Middletown resident Janet Greene likes to play a bit of a waiting game when it comes to dental care.
She narrowly avoided a $300 root canal a couple of weeks ago, but this time around, her cavities finally caught up with her.
Last Wednesday, Greene, 50 and unemployed, sat at Westside Family Healthcares Wilmington dental clinic awaiting treatment for two cavity fillings and a chipped tooth.
She is on Medicaid, but that wont help her. In Delaware preventative dental care – routine checkups, cleanings, fillings and X-rays are not covered. Greene is not alone in her situation. There are 124,532 other Delawareans lacking that coverage.
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Delaware is 1 of only 4 states without Medicaid coverage for adult dental care, forcing patients to pay out of pocket for care considered to be the first line of defense against health risks, including premature births, heart disease and complications from diabetes.
State medical experts say reform is clearly needed, but it comes with a hefty price tag: More than $6 million to implement.
For patients like Greene on fixed-income and without a monthly paycheck, scraping together $50 for a co-pay is a struggle.
Its a bit of a burden, she said.
Some clinics, like Westside, offer payment plans, but its still difficult.
Nineteen-year-old Destiny Chinski, of Wilmington, watches the time tick away until she is in Greenes shoes.
Chinski is enrolled in Medicaid through a state assistance plan, Delaware Physicians Care, but dental coverage cuts off as soon as she turns 21.
Without insurance, two routine dental exams, including X-rays and teeth cleaning, can cost around $350.
Such money can buy about 100 gallons of milk, 30 adult movie tickets or close to 350 basic paper notebooks. For some, $350 is the sum of a paycheck or a couple months worth of groceries.
Chinski worries about the looming cost of her dental care, so she is trying to fit in as many appointments as she can.
It only doesnt cost me for so long, she said. Health care in general in this state is hard to come by. Theres not much they [the state[ can do for every person.
Wilmington resident Norma Diaz, 32, is used to paying out of pocket for her dental care. A root canal costs her $140; an extraction costs $60.
Two weeks ago, she waited patiently to be seen at Westside for her final fitting and setting for partial lower dentures. The entire process to create dentures, impression, mold, fitting and setting, will cost her somewhere between $600 to $1,200.
Medicaid coverage for dental care would be a lifesaver, she said.
I wouldnt have to pay out of pocket, she said, smiling at the thought.
There are no requirements under the federal Centers for Medicare and Medicaid Services to provide preventative dental coverage to adult Medicaid beneficiaries. States have the flexibility to determine how and what dental benefits are provided.
Pennsylvanias Medicaid division, for instance, offers coverage adult dental exams, cleanings and pre-approved treatments for prosthetics, extractions and crowns for as little as a 65 cent co-pay.
Most states have jumped on board to add some facets of adult dental care to Medicaid benefits, but Alabama, South Carolina, Tennessee and Delaware do not offer that coverage. However, the Centers for Medicare and Medicaid Services is in the process of approving South Carolinas preventative dental care expansion.
The cost to taxpayers has been a major obstacle to expanding the states subsidized dental benefits, said Sen. Bethany Hall-Long, D-Middletown, chair of the state Senate Health Committee.
Hall-Long introduced two bills in the 147th Legislative session that specifically addressed that need for subsidized adult dental care in Delaware, but they failed to make it to the Senate floor.
State budget officials then estimated the expansion would cost $6.2 million a year for about 216,000 beneficiaries.
Yes, it is expensive, but, pending re-election, Hall-Long pledges to re-introduce the bills in January when the Legislature reconvenes.
A lack of dental care is far too great of a threat to overall health, she said.
Preventative care is so much less costly, Hall-Long said. We have to look at how we can provide a basic, minimum standard.
In an annual survey by the Centers for Disease Control and Prevention, 70 percent of adults living in Delaware had a dental visit within the last year, said Dr. Greg McClure, dental director for the states Bureau of Oral Health and Dental Services.
Though that is close to 700,000 people, McClure said the data does not specify whether those visits were routine or emergency.
Even though Westside recently opened a new community clinic in Dover to help better serve those on fixed incomes downstate and cut down on emergency visits, Tom Stephens, Westsides chief medical officer, said the need to expand Delawares Medicaid is still essential.
Mouths are a breeding ground for bacteria which constantly forms sticky mineral crust on teeth, known as plaque. Untreated plaque eats away at the enamel on teeth, causing decay and gum disease.
Regular brushing and flossing can get rid of plaque, but if care is neglected, only a professional cleaning can remove it, according to the National Institute of Dental and Craniofacial Research.
MaryClare Kubasko, a dentist with Westside Family Healthcare, said the bacteria that causes gum disease can be transmitted to spouses and children. Though it might be difficult, she urges her patients with gum disease to avoid kissing their children.
If its left untreated, it will progress, she said.
Without routine care, a host of medical risks escalate. For instance, pregnant women with gum disease are at a higher risk of having premature births, Stephens said.
Untreated plaque can cause inflammation that stresses a womans overall body immune response, causing early deliveries, he said.
Some studies link the bacteria in gum disease with higher chances for heart disease.
Similarly, if people with diabetes have poor oral hygiene, they are more susceptible to gum infections since their immune systems are already weakened, according to the Academy of Peridontology.
If they have really bad dental care, it can impact their well-being. If you have dental abscesses, if you lost teeth, that impacts your feeling of self-worth. We learn more and more almost daily of the impact [dental care] has on overall health, Stephens said.
The most recent survey by the Centers for Disease Control and Prevention showed 45.2 percent of adults in Delaware had permanent teeth extracted, slightly above the national average, which sits at 44.5 percent. The extractions are the result of tooth decay, gum disease or trauma, McClure explained.
Health care is expensive, but its important, McClure said.
If you have an infection because its in the mouth, does it make it any less important? We dont think so.
Luckily, Ramos Sandoval hasnt had to go to the emergency room for a dental procedure yet.
Sandoval, who works in a barber shop in Wilmington, said he wishes Medicaid subsidies would cover his dental care. On his salary, he doesnt have much room for many extra costs.
Its really important to me, I [would treat] dental insurance like my child, he said.
Jen Rini can be reached at (302) 324-2386 or firstname.lastname@example.org. Follow @JenRini on Twitter.