Monday, April 19, 2010

Dental care without Medicaid

Now that Michigan Medicaid no longer pays for preventive dental care for adults, we are not relying on dentists that accept Medicaid for our sons' routine dental care. The state's decision to drop dental care is cruel and short-sighted, but finding a dentist who was willing to try a different approach with our son Danny was an eye-opening experience.

Danny has severe cerebral palsy and profound mental retardation. Most importantly, when it comes to working on his teeth, he has a severe aversion to touch, especially around his face, mouth, hands and arms. And, at 33, he is strong. His movements are mostly uncontrolled, and if he is agitated, he is capable of inadvertently smashing you in the face, if you are not careful.

In the past, the only sedation that Danny received before dental appointments was Valium. Danny would have a nice
Valium-induced nap on his way to the dentist and be fully awake and agitated during the dental exam and cleaning. Then, on the way home, he would have another nap before the Valium wore off. This time, we sought out someone who would try IV sedation before working on his teeth. As it turned out, Danny got the most thorough dental exam and treatment ever with a minimum of trauma.

Danny is generally healthy, with no heart or respiratory problems and with a history of tolerating both IV sedation and general
anesthesia well. An experienced nurse anesthetist worked with the dentist and dental hygienists to sedate Danny and keep him "under" enough so they could work on him. The nurse anesthetist monitored Danny the whole time for blood pressure, heart rate, and oxygen saturation. Danny also received fluids through the IV and oxygen at least part of the time. The nurse controlled and monitored the amount of medication throughout. When it was all over, Danny came out of it immediately and was just fine. While Danny was under sedation, they did a complete set of X-rays, photos of his teeth, and a thorough deep cleaning. Danny had inflamed gums, but no cavities or periodontal disease. He did not need any other dental work, but the dental team was prepared for anything. His teeth are so clean now, he could eat off them.

It was costly, but having talked to a friend who looked into work being done on her child at a local hospital under general anesthesia, the expense was a fraction of what that would have cost.

This could have been done a long time ago, but we were discouraged from even contemplating it by one dentist who insisted
that IV sedation didn't usually work on "people like Danny". Another dentist said it was too expensive, unsafe, and Medicaid would probably never approve it. He also said it was unsafe to use sharp pointy objects to clean Danny's teeth and thought brushing his teeth with anti-bacterial mouth wash every day was sufficient. He would not recommend using anesthesia unless Danny had more obvious dental problems, like loose teeth and rotting gums (he used more technical language than this). Then I asked, if we could pay to have him anesthetized ourselves rather than trying to get approval from Medicaid, would they do it? Suddenly, the issue of safety dropped from consideration and he said he could probably arrange for the hospital to do it. We decided to look for a less ethically challenged dentist.

Danny is fortunate in many respects: he has a good set of choppers, he is relatively healthy despite all his problems, and he has family who are able to pay for good dental care. But I question the wisdom of the state allowing a whole segment of the population to go without access to preventive dental care, knowing the bad effects this has on general health that we will all pay for eventually, and knowing that some people like Danny who cannot communicate whether the pain and discomfort they are experiencing comes from a tooth ache or a belly ache, will suffer needlessly from the lack of care.

Look here for more information on trauma-free dental care.

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