Struggle for dental care

Louis Morris was nervously massaging his jaw over and over. The hygienic scent of dentistry around him was only deepening his anxiety.

The burly North Philadelphia man, 33, had not seen a dentist in 15 years. Several teeth had recently fallen out, and he had suffered three abscesses but couldn't afford dental care even when he worked a clerical job at the Burlington Coat Factory.

"Between kids, bills, taking care of my mom, who had cancer, you have to make a choice," he said.

On Saturday, his fears were confirmed. Mark Steel, a volunteer dentist from Glenside, told Morris his gum infection was so severe it had worn away his jawbone, and was advanced enough to infect other regions of his body. He also could lose all his teeth. Steel told him he needed to see a dentist and a doctor as soon as possible.

The news was bad, but Morris was among the lucky ones to score an audience with a dentist Saturday at a free clinic at the University of Pennsylvania dental school.

More than 500 patients entered an imposing room filled with rows of dental chairs. Another 500 or so were turned away. And hundreds more were placed on a waiting list.

A team of 188 volunteer dentists and hygienists worked to fill the gaps in the region's dental care - at least for a day.

As Morris knows, dental care can be hard to find. Even commercial plans can leave families with no coverage. Adults and children on public insurance often can't find dentists willing to treat them. And the uninsured face even worse odds in getting care.

Many patients find care where they can, in sliding-fee clinics, special one-day events, and emergency rooms. Saturday's free clinic was staffed by the Academy of General Dentistry and its foundation, which held its annual meeting at the Convention Center over the weekend.

To be eligible, patients had to be older than 18 and not have seen a dentist for at least one year.

Those requirements fit a vast number of residents. About 30 percent of Pennsylvanians did not visit a dentist in 2009, the latest figure available, according to a survey by the Centers for Disease Control and Prevention.

Dental care is about more than pearly white smiles. Unhygienic mouths can breed infection and gum disease that can spiral into abscesses, unbearable pain, and, in extreme cases, death.

Morris' three abscesses in the last two years "hurt very much." But strapped for cash, and without insurance, "I let them ride out," he said.

There can be many imposing obstacles to reaching a dentist's chair.

Take the Morrison family of Roxborough. Their health insurance does not cover dental care. Christine Morrison, a veterinary technician, took her children, Zachary, 10, and Alyssa, 7, to the office of Iris Lewis-Moody and Ernest Moody in Germantown on Wednesday. They were getting their first check-ups in 18 months free as part of Give Kids a Smile Day, an annual one-day event organized by the advocacy group Public Citizens for Children and Youth.

Morrison, a self-declared "tooth-nazi" at home, noted that the children's check-ups were fine, but she was disappointed not to get their teeth cleaned. "So many plans don't offer dental, which I feel is a huge chunk missing in insurance," she said.

She said she spends $1,000 on her family of five each year just for check-ups and X-rays. Implanting a crown in Alyssa's mouth for an earlier cavity cost more than $600.

"We try to get the kids done first and then take care of ourselves," she said. Her cost control strategy? "I try to take really good care of my teeth at home." Insurance options can befuddle the most engaged parents. Children in Pennsylvania are eligible for health insurance regardless of family income through the State Children's Health Insurance Program (SCHIP) and Medical Assistance. Both include full dental care.

But children have to be uninsured for six months to be eligible for SCHIP, and then they have to sign up for the full program. The Morrisons are not eligible because the children have medical coverage, so the family must either buy private health and dental insurance together or continue paying out of pocket for dental.

Many children with public insurance are not making it to the dentist. Only 52 percent of children in Medical Assistance and two-thirds of those with SCHIP went to the dentist in the last year, according to the Pennsylvania Insurance Department.

Awareness is one problem. "Those that don't have coverage don't seem to know they can get it," Lewis-Moody said.

Fear also plays a role, said Jeffrey Cole, incoming head of the Academy of General Dentistry. "Dental disease is 100 percent preventable, so if they feel that they are afraid, they don't want to go through difficult procedures, that's all the more reason to go to the dentist regularly, get regular care, do oral hygiene."

Financial reasons were often cited by patients and dentists on Saturday. Steel, the dentist working on Morris, said "with this economy, we have a lot of people coming in who are very aware - who are computer savvy, even - but are unable to afford dental care." Hurdles to care mount as children get older. They outgrow SCHIP at 19 and Medical Assistance at 21. After that, adults who fit the complex income requirements can get Medical Assistance only if they are pregnant or have children or a long-term disability, advocates said.

Lewis-Moody said she sees children until they outgrow SCHIP, and then "they stop coming." Many then struggle to find a dentist who takes their public insurance. Lewis-Moody is one of many dentists who opt out "because the reimbursement is too small." Only 27.5 percent of dentists accepted Medical Assistance patients in 2009, according to a report by the Pennsylvania Medical Assistance Policy Center.

Dentists can charge Cigna, a commercial insurer, $59 for a comprehensive oral evaluation. DentaQuest, an administrator for Medical Assistance, pays $20.

For a porcelain crown, Cigna reimburses $921; DentaQuest pays $300.

Most dentists work for themselves or in small groups, Cole said. They cannot risk giving poorly compensated care, even if they want to serve needy patients.

Services for adults on Medical Assistance were cut in last year's budget. Now adults who manage to reach a dentist can basically only get their teeth cleaned and cavities filled. Crowns and procedures such as root canals and gum scrapings are no longer covered.

Dentists are being forced to pull teeth instead of repair them, said Ann Bacharach, special projects coordinator for the Pennsylvania Health Law Project. "People are literally losing their teeth."

That could happen to Morris. The dentist "said I'm losing bone, that's the reason my mouth is loose." He is glad to know his diagnosis and have a sense of what to do, but he regrets the irreversible damage. "If I would have gone to the dentist, it wouldn't have been such a problem." But "I couldn't afford it at the time." Currently unemployed, he still can't afford it, but with a septic gum infection, "I've got to find a way."