When she was 3, Torrie Smith tripped on an uneven sidewalk, fell face down onto some steps and broke four front teeth. An emergency room doctor stopped the bleeding and gave her something for the pain, but Torrie didnt see a dentist for six months her first time ever because her parents didnt have dental insurance and didnt have cash to pay for an examination.
Now 4, Torries dental problems are so severe she has to go to an operating room, not a dentists chair, to have them fixed. While she is under anesthesia, an abscessed incisor will be pulled and nine other cavity-ravaged teeth will be pulled or treated.
Torries toothaches, along with the risk and high cost associated with curing them, probably could have been avoided. She is like many children in low-income families in Colorado who rarely, if ever, see a dentist even though they can go for free.
State Medicaid data reported to the federal government show that fewer than half of the 453,000 Coloradans younger than 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service. Only a quarter of Colorado counties met a 2010 state goal of getting at least 44 percent of Medicaid-eligible residents younger than 19 to visit a dentist, according to an I-News analysis of state records.
Dental disease is not self resolving, said Diane Brunson, director of public health for the University of Colorados School of Dental Medicine. Its not like catching a cold, and you put up with it for a week or 10 days and youre fine. You have to get treatment. And its so much more beneficial all the way around to the child, to their family, to taxpayers if dental problems can be prevented.
While the state appears to be making strides in improving its numbers, part of the problem is the paucity of dentists willing to see Medicaid children. Only 10 percent of Colorados 3,500 or so dentists are considered significant Medicaid providers, meaning that they are reimbursed for at least 100 visits per year. Moreover, 20 of Colorados 64 counties do not have a dentist who accepts Medicaid.
In total, 21 percent of the dentists report having some Medicaid patients, and only 16 percent say they are willing to accept new Medicaid patients.
Plenty of Colorado children covered by commercial dental insurance also fail to see a dentist regularly. But kids in low-income families are most at risk for tooth decay, which is the most common childhood disease.
A state health department survey released in October showed that 73 percent of third-graders in Colorados poorest public schools (measured by eligibility for free- or reduced-price lunches) have had a cavity compared with 41 percent of third-graders in more affluent schools. Untreated cavities affected 19 percent of kindergartners in the poorest schools, but only 7 percent in high-income schools.
Proper care of primary, or baby, teeth is just as important as adult dental care, dentists say. Baby teeth reserve space for the permanent teeth that eventually will replace them. They help in the development of speech and help give a childs face a normal appearance.
Decaying baby teeth can make it difficult for children to chew food and can damage the permanent teeth growing beneath them. Many kids in pain end up using expensive emergency room services or undergoing multiple dental procedures while under anesthesia.
People tend to believe that because theyre just baby teeth and theyre going to fall out, we dont need to worry about them, said Karen Cody Carlson, executive director of Oral Health Colorado, an umbrella group of oral health advocates. They dont realize that kids can get severe infections, life-threatening infections, sometimes.
Apples are Torries favorite food, but she also likes gummy fruit snacks, Sweet Tarts, chocolate and soda. In the living room of their home in Montbello, a northeast Denver neighborhood, Anthony and Wendie Smith say they thought they had been doing enough by brushing their daughters teeth twice a day ever since her first incisors erupted. They never took Torrie to the dentist because they didnt have dental insurance at the time (Anthony recently became eligible through his job) and couldnt afford the cost. Anthony, 27, is a mechanic and Wendie, 26, is a stay-at-home mom.
It didnt occur to the Smiths, they say, that Medicaid would cover Torries dental care. Wendie had qualified while pregnant and Torrie was enrolled in Medicaid as an infant. When she came along, Wendie says of Torrie, they gave me a (Medicaid) card and said it was for her doctor visits. They didnt say dental or anything like that.
After Torrie fell on the sidewalk, the emergency room doctor told them she needed to see a dentist. Wendie says she called several around Castle Rock, where they were living then, but all wanted money up front that they couldnt pay. Meanwhile, Torries front teeth were turning black and Wendie had to cut her food into small pieces.
A friend eventually mentioned that Medicaid might help. The first dentist to see Torrie reshaped her two front teeth with porcelain, but her parents didnt take her back for further treatment because she didnt feel comfortable there, her mother says.
The Smiths found Gillespie around Halloween when a flier sent home from Torries preschool mentioned that his Lil Teeth Dentistry practice in Aurora accepts Medicaid patients. Gillespie says he treats children on Medicaid, who make up about 60 percent of his practice, because he was on Medicaid as a child. For me, its very personal to make sure these kids get all the treatment they need, he says. Everyone deserves to be treated.