{"id":25879,"date":"2016-01-27T14:38:01","date_gmt":"2016-01-27T20:38:01","guid":{"rendered":"http:\/\/news.medill.northwestern.edu\/chicago\/?p=25879"},"modified":"2016-01-27T15:51:27","modified_gmt":"2016-01-27T21:51:27","slug":"chicago-a-city-divided-on-dental-care","status":"publish","type":"post","link":"https:\/\/news.medill.northwestern.edu\/chicago\/chicago-a-city-divided-on-dental-care\/","title":{"rendered":"Chicago: A City Divided on Dental Care"},"content":{"rendered":"

By Danielle Prieur and Neil Murthy<\/strong><\/p>\n

T<\/p>\n

his is a tale of two clinics.<\/p>\n

At first glance, it may seem that Drs. Robert Krueger and Susana Torres share much in common.<\/p>\n

Both are dentists in the Chicago area who have practiced for many years. Both have a passion for their profession and share a special concern for caring for the oral health care needs of children.<\/p>\n

But the patient populations each dentist sees \u00a0are polar opposites.<\/p>\n

<\/p>\n

Krueger has practiced for 40 years in Evanston. During his long clinical career, he said that he has seen the rate of \u00a0cavities dramatically decline to the point that he believes that there are a lot fewer things to do now in his clinic.<\/p>\n

\u201cParents are more educated and know what they need to do,\u201d Krueger explained. \u201cThey keep their kids away from soda and candy. There\u2019s little if any tooth decay in the last two generations of children.\u201d<\/p>\n

For Torres, however, the situation is entirely different.<\/p>\n

\u201cIn reality, [dental education] is a pretty big problem,\u201d Torres explained. \u201cPatients don\u2019t know to brush twice. They only brush once.\u201d<\/p>\n

Torres practiced dentistry in Humboldt Park and now works at Norwegian American Hospital. She often makes rounds in a dental van to low-income areas of the city to provide care. She stated that she frequently performs fillings for school-age children, many of whom are underinsured or uninsured.<\/p>\n

And that is the problem dividing these clinics: the patients coming in have vastly different frequencies of\u00a0cavities.<\/p>\n

According to the Martin Prosperity Institute at the University of Toronto, Chicago ranked among the top ten cities in the nation for socioeconomic disparities. \u00a0Researchers at the Sinai Health Institute in Chicago found that health disparities have widened for 11 out of 15 health status indicators, \u00a0including diabetes, cancer and heart disease. The results were\u00a0published in the American Journal of Public Health in February 2010.<\/p>\n

Adding to the litany of injustices, oral health status might be yet another indicator showcasing the marked health disparities affecting the city\u2019s population.<\/p>\n

The Problem<\/h2>\n

Ask Chicagoans what they think about the great divide between the city\u2019s affluent and impoverished neighborhoods, and you will likely not hear about cavities. Although not as well publicized as other public health concerns, a group of Chicago-area health professionals, known as the Chicago \u00a0Community Oral Health Forum, have documented these oral health disparities.<\/p>\n

In 2011, the forum published a comprehensive study of dental health in Chicago called, \u201cThe Burden of Oral Disease in Chicago.\u201d In it, they outlined several problems with poor dental health. Three in particular stand out, all of which were related to poor dental health in low socioeconomic areas.<\/p>\n

First, Chicago was \u201cworse than national indicators\u201d when it came to the number of cavities both treated and untreated in third graders.<\/p>\n

Healthy People 2020 Oral Health Objectives<\/h2>\n
\"Healthy
Chicago has a higher percentage of third graders with cavities compared to national averages – Courtesy of Heartland Alliance<\/figcaption><\/figure>\n

Second, Chicago did not have enough clinics to treat patients in low socioeconomic areas. In 2010, there were only 66 dental clinics for the city\u2019s 753,281 Medicaid enrollees, resulting in only one dental clinic exists for every 11,400 patients.<\/p>\n

Third, only 54 percent had some form of dental insurance.<\/p>\n

The American Dental Association \u00a0has found \u00a0the state of Illinois reimburses only a \u00a0third of the work \u00a0that dentists do, compared with a national average of nearly 50 percent. For adults covered by Medicaid, the program does not include \u00a0basic preventive services, such as teeth cleanings and sealants, and periodontal services.<\/p>\n

Last year, the Oral Health Community Forum conducted a follow-up study of dental health and obesity, entitled \u201cHealthy Smiles, Healthy Growth,\u201d focusing on third graders in Illinois public schools.<\/p>\n

Although many of the dental health problems in the original 2011 study had improved, including the number of untreated cavities, the researchers found that the \u00a0percentage of third graders in need of urgent dental treatment was higher than national averages.<\/p>\n

Illinois Progress Toward Healthy People 2020 Objectives<\/h2>\n

\"Illinois \"Illinois<\/p>\n

Illinois still has to make progress towards untreated decay – Courtesy of Heartland Alliance<\/div>\n

The researchers made a correlation between high percentages of third graders who needed urgent dental treatment with race as well as low income.<\/p>\n

\u201cThe proportion of children affected by untreated decay differs for racial\/ethnic minority groups as well as for children from low income families in Illinois. Overall, 19 percent of white, 21 percent of Latino, 27 percent of Asian, and 29 percent of African-American third graders are affected by untreated decay,\u201d the report said.<\/p>\n

Percentage of Illinois Third Graders with Untreated Decay,Treated Decay, and Cavities<\/h2>\n

\"Screen\"Percentage<\/p>\n

African-American third graders have more untreated decay whereas Latino third-graders have more treated decay and cavities-Courtesy of Heartland Alliance<\/div>\n

