A reason to smile

Local dentist goes face-to-face with Kentucky’s oral health challenges.

By Melanie Wolkoff Wachsman

Tooth decay, gum disease and oralpharyngeal cancers are no strangers to the Commonwealth. According to the Kentucky KIDS SMILE program, there are about 4,500 three-year-old children who have experienced toothache.

A simple toothache can lead to a downward spiral of health issues. For example, cavities and gum disease leads to serious infections, such as respiratory disease or a loss of tooth/teeth. Toothlessness affects speech and the ability to chew food properly, which then leads to poor nutrition and poor overall health. Poor overall health leads to a poor quality of life. Even poor oral health during pregnancy may lead to preterm and low birth weight babies or cause complications such as reclampsia, gestational diabetes and fetal loss. Further, emergency room visits continue to increase for adults seeking relief from dental pain.

Root of the Problem
Poor oral health stems from multiple factors including lack of access to care, lack of importance placed on oral health, lack of oral health knowledge and lack of money to pay for care, to name a few.

While there are federal and state assistance programs for dental care, they are limited. The Children’s Health Insurance Program (CHIP) requires states to provide limited dental coverage for enrolled children up to age 19. The Medicaid program requires states to provide limited dental services for most Medicaid-eligible individuals under the age of 21, but there is no assistance to provide dental services to individuals aged 21 and over.

Dental benefits sold in standalone policies are not subject to most Affordable Care Act provisions. Only pediatric benefits are required to be offered to individuals and small employers.

“Statistically speaking, more than 60 percent of Americans don’t have dental insurance,” said Dr. Michael Austin Brown, dentist/owner of Hurstbourne Dental Care, PLLC, in Louisville. “This means that a large majority of people here locally delay dental procedures, which is not good for dental health or overall healthcare.”

Brown decided to do something tangible to help these individuals and families afford quality dental care. “Even here in Louisville we see kids in our practice who are in chronic pain because a simple cavity was not caught in time,” Brown said. “That cavity was not caught because the parents perceived that they could not afford dental care. By the time the pain for the child is unbearable the cost of solving the problem escalated two or three times over what it would have been if caught a year earlier.

“This bothered me a great deal and I decided to be part of finding a solution.”

Numbers Don’t Lie
The solution that Brown helped develop with other dentists across the country is both simple and ingenious—and may prove to be a model for healthcare reform.

“We found that we could create a system where families could get earlier preventative and less expensive dental care,” he said. “I sat down with my front office team and saw how much money was going to insurance companies, claim forms, administration and collections costs. We also calculated how many hundreds of extra dollars families were spending by not catching potential problems that we could have found during a simple annual dental exam.

“When I began to run these numbers with other dentists around America we discovered that we could offer our patients free initial exams, free exam x-rays, free teeth cleanings, and as much as 20 percent off our usual fee structure simply by creating our own inhouse dental savings plan.”

The program, launched in 2009, is called QDP (Quality Dental Plan). QDP is currently rolling out nationally.

Coscto for Teeth
QDP works very much like a membership at Costco or Sam’s Club, explained Dr. Dan Marut, president/founder of QDP, based in Portland. “When a patient becomes a member they access savings and benefits,” he continued.

These benefits include necessary preventative services like free teeth cleanings, free exams, free x-rays, and free whitening. If a patient needs restorative treatment to treat dental disease, patients access savings off of regular fees. In fact, patients can receive as much as 20 percent off of regular fees, said Marut.

Dentists Benefit, Too
Dentists benefit, too. Some of the biggest challenges in being a dentist are the influence dental insurance has over patient decisions and providing access to care for those without insurance.

“Now dentists are able to increase access to care for those in the community who would normally put off dental care due to the high cost of traditional dental insurance,” said Marut.

“We strive to educate patients on their different treatment options, but unfortunately, ‘I’ll do whatever insurance covers” or ‘I can’t afford it because I don’t have insurance’ often drives their decisions,” added Brown.

“This one simple step has allowed us to eliminate the insurance company middle man and those savings go right back into the pockets of folks here locally.”

Currently dentists in 44 states offer QDP to their communities. Marut only sees those numbers growing. “Ten years from now QDP will continue to grow offering dentist and patients well thought out, affordable solutions to increase access to care in communities across North America,” he said.

Brown couldn’t be happier. “I’m really proud to be part of this forward looking cost-savings movement,” he said. “This is a great system for dental care everywhere.”