Toothless in Florida: How oral care gets lost in the health care crisis

Can't afford to see a dentist? Don't expect to get much help from Florida.

Last month, Danielle Beckmann, 24, visited the dentist for the first time since 2003. The news wasn't good.

"My gums on the front of my bottom teeth are receding so much that the bone is almost exposed," Beckmann said. "The dentist says I am jeopardizing losing my teeth."

The cost of the surgery needed to reconstruct Beckmann's gums? $1,300.

Beckmann, a senior at the University of South Florida's St. Petersburg campus, is no longer coverd by her parents' policy and cannot afford the school's private health insurance. But even if she could, her options would be limited: dental coverage is not included in USF's plan.

"USF does not provide dental coverage to help minimize the cost of basic health insurance. And dental coverage has never been requested or asked for," said Lara Wade, news director at USF. According to Dr. Egilda Terenzi, director of student health services, students have never raised it as a major concern.

But for Beckmann, lack of access to dental coverage is a major toothache.

"I guess it's deciding at this point whether to look homeless or be homeless," Beckmann said.

Statistics show a widespread failure in Florida to support quality dental care for low-income residents. But the attitude of USF is not uncommon. Dr. Charles Hoffman, president of the Florida Dental Association, said that most state universities laugh when asked about their dental care. (The University of Florida is an exception; its school of dentistry enables UF to offer services to their students.)

Hoffman noted that part of the reason is a general disregard for the importance of oral health to a person's over-all well-being.

"It has always been viewed as just teeth, part of the head, but not part of the body. But the evidence over the past few years between good oral health and good systemic health are just increasing astronomically," Hoffman said.

According to Dr. Hoffman, Florida has the 48th lowest Medicaid reimbursement rate for its providers. Dentists that offer Medicaid receive only about 25 percent of their costs back from treatments, discouraging many dentists from becoming providers. The situation may only get more dire if funding for Medicaid decreases with the proposed health care reform in Washington.

Last year, the Florida Pediatric Academy and the Florida Dental Association took steps to confront these inadequacies: They sued the state of Florida, alleging that the government has failed to provide essential medical and dental care for children on Medicaid. The suit also states that there is an insufficient number of dental and medical providers, due to the state's extremely low reimbursement rate.

Last week, the Pew Center for the States gave Florida another black mark. The center's comprehensive report on child oral health grades the states on how well they meet benchmarks for child dental care. Florida, which met only two of the benchmarks, received an F. (Not that the rest of the country did much better: The report found that one in five children in the nation go without dental care every year, and that two thirds of states lack policies that ensure access to treatment.)

Hoffman said part of the problem in Florida lies in restrictions regarding supervision. Currently, patients must see a dentist before receiving simple dental procedures like sealants and cavity varnishes. But those procedures will in most cases be performed by hygienists, who could do more work if they had access to patients without waiting for a dentist's OK.

"The whole key to this access-to-care situation is that we aren't going to drill and fill our way out of this," Hoffman said.

Annual free dental clinics statewide seem to be some Floridians' only option. Three weeks ago, a New Port Richey dentist held an annual free clinic for the public. Lines began nearly 24 hours before the clinic started.

Ralph Fucillo, president of the Dentaquest Foundation, which worked with the Pew Center's study on oral health, said he isn't surprised.

"For some people, these volunteer free clinics are the first dental appointments they've had in their lifetime. What you see in Tampa and St. Petersburg is repeated in numerous places throughout the country," Fucillo said.

Fucillo said the tragedy is that most dental problems could have been prevented.

"Oral disease is 98 percent preventable. We just have not, as a nation, emphasized how important oral health is on health," Fucillo said.

The price of private dental care without health insurance can be crippling, as Beckmann has experienced. Without regular cleanings, cavities often occur, and when those are not tended to, the decay hits the root. Root canals run an average of $800 per procedure, and that doesn't include crowns, which can cost an additional $800. Hoffman has practiced dentistry for 28 years and blames dentistry's high overhead on the pricing.

"Dentistry runs on average 50-70 percent overhead in our procedures. So the more high-tech you get, for example I use lasers and work under a microscope, that carries a high price tag," Hoffman said.

Few dentists offer payment plans, except for expensive procedures. But Beckmann didn't qualify.

"At that age, gums receding like that is very serious, because if you are having a periodontal problem it may not be painful, but you are slowly losing the support that holds the teeth in. And once you lose bone, you never get it back," Hoffman said.

Next December, Beckmann graduates with her Bachelor's in journalism and media studies. She isn't certain how to finance her dental woes, but hopes that perhaps Washington can figure it out before she does.

"I am going to try and save, but it's virtually impossible. All I can do is floss a lot more and hope that the tooth doesn't fall out," Beckmann said.

read more in our story More cavities in our dental care system.