Post by Moses on Apr 13, 2005 23:22:14 GMT -5
Filling a Need (and a Tooth) in America's Poorest Pockets
ALBUQUERQUE - His teenage patient is dressed in a khaki work suit and flip-flops, reclining in the dental chair as Dr. James Strohschein probes with his mirror and says, "Huh!"
Anticipating the diagnosis, his patient mumbles: "Yeah, crystal meth. It broke my tooth."
Dr. Strohschein, an assistant professor of surgery and dental services at the University of New Mexico School of Medicine, sees patients at the Youth Diagnostic and Detention Center in Albuquerque, the entry port for New Mexico's juvenile offenders.
"Most of these kids have horrible teeth," he says, "but they qualify for Medicaid because they're wards of the state, and by the time they've left this facility, we're able to fix most of their dental problems. In a strange way, they're the lucky ones. It's safe to say that most poor kids aren't in trouble with the law, but they have big problems with their teeth."
In 2000, Dr. David Satcher, then the surgeon general, issued the first report on oral health in America. Calling dental and oral diseases a "silent epidemic," the report details significant oral health problems in poor people of all ages, members of racial and ethnic minorities, people with disabilities and those living in rural America.
The report emphasized that the major factors exacerbating the condition of Americans' teeth and gums were lack of community fluoridation programs, lack of transportation to see dental providers and low rates of dental insurance coverage.
According to most authorities on oral health, dental care for Americans has not improved since the surgeon general's report, and there are many indications that it is getting worse.
This state is among the poorest and most rural in the country. About 600 dentists practice in New Mexico, and more than 400 of them are in Albuquerque's most affluent neighborhood. The rest are mostly in the next largest cities, Santa Fe and Las Cruces.
"I'd been busy trying to get doctors and nurses and physician assistants to come here, but I knew nothing about dentists and oral health," said Dr. Jerry Harrison, the executive director of New Mexico Health Resources, an agency whose main focus is recruiting health providers to the state.
"About five years ago," he said, "I got a call from the director of a rural health clinic in northern New Mexico. His only dentist was seeing patients from 17 different counties in New Mexico and southern Colorado. Even insured patients travel hundreds of miles to see dentists."
Dr. Harrison said the rest of the country was no better off. The United States has 56 dental schools; seven have closed over the last 15 years. Although three new schools have opened in recent years, the number of dentists who retire exceeds the number of dental school graduates by at least 2,000.
The number of dentists who are members of minorities has declined, particularly in urban centers, and according to some estimates, 50 percent of children's cavities in African-American communities go unseen by dentists.
New Mexico does not have a dental school, but in June 2004, the University of New Mexico Health Sciences Center began a dental residency, a one-year postgraduate training program for five newly minted dentists. The program's mission is to keep these young dentists in the state and to encourage them to practice in underserved communities.
"Most of my classmates in dental school went right into practice - and right to the suburbs," said Dr. Steve Beetstra, assistant professor of surgery and dental services at the University of New Mexico.
Dr. Beetstra was hired to get the residency program started, and he and other faculty bring a strong public health perspective to their effort.
"Unfortunately, dentistry does not share the degree of social concern that medicine does - the burden of providing good care for poor people," Dr. Beetstra said. "Most dentists see themselves as small businessmen. They're more like mom-and-pop operations."
Dr. Steve Wagner, also on the dental faculty, noted that the field of dentistry was in transition.
"Twenty or 30 years ago, the best dentists in town were considered those who could craft the best dentures," he said. [n]"Now it's all cosmetics[/b], at least for people who can afford it: it's creating the whitest teeth, the best veneers, the brightest smile."
The faculty and residents in the dental program and a few other clinic dentists in the area give about the only care for the poor here, and for those living hundreds of miles away.
Dr. Charles Tatlock, a dentist on the faculty, sees patients at Albuquerque's Health Care for the Homeless Clinic and, like Dr. Strohschein, reports more and more patients with "meth mouth."
Dr. Tatlock and Dr. Wagner are conducting research to characterize the effects of methamphetamine use on the teeth and gums. "Meth use is an emerging epidemic," Dr. Wagner said. "It explodes people's teeth. It's like ice crystals forming in the crevices of rock, fracturing the teeth."
Dr. Erika Smith and Dr. Dania Pellerano, both dental residents, say they came to this state for the opportunity to work in the public sector. That, and the fact that New Mexico offers substantial loan repayment subsidies for dental graduates who enlist in the National Health Service Corps, a joint federal and state program that places doctors, dentists and other health providers in rural and underserved communities.
The average loan payback for a dental school graduate is about $200,000. "That's why dentists go right into private practice," Dr. Beetstra said. "The cost of setting up an office can run $150,000 to $200,000 or more, and that's on top of their loans."
Sixty percent of children in New Mexico qualify for Medicaid, entitling them to two examinations and two cleanings a year. According to the Centers for Disease Control and Prevention, not even one child in five is seen by a dentist, though dental caries is ranked as the most common chronic childhood disease.
In New Mexico, Medicaid patients account for only 1 percent of the gross revenue of dentists in private practice, primarily because the reimbursement rates are so low.
"The real issue is poverty," Dr. Harrison said. "Less than 50 percent of Americans have dental insurance, and the working poor can't afford to see dentists, or bring their kids."
