Maryland's proud record on youth dental care

Four years ago, a 12-year-old boy from Prince George's County named Deamonte Driver died from complications of an untreated dental infection. Lacking access to routine dental care that could have prevented the problem, and to basic treatment that could have contained it, Deamonte finally came to medical attention after the infection had spread to his brain.

Deamonte's death was a shocking call to action. Elected officials, led by Congressman Elijah Cummings, called Deamonte's death a moral failure as well as a policy failure. Public and private partners formed the Maryland Dental Access Committee and proposed an ambitious set of reforms for the state. Gov. Martin O'Malley, Lt. Gov. Anthony Brown and former health secretary John Colmers made improvements in access to dental care a top state priority.

Among many steps taken, Maryland increased reimbursements for dentists in the Medicaid program; created Maryland Healthy Smiles to streamline dental access for Medicaid children and pregnant women, and trained primary care providers to perform dental screenings and apply fluoride varnish. Also, new dental clinics became part of a stronger dental public health infrastructure throughout the state.

Last week, our report card arrived. We learned that Maryland is now leading the nation in oral health care for children. Using eight key benchmarks as its guide, the Pew Center on the States, a division of the Pew Charitable Trusts, says Maryland is the only state meeting seven of the eight standards.

Before Deamonte Driver died, there were 743 dentists participating in Medicaid's dental program. After Maryland changed its incentives, there are now 1,104 participating — a 49 percent increase.

Before, 46 percent of Maryland kids in the Medicaid program for more than 10 months received dental care. In 2009, 59 percent received dental care, an increase of 28 percent.

Before, zero primary care clinicians were trained to provide fluoride varnish, which prevents cavities from developing. Today, more than 400 pediatricians, family physicians and family nurse practitioners are trained to provide this needed care, identify early disease, and refer to appropriate dental care providers. More than 300 of these health care providers are eligible to bill Medicaid for this service. To date, there have been more than 28,000 medical claims for fluoride varnish application from these practitioners.

Before, there was little public outreach and education. Now, Maryland is using a $1.2 million federal grant to spread the word, thanks to Maryland's congressional leadership, notably from Congressman Cummings, Sen. Barbara Mikulski, Sen. Benjamin L. Cardin, and Congressman John Sarbanes.

This campaign will help families understand the importance of oral health to overall health; empower them to make informed decisions about their oral hygiene and diet; and teach them how to navigate the dental care delivery system.

Maryland's work is not yet done. The independent and renamed Maryland Dental Action Coalition just announced an ambitious, five-year vision to do more for children and adults. Implementation of the Affordable Care Act (the national health reform initiative) and the reauthorized Children's Health Insurance Program will help; so will new delivery models proposed for dental care services in schools, Head Start programs and adult centers.

Maryland has quickly and drastically improved access to oral health care. This progress is an example of what our state can accomplish when we focus our energy and resources on ending unacceptable conditions and disparities. Sustaining and building upon this foundation will honor the legacy of Deamonte Driver and promote the health of all of Maryland's residents.

Dr. Joshua M. Sharfstein is secretary of the Maryland Department of Health and Mental Hygiene. He can be followed on twitter at @DrJoshS.

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