Troublesome teeth: Report gives state a 'D' grade in dental care for at-risk kids

Dr. Jason Horgesheimer sees a daily parade of children whose black or missing teeth remind him of mouths he saw in a Third World country. These Utah children, and so many more like them, don't get the dental care they need.

And he can't possibly treat them all.

He can't afford to.

That's one reason Utah received a "D" in a report issued Tuesday by the Pew Center on the States, which listed recent cuts in Medicaid reimbursement rates for dentists as one of the reasons for the sub-par grade when it comes to dental care for at-risk children in the Beehive State.

The Pew report chided Utah's 2008 Medicaid reimbursement rate of 45.1 percent for ranking far below the national average of 60.5 percent that year. But that was before legislators cut funding even further in 2009, paring it back to "one of the lowest rates in the nation," Horgesheimer said.

The federal government has stepped in, and is now demanding that Utah restore funding because the current rates have cut children's access to dental care dramatically, he said, though there has been no definitive word on when the funding will return.

Since May, local dentists who agreed to continue treating children on Medicaid have been reimbursed "roughly 30 to 32 cents on the dollar," said Horgesheimer, who is president of the Utah Academy of Pediatric Dentists. With a typical dental office running overhead of 50 (percent) to 60 percent of overall costs, "we're simply just having to eat the rest of it. … You can only do that for so long and still keep your doors open."

Horgesheimer, who spent time last spring treating children in Ethiopia, said it's difficult to imagine not only the health impact, but the "huge social implications when a child smiles and has black front teeth. It's very common; we see it every day," he said.

The economic downturn has been especially cruel to children whose parents simply can't afford dental care, as infections set in that prevent them from eating, sleeping or even being able to attend school.

"An abscess can become life-threatening, and that poses real challenges for a family. When they call multiple offices and can't get in, it's a great hardship on them," he said.

Dr. Steven Steed, state dental director with the Utah Department of Health, said he was disappointed with the "D" grade. "We've made improvements" since the data from the Pew report were compiled, he said. "We feel we would have had a higher grade if we had had the chance to give more current information."