— Ben Daitz
New York Times
2005-04-12
query.nytimes.com/mem/tnt.html?emc=tnt&tntget=2005/04/12/health/12teet.html&tntemail1
ALBUQUERQUE - His teenage patient is dressed in a khaki work suit and flip-flops, reclining in the dental chair as Dr. James Strohschein probes with his mirror and says, "Huh!"
Anticipating the diagnosis, his patient mumbles: "Yeah, crystal meth. It broke my tooth."
Dr. Strohschein, an assistant professor of surgery and dental services at the University of New Mexico School of Medicine, sees patients at the Youth Diagnostic and Detention Center in Albuquerque, the entry port for New Mexico's juvenile offenders.
"Most of these kids have horrible teeth," he says, "but they qualify for Medicaid because they're wards of the state, and by the time they've left this facility, we're able to fix most of their dental problems. In a strange way, they're the lucky ones. It's safe to say that most poor kids aren't in trouble with the law, but they have big problems with their teeth."
In 2000, Dr. David Satcher, then the surgeon general, issued the first report on oral health in America. Calling dental and oral diseases a "silent epidemic," the report details significant oral health problems in poor people of all ages, members of racial and ethnic minorities, people with disabilities and those living in rural America.
The report emphasized that the major factors exacerbating the condition of Americans' teeth and gums were lack of community fluoridation programs, lack of transportation to see dental providers and low rates of dental insurance coverage.
According to most authorities on oral health, dental care for Americans has not improved since the surgeon general's report, and there are many indications that it is getting worse.
This state is among the poorest and most rural in the country. About 600 dentists practice in New Mexico, and more than 400 of them are in Albuquerque's most affluent neighborhood. The rest are mostly in the next largest cities, Santa Fe and Las Cruces.
"I'd been busy trying to get doctors and nurses and physician assistants to come here, but I knew nothing about dentists and oral health," said Dr. Jerry Harrison, the executive director of New Mexico Health Resources, an agency whose main focus is recruiting health providers to the state.
"About five years ago," he said, "I got a call from the director of a rural health clinic in northern New Mexico. His only dentist was seeing patients from 17 different counties in New Mexico and southern Colorado. Even insured patients travel hundreds of miles to see dentists."
Dr. Harrison said the rest of the country was no better off. The United States has 56 dental schools; seven have closed over the last 15 years. Although three new schools have opened in recent years, the number of dentists who retire exceeds the number of dental school graduates by at least 2,000.
The number of dentists who are members of minorities has declined, particularly in urban centers, and according to some estimates, 50 percent of children's cavities in African-American communities go unseen by dentists.
New Mexico does not have a dental school, but in June 2004, the University of New Mexico Health Sciences Center began a dental residency, a one-year postgraduate training program for five newly minted dentists. The program's mission is to keep these young dentists in the state and to encourage them to practice in underserved communities.
"Most of my classmates in dental school went right into practice - and right to the suburbs," said Dr. Steve Beetstra, assistant professor of surgery and dental services at the University of New Mexico.
Dr. Beetstra was hired to get the residency program started, and he and other faculty bring a strong public health perspective to their effort.
"Unfortunately, dentistry does not share the degree of social concern that medicine does - the burden of providing good care for poor people," Dr. Beetstra said. "Most dentists see themselves as small businessmen. They're more like mom-and-pop operations."
Dr. Steve Wagner, also on the dental faculty, noted that the field of dentistry was in transition.
"Twenty or 30 years ago, the best dentists in town were considered those who could craft the best dentures," he said. [n]"Now it's all cosmetics[/b], at least for people who can afford it: it's creating the whitest teeth, the best veneers, the brightest smile."
The faculty and residents in the dental program and a few other clinic dentists in the area give about the only care for the poor here, and for those living hundreds of miles away.
Dr. Charles Tatlock, a dentist on the faculty, sees patients at Albuquerque's Health Care for the Homeless Clinic and, like Dr. Strohschein, reports more and more patients with "meth mouth."
Dr. Tatlock and Dr. Wagner are conducting research to characterize the effects of methamphetamine use on the teeth and gums. "Meth use is an emerging epidemic," Dr. Wagner said. "It explodes people's teeth. It's like ice crystals forming in the crevices of rock, fracturing the teeth."
Dr. Erika Smith and Dr. Dania Pellerano, both dental residents, say they came to this state for the opportunity to work in the public sector. That, and the fact that New Mexico offers substantial loan repayment subsidies for dental graduates who enlist in the National Health Service Corps, a joint federal and state program that places doctors, dentists and other health providers in rural and underserved communities.
The average loan payback for a dental school graduate is about $200,000. "That's why dentists go right into private practice," Dr. Beetstra said. "The cost of setting up an office can run $150,000 to $200,000 or more, and that's on top of their loans."
Sixty percent of children in New Mexico qualify for Medicaid, entitling them to two examinations and two cleanings a year. According to the Centers for Disease Control and Prevention, not even one child in five is seen by a dentist, though dental caries is ranked as the most common chronic childhood disease.
In New Mexico, Medicaid patients account for only 1 percent of the gross revenue of dentists in private practice, primarily because the reimbursement rates are so low.
"The real issue is poverty," Dr. Harrison said. "Less than 50 percent of Americans have dental insurance, and the working poor can't afford to see dentists, or bring their kids."
— Ben Daitz
New York Times
2005-04-12
query.nytimes.com/mem/tnt.html?emc=tnt&tntget=2005/04/12/health/12teet.html&tntemail1