, who managed to keep the squirming and moaning to a minimum as she got four sealants brushed on her back teeth. “I need you to brush twice a day, no excuses. No, ‘I’m tired.’ OK?”
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