As reported by the Waterbury Republican-American, April 10, 2006.

Children's Dental Care Needs Help

By Cara Rubinsky

NEW HAVEN -- Before the mobile clinic showed up at Clinton Avenue School, Carleen Nerreau's four children bounced from dentist to dentist, looking for one who would accept state health insurance.

Now they get regular checkups and cleanings, along with sealants to help prevent cavities. The van's staff, from St. Raphael's Hospital, recently fixed a chipped tooth for the youngest, second-grader Joseph Ortiz.

"He can't stop smiling," said Nerreau, a teacher's aide. "It's a big help."

Dental professionals say the St. Raphael's van and other hospital-sponsored clinics are increasingly overwhelmed because low reimbursement rates discourage private dentists from seeing children with state health insurance.

Legislators are working to increase those rates, though the budget recently voted out of the Appropriations Committee includes less money for a pilot program than dental professionals had hoped.

Because so few private dentists participate, only about 30 percent of the 185,000 children with state health insurance are getting dental care, according to Marty Milkovic, executive director of the Connecticut Oral Health Initiative.

"We're at full capacity. We're maxed out," said Peter Robinson, dean of the University of Connecticut School of Medicine, which treats about 90,000 Medicaid-eligible children and adults a year.

The school's clinics, which treat nearly 20 percent of children with state health insurance, have a four-month waiting list for children who need general anesthesia and a two-and-a-half-month wait for those who need to be sedated.

Sharon McCreven, the dental hygienist who manages the St. Raphael's van, has seen it all: a 4-year-old with teeth so badly infected that her left eye swelled shut. A 5-year-old with 14 cavities.

McCreven is part of a four-person team that travels to New Haven schools and neighborhoods to see about 1,000 children a year in the van.

The program is running a deficit of about $350,000. It provides an estimated $135,000 worth of services a year but only gets $67,000 from state health insurance programs. Without it, Greater New Haven would return to the days when a study found only one in five children getting dental care.

"We've found the best way is to go out to the kids," she said. "There's just a huge need, and we can't seem to fill it any other way."

"We need to engage a broader number of dentists in the state to help out," Robinson said. "I'm not blaming or condemning them at all. A lot of them do give away treatment, but if they become a full-fledged Medicaid provider, they're overwhelmed with patients seeking treatment."

Under a pilot program proposed by lawmakers, the state would pay dentists 70 percent of the average insurance reimbursement rate for services such as teeth cleaning, fillings and X-rays.

The rate, which hasn't increased since 1993, varies depending on the service provided but is lower than in any other New England state, according to the Office of Legislative Research.

The Public Health Committee approved a bill that would have set aside $20 million for a yearlong project to determine if increasing reimbursement rates will encourage more dentists to participate.

But the budget voted out of the Appropriations Committee included only $10 million, meaning the project would start Jan. 1, 2007, instead of July 1, 2006, and last six months. Lawmakers are expected to vote on the final budget before the legislative session ends May 3.

Robinson says children who can't see a dentist experience a range of other problems.

"They're losing time at school," he said. "They're keeping their parents up at night, they're keeping themselves up at night. They're not keeping a proper diet because they can't chew."