Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: FRIDAY, November 17, 1995                   TAG: 9511170031
SECTION: EDITORIAL                    PAGE: A-18   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

DENTAL DEARTH

The poorest children, covered by Medicaid, should be able to get care. But when Jacqueline Green tried to find a dentist to look at her son's tooth, which she thought might be broken, she found that simply being covered offers little protection if dentists won't accept Medicaid.

Only 13 in the Roanoke Valley do, and only three of these are taking new patients. Others find the reimbursement (or profitability) too low, and the hassle too large, to bother with Medicaid.

And the Roanoke Health Department, which had offered dental care for children, has stopped. When its one dentist left, the department dropped the program. Its budget was cut. The state doesn't require it to provide dental services.

Like the shooting pain of an abscessed tooth, the challenge of getting proper dental care in the Roanoke Valley when you are poor is but a symptom of an underlying problem: gaps in our piecemeal approach to meeting health-care needs. As budgets get tighter, the gaps start to gape.

The valley is in better shape than most communities because of the Bradley Free Clinic and CHIP. Volunteer dentists associated with the clinic offer services once a week to the uninsured working poor. As valuable as this is, it doesn't meet all the demand among even this one segment of the poor.

The Child Health Investment Partnership assigns a dentist as well as physician to every impoverished child fortunate enough to participate. CHIP-affiliated health-care professionals agree to see the youngsters at Medicaid rates. But CHIP, too, lacks the wherewithal to serve all those eligible. And many adults eligible for Medicaid still aren't getting dental care.

New approaches dealing with broader health-care concerns apply to dental care as well. Just as consumers are being urged to emphasize preventive measures to cut into the astronomical costs of intervention medicine, people need to take personal responsibility for dental hygiene.

Dentists help teach good practices, though. If someone never sees a dentist, it hardly helps to admonish him to take better care of his teeth. And all the instruction in the world on proper brushing and flossing won't eliminate every toothache or flare-up of gum disease. Just about everybody needs dental work at some time.

As the free-clinic and CHIP examples suggest, part of the solution to lack of access for the poor - from the dearth of dental practices that accept Medicaid to inadequacies in transportation for people without cars - will have to be found locally. Certainly, as the federal government devolves more power to the states, and states devolve more to communities, the region's share of responsibility must grow.