Could changing Medicaid cut ER visits for dental emergencies?

Emergency room visits for preventable dental conditions are up 16 percent across the nation, according to a report from the Pew Center on the States.

Health advocates say changing Medicaid would be a good start toward reversing that trend.

In Pennsylvania and New Jersey, children and adults can get dental care through the Medicaid program. In Delaware, that coverage is only available until age 21.

Shelly Gehshan leads the Pew Children’s Dental Campaign. She says Medicaid needs to be easier to navigate and the program should pay dentists better.

Raising reimbursement to 60 percent usually is enough to cover the cost of care, she said, and that would entice more dentists to accept Medicaid.

“In Pennsylvania the rates are below, they’re only at about 49 percent, in New Jersey the rates are even lower than that, there only about 43 percent, so dentists lose money on every patient they see,” Gehshan said.

Amid Ismail, the dean of Temple University’s Kornberg School of Dentistry wants to bring more education and outreach to poor communities. He says poor people need low-cost care options on nights and weekends — and the help of care navigators who can connect patients with the right resource before an emergency.

Ismail said reimbursement for pulling teeth and other surgery is OK, but the government pays poorly for preventive care.

“The community education is not paid for, so we need a system to pay for outcomes of care, health outcomes rather than just procedures and that’s a policy issue,” Ismail said.

“There are a lot of issues there,” Ismail said. “Including even if we provide the opportunity for people to get care, people don’t show up to the appointment we give them. There are so many social, political, cultural, behavioral issues that impact care. If people are worrying about what to eat, housing, security and their children’s education, then they have a problem paying attention to things that are not causing them pain. They wait until they have pain and then seek care.”

In the Garden State, the New Jersey Dental Association is trying — once again — to get lawmakers to expand access to drinking water with fluoride. Association spokesman Eric Elmore says adding fluoride to public drinking water is a safe, community-wide and low-cost way to fight tooth decay but New Jersey’s “home rule” laws have stifled the push.

“When it comes to water systems, we may have many towns on one water line,” Elmore said. “If 14 towns vote to put fluoride in their water and one votes to not, none of the towns get fluoride.”

New Jersey ranks 49th out of 50 states for the percentage of citizens who have access to public water with fluoride, Elmore said.