Opinion – Oral Health Care Left Out of Vermont Reform Efforts



Opinion – Oral Health Care Should Be Included in Vermont Health Care Reform Efforts

By Peter Youngbaer, Director

Peoples' Health & Wellness Clinic, Barre, Vermont

Good oral health is integral to good overall health. The mouth reflects general health and well-being. Being able to chew food properly, or at all, is essential for proper nutrition and diet. Avoiding diseases of the gums and mouth helps keep us from developing more debilitating medical conditions that can spread throughout the body.

Yet, to date, Vermont's health care reform efforts have excluded oral health, much as we excluded mental health for many years. For people with commercial health insurance, dental insurance is not included, and a secondary policy is often not available, or affordable.

Children covered by Dr. Dynasaur fare better – comprehensive dental benefits are included. Still, in 2009 over 40 percent of Vermont children with Dr. Dynasaur did not see a dentist. Medicaid provides a meager $495 per year for adults – perhaps covering an extraction or two, but certainly not comprehensive care. The other Green Mountain Care programs,VHAP (Vermont Health Access Plan) and Catamount, have no dental benefit. The uninsured have it even worse. Far too many Vermonters lack access to important preventive and routine dental care, as it is out of reach because of cost.

At the Peoples' Health & Wellness Clinic, which serves all of Washington County plus neighboring towns, we deliver primary health care and wellness education to uninsured and underinsured Vermonters, along with case management services, and assistance with application and enrollment to a variety of health insurance and assistance programs.

For the vast majority of people who come to our clinic needing dental care, however, we have little or nothing to offer. Many are suffering from a lifetime of oral health problems. Infections, injuries, serious pain, and even disfigurements lead to a host of health issues. Missing or diseased teeth make it hard to seek a job or interface with the public. If you’re in constant pain, it is difficult to focus – at school or at work. If untreated, dental and gum diseases can lead to far more serious medical conditions, and even death.

Unfortunately, our Clinic does not have facilities, equipment, or volunteers to provide oral health care at this time. Beyond general education on wellness, nutrition, and occasional toothbrush and toothpaste samples, we can do little here on site except try to hook patients up with spotty available resources.

Still, our patients frequently have severe oral health needs. So, what is available to them?

For routine cleanings, we can refer them to the Vermont Technical College Dental Hygiene Clinic in Williston. For a modest fee, patients can be seen, but transportation and travel time are often barriers.

Uninsured people residing within the six-town catchment area of the Plainfield Health Center can be seen on a sliding fee scale basis. People from outside the six-town catchment area do not have access to the sliding fee scale, and must pay full fare for exams. In both cases, full payment is required the day of service, which is often a barrier. Non-emergency appointments are 6-8 weeks out; emergencies are done the same day, if possible.

If the patients are unable to afford the services needed, a General Assistance Voucher is sought. The process requires coordination between the Clinic, the Community Action agency processing the application, the State Economic Services Division office, and the provider. GA vouchers can be used for exams, x-rays, and extractions, but not for restorative work. For example, a patient may be given a clinical choice between root canal and extraction, but the GA voucher will only cover the extraction.

Meeting the oral health needs of all Vermonters will put in place a critical missing piece of a comprehensive health care system. Just as Vermont recognized that mental health is not separate from physical health, the same parity should be recognized for oral health.

As our state and national health care reform efforts move forward in the coming years, we need to ensure that oral health becomes a priority. From educating parents and young children about good prevention habits, to supporting public oral health programs such as school-based initiatives and fluoridation, to bolstering the spectrum of qualified professionals on the dental team to ensure sufficient capacity to serve all Vermonters, and appropriate levels of compensation to remove disincentives to serve, we need to work on all aspects of the issue until we reach the goal of oral health care for all.

Contact: Peter Youngbaer, Director

People's Health & Wellness Clinic

(802) 272-3802 (cell)

(802) 479-1229 (office)

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