Michigan may start mandatory dental exams for incoming kindergarteners

Michigan policymakers finally may be getting the message dentists have been extolling for years: Pearly white smiles are for more than scrapbook photos and Instagram selfies. Good overall health begins with healthy teeth and gums, especially in kids.

It's also a particularly relevant message now, as Michiganders who were unable to visit their dentist during the pandemic finally can.

Preventive oral care, dentists say, saves teeth, saves money, and, in many instances, lives. That's because the mouth, no matter how old you are, is the gateway to the digestive and respiratory tracts, where certain infections can be deadly.

With this in mind, the Michigan Department of Health and Human Services recently announced tens of millions of dollars for Medicaid reimbursements aimed at improving "access to dental services" — including cleanings, fillings, root canals, crowns and dentures — and preventing more serious, and more expensive, problems to treat.

"This positive change recognizes the strong correlation between oral and physical health outcomes," MDHHS Director Elizabeth Hertel said last month. "With better services and closer care coordination, we can maximize opportunities to create healthy outcomes for beneficiaries of all ages while also expanding the number of providers so Michigan’s residents can get care where and when they need it."

On top of that, a new state legislative proposal is seeking to mandate dental exams for schoolchildren before they are able to start kindergarten to ensure good oral health, much like the vision and hearing screenings that youngsters already are required to undergo.

"Every kindergartener would have an oral health exam," said state Sen. Sam Singh, D-East Lansing. "You have a lot of kids who, unfortunately, don't have access right now to a lot of dental care, and what we're seeing is a lot of young people missing school because they have tooth decay."

There's data to back that up.

But Michigan's legislative proposal also raises some questions, even among dental professionals, who are concerned the legislation could prevent kids from getting an education and who say screenings don't do nearly enough to solve the problem.

Oral hygiene, dental care

The reimbursement changes and legislative proposal follow decadeslong research that shows good oral care is integral to one's general health as well as public health initiatives to treat kids, some of whom have never been to a dentist, at schools. Among them: University of Detroit Mercy School of Dentistry's Titians for Teeth program, which features a mobile clinic to address oral health needs of metro Detroit children.

To emphasize why oral care is important, dental experts point to findings from the Association of State and Territorial Dental Directors that tooth decay is among the most prevalent chronic conditions among children in America.

More than one-quarter of preschool-age children get visible cavities before entering kindergarten, the dental directors association reported in a policy brief on dental screenings. The group added the consequences of tooth decay take a toll on "children, their families and communities."

Dental-related illness cause kids nationwide to lose an estimated 51 million school hours annually, according to a 300-plus-page U.S. Department of Health and Human Services report, Oral Health in America: A Report of the Surgeon General.

And cavities, that report added, are five times more common than asthma and seven times more common than hay fever; and kids from low-income families suffer nearly 12 times more restricted-activity days than students from higher-income families.

On top of missed school, tooth pain leads to eating and speaking problems.

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All that is a big reason why Singh and state Rep. Phil Skaggs, D-East Grand Rapids, said they introduced Senate Bill 280 and House Bill 4445, respectively, which are aimed at promoting better health and align with requirements for dental examinations with the nearly 50 years of successful vision and hearing tests.

Their proposal also is similar to what at least a dozen states — including California, Illinois and New York — have done, and is in line with a broader push by state health departments to promote and provide more oral care access and coverage.

Dangers of neglected teeth

If passed, Michigan's proposed legislation also would make permanent an oral health pilot program run by the Michigan Department of Health and Human Services during the 2021-22 school year.

Skaggs noted he authored the House proposal because "too often, children are suffering from an issue that could easily be resolved from a dental exam," and that his plan could help "ensure that all students are receiving proper oral health care."

To help kids, Detroit Mercy Dental’s Titans for Teeth Mobile Clinic treats hundreds of schoolchildren a year. The dental school's faculty and students roll onto a participating school's campus in a 38-foot, red-white-and-blue mobile clinic with a grinning Tommy Titan — the school's mascot — holding a giant toothbrush on it.

The specially outfitted RV is decorated with "Finding Nemo" characters swimming about portholes, transforming the roving dentist office into a submarine. Inside, four dental chairs and other equipment allow a dentist, two dental hygienists and several dental students to see about 20 kids a day.

"We appreciate the intention of the legislation," said Mert Aksu, the dean of the University of Detroit Mercy School of Dentistry. "However, the legislation may have unintended consequences and fail to address the many barriers facing families today."

Aksu, who has degrees in dentistry and law, said "many families struggle with managing work and family responsibilities immediately before the school year begins and dental screening may not address the need to ensure children entering school have adequate oral health." One University of Detroit Mercy study, he said, found only 11% of parents follow up with oral health treatment.

The focus, he added, should be on disease management and definitive care, which a screening is not.

Many young children, Titians for Teeth clinicians said, have never been to a dentist and it's sometimes shocking to them to see how much pain some of the kids are in. Some kids have no dental insurance — or, even if they do, can't afford the care.

And some kids have no oral hygiene habits.

With a handheld mirror, the dental students teach kids what angle to hold a toothbrush: 45-degrees; how long to brush each time: 2 minutes, and try to explain the consequences of neglecting their teeth: bad breath, rotting teeth and harmful bacteria — yuck — spreading throughout their entire bodies.

Medicaid reimbursements increased

Dentists add that everyone — not just kids — needs oral health care.

It helps prevent deadly diseases and conditions such as endocarditis, an infection of the heart; cardiovascular disease, including clogged arteries that lead to strokes; pregnancy complications, such as premature birth and low birth weight, and pneumonia.

MDHHS has called the Medicaid changes an "$85.1 million investment." The changes, MDHHS said, mean dental care providers are now being paid at 100% of the average commercial rate, which enhances access and incentivizes providers to treat Medicaid beneficiaries.

As of April 1, MDHHS added dental services for Michiganders who are 21 and older that include X-rays, teeth cleanings, fillings, extractions, dentures, deep teeth cleanings, sealants, root canals, crowns and care to keep their gums healthy.

Vince Benivegna, an East Lansing oral surgeon whose term as president of the Michigan Dental Association just ended, said that under the previous adult dental Medicaid program the reimbursement rates for providers were too low.

"Dentists would lose money by treating adult dental Medicaid patients, and, as small business owners, this was not sustainable," he added. "The new rates recognize the value of quality care and will allow more dental health providers to treat Medicaid patients."

As for the proposed dental screenings for schoolchildren, the legislation would require parents to submit a form to their student’s school administration confirming they have received an oral health screening within six months of the first day of school.

"The Michigan Oral Health Coalition is very excited about the introduction of this important legislation," said Ellen Hyman, the coalition's executive director, adding that it would "help address the most chronic disease for children, tooth decay, and reduce the number of school days missed due to dental pain and infection."

Singh added he expects that screenings would be provided to families who don't have dental insurance or can't afford screenings and that there would be an appropriation to cover the cost, estimated to be about $4.5 million.

And, under this plan, each community could figure out how to offer the free dental screenings, such as through health departments or use mobile clinics, like the Titians for Teeth bus.

"This is to start a baseline," Singh said, comparing it to a vision screening. Because, he added, one student's health problems can become an entire classroom's education problems: If you are "having a toothache, or you can't see because you don't have glasses, or other types of things, those are barriers for kids to learn, and they act out because they're not provided the best access to health care."

Contact Frank Witsil: 313-222-5022 or fwitsil@freepress.com.

This article originally appeared on Detroit Free Press: Michigan legislators propose dental exam mandate to start kindergarten