RI kids' access to oral care improving

Over the past decade, Rhode Island has made progress in improving access to oral healthcare for children, but more work still needs to be done, according to a news brief issued this week by Rhode Island Kids Count.

According to a statewide oral health survey conducted by the Rhode Island Department of Health Oral Health Program, dental decay was found to be a significant public health problem for Rhode Island children, particularly for minorities and those in low-income families.

Of the third-graders surveyed during the 2010-2011 school year, half had previous cavities and/or fillings. Approximately one out of four (26%) of the children surveyed had tooth decay that was untreated and needed dental treatment. Minority children and children in schools with higher free and reduced-price school meal program eligibility status were twice as likely as their peers to have untreated tooth decay, and they were five to six times more likely to have rampant decay (defined as more than six untreated decayed or filled teeth) than their peers.

On a more positive note, Kids Count found that Rhode Island has been making progress when it comes to insurance coverage for dental care. In 2008, 89% of children in Rhode Island had dental insurance that pays for routine dental (commercial insurance, direct pay, or public coverage), up from 73% in 2001 and 62% in 1990.

However, dental insurance is still not available to many working families in Rhode Island. In 2009, 52% of Rhode Island employers reported offering dental insurance to full-time employees and 15% offered it to part-time employees, according to Jill Beckwith, policy analyst at Kids Count and co-chair of the Rhode Island Oral Health Commission.

Currently, two programs in Rhode Island provide dental benefits to children enrolled in Medicaid, depending on their age. Children born on or after May 1, 2000, are enrolled in the RIte Smiles managed care dental benefit program, while children born before May 1, 2000, receive their dental benefits under fee-for-service Medicaid dental coverage.

Roughly half (52%) of the state's children who were enrolled in either RIte Smiles or Medicaid Fee-For-Service on June 30, 2010, received a dental service cleaning during fiscal year 2010, Kids Count said. In 2006, prior to the creation of RIte Smiles, there were only 27 dental providers who offered dental care to children with Medicaid coverage. Today 202 dentists in more than 380 locations throughout the state are delivering dental services to children with Medicaid coverage.

In 2010, there were 614 actively practicing licensed dentists in Rhode Island, according to Kids Count. Sixteen of Rhode Island's 39 cities and towns are federally designated dental health professional shortage areas, based on an insufficient number of dentists to serve low-income or special populations. Also, a large number of Rhode Island dentists are nearing retirement age. As of December 2010, 44% of practicing dentists in Rhode Island were age 55 or older (16% were older than age 65).

There are several steps that can be taken to continue to improve access to oral healthcare for Rhode Island's children, Kids Count noted:

• Build upon the success of RIte Smiles by increasing the age range of children who are eligible.
• Ensure that pediatric dental benefits are available through Medicaid and the Rhode Island Health Insurance Exchange (starting in 2014) at an affordable cost, to ensure that all children have insurance coverage for oral health services.
• Identify ways to involve primary care health providers in providing oral health assessment, referrals, and preventative measures for children and pregnant women.
• Implement workforce recruitment and retention strategies to ensure an adequate supply of high-quality dentists, dental hygienists, and dental assistants, especially those who will treat very young children and participate in RIte Smiles and Medicaid.
• Improve knowledge and eliminate barriers to care access for families with young children.
• Continue to strengthen the infrastructure of dental safety net providers by investing in capital needs for maintaining and expanding existing sites and establishing new dental centers in underserved areas.