Researchers \u00a0also found a correlation between urgent dental treatment need and students who were part of the Free and Reduced Meal Program.<\/p>\n

\u201cIn the same way, 26 percent of children eligible for Free and Reduced Meal Program had untreated decay as compared [with] 16 percent of non-eligible children.\u201d<\/p>\n

Oral Health Status of Illinois Third Graders by Eligibility for FRMP<\/h2>\n

\"Screen\"Oral<\/p>\n

Third graders who are eligible for Free and Reduced Lunch Program have more untreated decay, treated decay and cavities experience than their counterparts-Courtesy of Heartland Alliance<\/div>\n

Still, access to dental care is at the top of the list of problems patients face.<\/p>\n

\u201cThere are many areas of the city where there are not a lot of dentists and in those communities the number that will take [Medicaid] patients are low and reimbursement is very low,” said James Alexander, executive director of Chicago-based Otho S. A. Sprague Memorial Institute.<\/p>\n

The institute is a \u00a0philanthropic organization engaged in public health advocacy efforts in Chicago. The institute funds the work of the Oral Community Health Forum.<\/p>\n

Geographic Distribution<\/h2>\n

The Chicago Health Atlas is an online tool that provides digitized public health data, based on information obtained from the Chicago Public Health Department and local hospitals. Each map shows the geographic spread of conditions experienced by the city\u2019s various communities.<\/p>\n

The maps of Chicago all point to one stark reality: the great divide between the city\u2019s haves and have-nots. Each map bears an uncanny resemblance to the other. Communities that have a scarcity of supermarkets, known as \u201cfood deserts,” seem to correlate with communities that have a dearth of dentists.<\/p>\n

Percent of households under the poverty level for the years 2007-2011<\/h2>\n

\"Percent<\/p>\n

West Garfield Park, East Garfield Park, North Lawndale, and Humboldt Park have the largest percentage of residents living below the poverty level-Courtesy of Chicago Health Atlas<\/div>\n

Practicing dentists per 1,000 residents by Chicago community area in 2010<\/h2>\n

\"Practicing<\/p>\n

Areas that are below poverty level tend to have fewer dentists-Courtesy of Chicago Health Atlas<\/div>\n

Food Desert Map<\/h2>\n

\"Food\"Supermarket<\/p>\n

Neighborhoods with fewer supermarkets tend to coincide with food deserts-Courtesy of The Food Trust<\/div>\n

The Solution<\/h2>\n

Despite the significant burden of oral health disparities, the Community Oral Health Forum reports provided one ray of hope: untreated tooth decay decreased from 30 percent to 22 percent among improved third-grade students over the past decade.<\/p>\n

Dr. Mona Van Kanegan, co-founder and co-director of the forum and contributing author on both reports, said that the reason dental health has improved for pediatric patients is that the Chicago Public School system implemented a mandatory dental screening program.<\/p>\n

She said school-based programs have been successful because it is easy for parents to sign a form to provide children access to care.<\/p>\n

Students can get access to emergency dental care through the Chicago Public Schools.<\/p>\n

\u201cWe have a case manager program funded by the institute that helps to connect kids [to dental care], to first inform the parent of the need and then looks to community resources,\u201d Van Kanegan said.<\/p>\n

Alexander said another key aspect of these programs has been raising awareness among both parents and children about the importance of dental education.<\/p>\n

\u201cMany families don\u2019t realize the effect that sugary drinks have on oral health: a baby might be put to sleep with apple juice or milk or formula and their teeth might start to decay because of sugar on teeth when they sleep,\u201d Shenkin said.<\/div>\n

\u201cChicago\u2019s preventative strategy is putting fluoride in the water, but many families don\u2019t drink water from the tap.\u201d<\/p>\n

Even if patients were \u00a0better informed, however, one of the largest obstacles is the lack of healthy food options in low-income areas. Residents in these areas, known as \u201cfood deserts,” must resort to convenience stores filled with sugary snacks instead of grocery stores stocked with fresh fruits and vegetables.<\/p>\n

In order to combat this lack of dental \u00a0knowledge, the Supplemental Nutrition Assistance Program spends about $500,000 a year educating food stamp users about healthy eating. The city also has implemented a food truck program that makes healthy food more available \u00a0in low-income communities.<\/p>\n

\u201cIt\u2019s not just what\u2019s available, but what people ask for. If we are able to change the perspective of consumers, we can eliminate food deserts,\u201d said Dr. Jonathan Shenkin, clinical associate professor at Boston University School of Dental Medicine. He argued that if consumers are educated about healthier food choices and have access to them, oral health would improve substantially.<\/p>\n

Ultimately changes in access to dental care will solve the problem of poor dental health among low-income patients, Shenkin conceded.<\/p>\n

\u201cOnce they\u2019re diagnosed, getting them treatment is still a major concern,\u201d he said.Although Van Kanegan is hopeful that access for<\/p>\n

Although Van Kanegan is optimistic that access for low-income adults might improve with impending changes in the Medicaid system. But she said budget cuts might limit school dental exam programs. \u00a0In turn, she said \u00a0this might determine whether Chicago can meet the Healthy People 2020 Goals set by the U.S. Department of Health and Human Services.<\/p>\n

In the meantime, dentists such as Krueger and Torres continue to treat two different patient populations. A tale of two clinics will continue until access and education become a reality for everyone.<\/p>\n

Photo at top by Flickr<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

By Danielle Prieur and Neil Murthy T his is a tale of two clinics. At first glance, it may seem that Drs. Robert Krueger and Susana Torres share much in common. Both are dentists in the Chicago area who have practiced for many years. 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