"It was awful," Teri Langston said, recalling the ordeal of her little boy's dental problems.
When he was about 18 months old, his new teeth crumbled with the decay called "bottle rot." The toddler endured massive dental surgery. Langston was on public assistance at the time. Only one dentist in the whole area would take on the job, and she was unhappy with his manner.
"I felt bullied," she said. "I will never take my child to that man again."
But a year later, the toddler flared up with an abscess on a Friday afternoon. He had fever and swelling, and his frantic mother began calling dentists' offices.
"I know I called everyone in the phone book," she said. "The answer was always, 'We don't see children under 5.'"
She returned to the first dentist. He gave her a list of $2,000 worth of dental work and said he would not touch the child unless she agreed to the whole package.
"I said I would find someone else," she said.
After a nightmare weekend, she found a dentist who was willing to pull the tooth, but without any pain killers on account of the child's age.
Subsequently she took the boy to Anchorage to see a dentist she and her son liked, even though he would not accept her Medicaid and required cash up front.
"Whenever you go to Anchorage, you have to take a whole day off. ... It's a pain in the butt," she said.
Langston's bad experience is not unique.
According to a study completed last summer, about one child in four on the Kenai Peninsula is eligible for Medicaid dental benefits. Of those, fewer than one in five received those dental benefits over the course of year. Of those who do see dentists, about a third go to Anchorage or Homer for service.
The study was released last summer by the Community Dental Health Project. Begun in the spring of 2000, the project examines dental care needs in the central peninsula. It is run through the Healthy Communities/Healthy People coalition and funded by a grant from the Alaska Department of Public Health and Social Services' Division of Public Health. The grant and program will expire June 30.
Tuesday, the project will host a community meeting to build partnerships to improve the oral health of area children. It will convene at 6:30 p.m. Tuesday at the Soldotna Senior Citizens Center on Park Avenue.
The goal of the meeting is to set up a coalition to pursue the matter further, said Traci Martinson, the dental hygienist who coordinates the project.
A coalition will have to involve lawmakers, dentists and others. Community involvement is a key to change. In other areas, the most effective ideas for improvement have come from the dentists themselves, she said.
"I think right now the biggest barrier is a total lack of communications," she said.
"Everyone involved in this has a different agenda. ... If there were an easy answer, someone would have thought of it."
Although the original plan for the project was to find solutions to the dental care gap, what it has done instead is better reveal the vastness of the problem, she said.
"Probably the bottom line is (dental decay is) a preventable disease, but it's rampant here. Kids are in pain -- and that's not even touching adults' needs," she said.
The study found that the peninsula has the highest ratio of patients per dentist in the state. Figures it quoted from the state Medicaid claims report show that in 1999 the state reimbursed more than $11,000 in travel expenses for central peninsula families to take children out of town for care, plus it paid out more than $130,000 to out-of-town dentists.
Martinson described the current system as a frustrated gridlock. People can't get care, and dentists can't get paid, she said.
Dr. Dan Pitts, a Soldotna dentist, agreed.
"It's a national problem," he said. "This is all coming to a head. It has been a problem for a long time."
The Community Dental Health Project study concluded that "The most significant barrier to gaining access to dental care is the lack of local dentists who take new Medicaid patients."
Martinson said accusing the dentists of turning away poor patients is unfair and inaccurate. She noted that many, even if they do not accept Medicaid patients, do charity work on the side.
"There's a lot of disincentives. No matter what the dentists do, they come out looking like bad guys," she said.
The dentists pan the way the Medicaid program works in Alaska.
The Alaska Dental Society is working with the state to resolve fundamental problems with Medicaid. The president of the group, Dr. Thomas Hipsher, plans to attend the Soldotna meeting, Pitts said.
Alaska dentists have been pulling out of Medicaid. They have weathered a lot of criticism for their decisions because people do not understand their reasons. He hopes this meeting will explain the dentists' point of view to community leaders, he said.
Alaska's Medicaid provider agreements with dentists include one clause that could force them to pay for defending the state of Alaska in lawsuits, and another that allows the state to sue health-care providers who give price breaks to charity cases, he said.
Pitts praised the Community Dental Health Project and said he is looking forward to Tuesday's meeting as a step forward in airing the thorny, interlocking issues.
"It gets to be an emotional issue," he said. "We are talking now. I believe we are on the road to a solution."
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