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Mandatory dental exams called `a baby step' for children's health

January 06, 2007|Mary Engel | Times Staff Writer

Kindergartners and first-graders who haven't seen a dentist in the last year have until May 31 to get a checkup under a new state law requiring an oral screening within the first year of entering California public schools.

The law is "a baby step in the right direction" in fighting tooth decay, a chronic disease that afflicts more children than the better-known epidemics of asthma and obesity, said Wynne Grossman, executive director of the nonprofit Dental Health Foundation.

The Oakland-based foundation surveyed kindergarten and third-grade students at schools statewide last year and found that two-thirds had experienced tooth decay. More than a quarter of these had untreated cavities.

The new law, which went into effect Monday, seeks to raise public awareness of the role oral hygiene plays in overall health, Grossman and other supporters said.

"We always hear, 'They're only baby teeth -- they'll fall out anyway,' " said Dr. Paul Reggiardo, a Huntington Beach dentist and a past president of the American Academy of Pediatric Dentistry. "Long before they fall out, they can cause a child a lot of problems. More kids miss school because of dental problems than any other single health cause."

Tooth decay was especially pervasive in children from low-income and minority families, the survey found.

The new law does nothing to counter the lack of insurance, dearth of free clinics and other barriers that limit access to dental as well as medical care. Supporters, however, hope that it will prod eligible families to sign up for Medi-Cal and Healthy Families, which cover dental visits. More than half of California's estimated 800,000 uninsured children qualify for these public insurance programs but are not enrolled in them.

The law carries no penalties, but families who opt out will be asked to fill out a form explaining why. Grossman and other oral health advocates hope that data collected under the new law will lead to new approaches for reaching low-income children.

"We want to find out what the specific barriers are," said Gayle Mathe, a community health advocate with the California Dental Assn., which sponsored the law. "Is it that you have Denti-Cal but can't find a provider who will take it? You don't have [insurance] coverage? We want good, locally specific data for counties, the PTA, whoever wants to look at it, to bring it down from 'California has this problem' to 'Who in our community, our kindergarten, isn't getting care?' "

Some rural areas of California are short of dentists, Mathe said. In urban areas dentists are plentiful, but not all private practices accept Denti-Cal patients, and others limit the number they treat. As with Medi-Cal, California's reimbursement rates are among the lowest in the country.

Dental care advocates say the state's reluctance to raise those rates is short-sighted. Poor early habits often carry over into adulthood. Toothaches that once hurt school attendance can later cost jobs, and lost teeth can hinder speaking and eating. Researchers are studying the connection between gum and heart diseases and have linked periodontal disease during pregnancy to premature births.

A severe tooth infection can land patients in an emergency room, "and we all know what impact that has on society," said Dr. Santos Cortez, a pediatric dentist in Long Beach. A three-day hospital stay with intravenous antibiotics and pain medication can cost up to $20,000 and still not solve the underlying problem, he said.

"The reasoning behind this assessment is, 'Let's catch those kids early, or at least earlier,' " Cortez said. "We'd like to see them at age 1. But as a safety net, we'll catch them at kindergarten age, reducing costs to families, hospitals, society and government-sponsored programs."

Habits children learn when young "are going to affect their place in society for the rest of their lives," the Dental Health Foundation's Grossman said.

"If you look at gang members, one of the most noticeable things you see are the state of their teeth," she said. "It's really hard to participate fully in society if your teeth are rotted out."

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