Survey ranks states on children's dental health; time to ask your local dentists some questions

One in five U.S. children each year go without dental care, and states vary widely in their use of Medicaid and other programs for pediatric oral health, according to an analysis by the Pew Center on the States. "A 50-state report card shows that just six states earned an A and that 36 states received a C or lower," the center reports. Much of the problem is in rural areas.

"Rural and low-income urban locales have little chance of attracting enough new dentists to meet their needs," the report says. "Just 14 percent of dentists nationwide practice in rural areas, according to a report by the National Rural Health Association. . . . Only 3 percent of all dentists are pediatric practitioners who are skilled at caring for young children and trained to handle the highest-need cases." Also, "Not enough dentists are willing to treat Medicaid-enrolled patients. Dentists point to low reimbursement rates, administrative hassles and frequent no-shows by patients as deterrents to serving them."

There may be other reasons. Which dentists in your locality are in Medicaid, the federal-state program for the poor and disabled? Do some take it only for children? What reasons do they give for accepting or not accepting it? Do they fear that their more well-to-do customers don't like sitting in a waiting room with poor people and their children? If they say that's not a factor, why do some dentists schedule Medicaid patients for certain days of the week? What do they think is the state of pediatric oral health in your community, and what do they think could be done to improve it? What other questions should you ask?

The analysis found four successful strategies that states are using: "Preventive strategies such as school sealant programs and water fluoridation;" expansion of Medicaid; "workforce innovations that can expand the pool of providers; and tracking and analysis of data to measure and drive progress." The report is titled "The Cost of Delay," pointing to the long-term health-care cost of ignoring oral health in youth. It was produced with support from the W.K. Kellogg Foundation and the DentaQuest Foundation. Here is a PDF.