Maryland needs to double-down on its Medicaid dental program

As the former director of the Office of Oral Health at the Maryland Department of Health and Mental Hygiene, I was most gratified to see The Sun’s high profile coverage of the pilot adult Medicaid dental program on the front page of the Sunday paper. It reminded me of another story on your front page many years ago about the then low access to dental services and high disease rates for poor Maryland children.

Maryland once was rated as having the lowest access to dental care in the country for Medicaid enrolled children. It wasn’t until the 2007 death of Deamonte Driver, a 12-year old Maryland child who needlessly died from an undetected dental infection, that a sense of urgency developed regarding access to oral health care services. As a result of the seminal reforms that were instituted in the immediate aftermath of his tragic death, Maryland is now a national leader in oral health for children.

Deamonte Driver died in 2007 after an untreated tooth infection spread to his brain. (Handout/Baltimore Sun)

I am quite pleased to see the pilot dental program for dual eligible individuals in the Medicaid and Medicare program. However, it is just a start; hopefully this program will expand to all Maryland adults in the Medicaid program. State Medicaid dental coverage for children is mandated by the federal government, but dental coverage for adults is a state decision. And, despite being one of the wealthiest states in the nation, Maryland is one of only a few states without a systematic adult dental Medicaid benefit.

I honestly do not understand why there isn’t once again a sense of urgency regarding adult dental care coverage. Oral health is health, and didn’t we learn that with the death of Deamonte Driver? Former U.S. Surgeon General Dr. C. Everett Koop once said that “you can’t have good health without good oral health.” There are strong links between poor oral health and diabetes, between poor oral health and cardiovascular disease, between poor oral health and a combination of factors leading to aspiration pneumonia, a leading cause of hospital readmission visits. Often the first signs of HIV infection show up in the mouth.

Further, poor oral health can cause severe pain and can significantly contribute to the opioid crisis. Poor oral health in low-income adults all too often leads to emergency department visits and admissions; usually the only services patients receive in an ED for their toothache are pain medications that can include opioids as well as antibiotic therapy. It becomes a vicious cycle; these same patients often return to the same ED for the same problem within a matter of months and receive the same “therapy.” Finally, quality of life due to dental problems can be horribly compromised. You can’t eat, you can’t sleep, you can’t think. Poor oral health in adults is a substantial cause of missed employment days; poor mouth aesthetics in adults often impedes finding employment.

Expansion of this pilot program to all Medicaid enrolled adults will also serve as a definite benefit to three other populations: 1) children who will benefit from a family centered health care approach if both the child and their parents/caregiver are given coverage; 2) expectant mothers who will receive dental coverage beyond the full term of their pregnancy, which is the current situation for this group; and 3) older adults who will enter their senior years with less accumulated untreated oral disease if they have access to necessary dental services during their preceding 40-plus years.

I am hopeful that in the aftermath of this pilot program, the executive and legislative branches of government as well as other key stakeholders will discover that this program will not only improve health but in the long term help the state’s economy. In time, there will be both medical and dental health care cost savings with a healthier adult population, a reduction in opioid use, and a reduction in ED and hospital visits.

Maryland successfully addressed its child oral health crisis in the past when faced with a tragic death, and we must now double down on that effort with adults. But avoiding a negative should not be the primary motivation to expand this program; the most important rationale for its passage is that a healthier adult population cohort will emerge whose own quality of life will be improved, providing benefits to the state’s economy, well-being and productivity.

Dr. Harry Goodman served as director of Maryland’s Office of Oral Health from 1990-1992, 1996-2002 and 2008-2016. His email is harrygoodman2307@gmail.com.