Our system has failed’
FORT GAY — Seven months pregnant, Stacey Handley squeezed into the dentist’s chair, opened wide and watched the whirling high-speed drill disappear into her mouth toward the broken tooth that ached with pain.
“Get ready, here comes Mr. Bumpy,” Dr. Dan Brody said after capping the drill with a grinding bit.
Handley, who lives in Louisa, Ky., and is covered by Kentucky’s Medicaid insurance program, had at least 10 cavities. The 24-year-old had four teeth previously pulled.
On a recent afternoon, Handley drove across the river from her Kentucky home to Valley Health’s Fort Gay dental center to get the broken tooth filled and repaired.
“It hurt,” said Handley, who also has a 10-month-old child. “I was eating Fritos when it broke off the night before last. It was an emergency. I couldn’t eat at all.”
As a pregnant woman on Medicaid, Handley was fortunate she wasn’t from West Virginia.
In Kentucky and at least a dozen other states, pregnant women of all ages can get cavities filled and teeth cleaned, and Medicaid will pay for it.
Not so in West Virginia.
Here, Medicaid covers dental services for pregnant women under 21. For older women, though, West Virginia’s health insurance program for the poor will pay only for teeth to be pulled or X-rayed. Nothing else.
Dentists, hygienists and oral health advocates say that’s wrong. Two groups plan to ask the state Medicaid office to look into expanding dental benefits for pregnant women.
“We’re seeing all these moms — 22, 23 years old — who can’t be helped,” said Bobbi Jo Muto, oral health director with Valley Health in Huntington. “Our system has failed.”
Better oral health, better births
The state’s Perinatal Partnership Oral Health Committee is recommending that Medicaid start providing preventative dental services to pregnant women of all ages, saying the change would decrease health costs in the long run by reducing the number of premature and low birth-weight babies across the state. Studies have shown a link between infectious oral disease and distressed babies.
West Virginia has the fifth-highest rate of low birth-weight babies in the nation and ranks seventh for the percentage of premature births, according to the National Center for Health Statistics.
As many as 25 percent of babies born too small and too early in the United States each year may be attributed to infectious oral disease, according to the National Institutes of Health. It’s suspected that bacteria and toxins from gum disease enter a woman’s bloodstream and cause inflammation that triggers premature labor.
“With better oral health, you have better birth outcomes. The data supports that,” Muto said. “You could hurt your baby by not going to the dentist.”
Another group called the West Virginia Partners for Oral Health, which includes the state dentist and hygienist associations, is urging the state’s Medicaid office to study the costs and benefits of providing dental coverage to pregnant women.
A Medicaid official said last week that her office has discussed possibly covering some dental services for women during pregnancy as part of Medicaid’s revamped incentive program called Mountain Health Choices. No decisions have been made.
“Oral health during pregnancy is a complicated issue,” said Shelley Baston, deputy commissioner at the West Virginia Bureau for Medicaid Services. “We have not yet identified what services are appropriate during this time, nor have we completed a cost analysis of providing them.”
About half of all pregnant women in the state receive Medicaid benefits, and an estimated 10,000 babies are born to Medicaid mothers in West Virginia every year.
Oral health advocates also have suggested that adult women receive Medicaid dental coverage up to two years after their babies are born.
Cavity-causing bacteria often is passed from mother to child — sharing a spoon when tasting baby food, cleaning a pacifier and wiping a baby’s mouth.
What’s more, women who go to the dentist are more likely to take their children to the dentist. It’s now recommended that infants see a dentist by their first birthday.
“When we start trying to get a parent to get a child in for dental care, it’s a lot easier if that care is already a priority with the parent,” said Dr. Elliot Shulman, a pediatric dentist at West Virginia University’s School of Dentistry.
If left untreated, children’s cavities can grow larger and require extensive treatment.
At a young age, children often must be sedated and treated in a hospital operating room under general anesthesia, and that can be expensive — up to $6,000 for hospital costs alone.
“We’re trying to decrease the cost of care,” Shulman said.
‘Alarming’ number of women with no teeth
At Roane County Family Health Care in Spencer, doctors see women with broken teeth, rotted teeth, and no teeth at all, said Larry Dent, the health center’s chief executive.
“In both Roane and Calhoun counties, we see an alarming number of young pregnant women with no teeth,” Dent said. “It’s pretty tragic. It’s a major problem for us.”
Medicaid recipients make up nearly half of all patients served at the federally subsidized rural health center. The clinic often sends patients to a local dentist and picks up the cost.
“Traditionally, the answer has been to pull the tooth. That’s cheapest and easiest,” Dent said, “but it really affects people for the rest of their lives when you get your teeth pulled early.”
The Roane health center is trying to put together a dental clinic to serve pregnant women and children. Someone donated a van and dental chairs. However, the health clinic needs another $300,000 to get the program up and running.
Dent also is searching for a dentist.
“We’re going to be swamped,” Dent predicted. “If you’ve got pregnant women who can’t eat, women who are hurting with pain, they’re not going to get the nutrition they need.”
Few pregnant women go to dentists
Oral health advocates also want to increase the number of pregnant women under 21 covered by Medicaid who see a dentist.
Only about 25 percent of younger pregnant women across the state receive dental work each year, and the percentage has dropped in recent years, according to data from the West Virginia Health Care Authority.
One possible reason: Some West Virginia dentists won’t accept low-income patients covered by Medicaid. Dentists say Medicaid patients often miss appointments. The dentists also complain about Medicaid reimbursement rates for dental services, which are among the lowest in the nation and far below dentists’ costs.
Oral health advocates are trying to spread the message that pregnant women with good oral health have healthier babies
Nurses and social workers across the state are receiving training through the state’s Right from the Start pregnancy education program. They’re expected to pass the information to pregnant women.
“Cleanings during pregnancy should be as routine as ultrasounds,” said Gina Sharps, a dental hygienist and assistant director of WVU’s Childhood Oral Health Project. “Oral health is part of total health care. It’s treating the whole body.”
‘It’s going to cost money’
Some dentists hesitate to treat pregnant women.
However, Dr. David Walker, the state’s dental health director, said dentists can perform dental work on pregnant women safely, with precautions.
Patients with abscesses and gum disease should be treated immediately to stop the spread of infection. “It’s better to extract a tooth than have a chronic infection,” Walker said.
Other procedures, such as fillings, are best done in the second trimester and first half of the third trimester, Walker said.
The American Dental Association recommends that X-rays be delayed until after pregnancy unless there’s an emergency to
treat pain, swelling, bleeding and infections.
Even then, there’s little risk to the unborn child, because most dentists use low-dose digital X-rays and cover women with lead aprons, Walker said.
Walker, who practices at CAMC Memorial Hospital in Charleston, said it’s also a good idea for dentists to get consent letters from pregnant women’s doctors.
Brody, the dentist at the Fort Gay clinic, sees dozens of pregnant women from both sides of the border every year.
Clean mouths make for happier mothers and healthier babies, he said.
“I had patients I did work on, and their stomach’s shifted,” Brody said.
Walker acknowledged that he had “reservations” at first about the proposal to expand Medicaid dental services to pregnant women older than 21. He changed his mind after speaking with fellow dentists and examining studies about oral health care during pregnancy.
Louisiana and California are among several states that have expanded Medicaid programs to cover pregnant women in recent years.
“It’s going to cost money to increase this, but if you’re going to treat the whole person during pregnancy, it’s difficult to provide care if you have a woman with an open cavity and abscessed tooth,” Walker said.
“The focus needs to be on preventative care.”
To contact staff writer Eric Eyre, use e-mail or call 348-4869.