BATON ROUGE (AP) — Cavities drilled and filled in the school library. Teeth pulled in the school gym. Students getting teeth cleanings and dental X-rays, then heading back to math and reading classes.
Such mobile dental clinics have provided care to thousands of poor Louisiana children on school campuses. But the clinics would be forced to close if lawmakers agree to a proposed ban on dental surgeries and other tooth work at schools.
Supporters of the ban say they want to outlaw “drive-by dentistry” that they consider unsanitary and unsafe for children.
“Louisiana’s children do not deserve Third World dentistry,” said Claudia Cavallino, a pediatric dentist from New Orleans.
Opponents argue the mobile clinics bring care to poor children who otherwise might never see a dentist. They say the bill is a bid by some dentists to get more money for themselves, now that the state has increased reimbursement rates for dental work through the Medicaid program for the poor.
“We are doctors going to treat children that will never (otherwise) get it. We are regulated by the State Board of Dentistry. How is it good for us to do free services and then all of a sudden it’s not good when we bill for them?” said Gregory Folse, a Lafayette dentist who provides mobile dental care at schools in New Orleans, Baton Rouge and Shreveport.
The House Health and Welfare Committee plans to debate the bill by Rep. Kevin Pearson, R-Slidell, on Wednesday, a week after some lawmakers on the panel called for more information before they make a decision.
Mobile clinics have been growing in Louisiana, where a majority of poor children lack regular access to dental care even though the state’s Medicaid program will cover the costs.
Cavallino questioned whether the clinics can properly handle infections and emergencies and knew enough detail about the children’s medical history and drug allergies before treating them.
“I have grave concerns about the quality of dental care being delivered by the transient nature of school-based dental programs,” she told the House committee last week. “I also fear that a disaster is waiting to happen when invasive, irreversible surgical procedures are being done and anesthetics are being given to a child” in a school library or cafeteria.
The Louisiana Dental Association is pushing the ban on the mobile clinics, saying children need a “dental home” with coordinated care in a permanent office that can track medical records and follow-up appointments.
Ginger Hunt is CEO of Primary Care Providers for a Healthy Feliciana, which has provided dental care at schools in rural East Feliciana Parish since 2003. She said shuttering the school clinics would harm underserved children.
“I believe this is a money issue. Ten years ago when we knew we were in crisis in Louisiana, and we knew we were in crisis across the nation, where was the dental association then?” she said. “This year when the money is there, it seems as though the service is coming. It’s coming a little late.”
Opponents of the bill include the Louisiana Primary Care Association and the state chapter of the American Academy of Pediatrics. The Federal Trade Commission questioned whether Pearson’s bill would curtail access to dental care for poor children.
Proponents and opponents of the ban disagree on how much care would be available to children in the Medicaid program without the school clinics.
Marty Garrett, a Baton Rouge dentist and past president of the Louisiana Dental Association, said more than 1,100 dentists in Louisiana have signed up to treat Medicaid-eligible children in their offices. Garrett supports the ban on the mobile dentistry units.
But Sue Catchings said getting an appointment can be difficult for working parents.
Catchings, CEO of Health Care Centers in Schools, which provides dental care in Baton Rouge schools, said parents who are paid an hourly wage often can’t afford to lose money to take their children to the dentist or don’t have transportation to easily get there.
Of a survey of 146 dental offices in the Baton Rouge area, Catchings said she found 33 who would take children on Medicaid. But only five of those offices would take after-hours appointments and only two would take patients on Saturdays, she said.
“They’re not open when our parents can get there,” Catchings said.
It’s unclear where state officials stand on the ban.
The state Board of Elementary and Secondary Education voted to support the bill. But Joe Salter, speaking for BESE, said board members didn’t have accurate information from bill supporters at the time and now had concerns.
State Health and Hospitals Secretary Alan Levine hasn’t offered a position.
“The debate should be about how we get these children dental care. We’re not taking a particular side in the debate, but our posture is that we want kids to have access, and we’re willing to look at different ways of getting to that goal,” Levine said in a statement.
Pearson’s bill would allow certain limited types of dental care at schools, including dental cleanings and fluoride treatments — if they are free.
