The Dental Gap in the Affordable Care Act

The Affordable Care Act (ACA) mandates that insurers cover dental care for children. Children’s dental care is one of the ten essential health benefits that set the bar for health insurance.   But children’s dental care is separate from other essential benefits on the exchanges. Dental plans are sold separately from medical insurance and children’s dental coverage is optional.  People shopping on the federal and state exchanges are not required to purchase dental insurance, and they won’t receive financial support for it.  Experts are now warning that this flaw in the program may leave children without dental coverage.


Tooth decay is the most common disease of childhood.  Of children ages 6 – 19, fourteen percent have cavities that have not been treated. This can cause pain and might lead to severe infections.  The percentage of uninsured children who visited the dentist at least once per year was 25% in 2011 – down from 31% in 2003.  If children’s dental insurance were mandatory on the insurance exchanges, 3 million children would have coverage by 2018.  Data for this blog post was supplied from an article in the New York Times on December 17, 2013.



Rehaan lost his first baby tooth today. His Dad snapped this photo on his iphone and emailed it to me.  His permanent incisor is starting to erupt behind where the baby tooth fell out.  He received $5.00 under the pillow for this momentous event.  Such inflation! – I remember when a lost tooth was worth $1.00.  His twin brother Naseem is not far behind.  His permanent tooth is also erupting and his baby tooth is very loose.  The twins turned six just two weeks ago.  Tooth development is right on schedule!

MSN’s Health Today ran an expose of a dental clinic that was bilking taxpayer of their money by charging patients for unnecessary, painful and shoddy dental work.  The clinic has been repeatedly investigated by the government and has had to pay large fines but it is still in business.  Unnecessary root canals and crowns, insufficient anesthesia, over use of restraints and large mouth props are only a few of the complaints.  See: How sad that children have to suffer for someone’s greed.

February is National Children’s Dental Health Month

Calling all patients ages 12 and under!  Enter the “Draw a Picture of your Dentist” Contest!  You could win a prize which will be awarded at the Suffolk County Dental Society general membership meeting on March 23.  The SCDS runs this contest every year and it is always lots of fun.  All you have to do is draw the picture and we will submit it for you.  I submit patient drawings every year and this year I hope to have a winner!

The U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) announced this week that the recommended level of fluoride in drinking water be set at the lowest end of the current optimal range to prevent tooth decay.  The EPA is also reviewing the maximum amount of fluoride allowed in drinking water.

The new guidelines will reduce the possibility of children ingesting too much fluoride, while maintaining fluoride’s benefit in preventing dental decay.  The HHS proposed recommendation of 0.7 milligrams of fluoride per liter of water replaces the current recommended range of 0.7 to 1.2 milligrams. The new recommendation is a result of recent EPA and HHS scientific studies seeking to balance fluoride’s benefit in preventing cavities while limiting any undesirable health effects. The EPA will also determine whether to lower the maximum amount of fluoride allowed in drinking water.

Dental fluorosis may occur with excess fluoride intake while teeth are developing.      Dental fluorosis in the United States is mostly in the mild form: lacy white spots on the outside of the teeth. The severe form of dental fluorosis, including staining and pitting of the enamel, is rare in the United States.

Today we have access to more sources of fluoride than were available when water fluoridation was first introduced in the 1940s. In addition to fluoridated water, we may receive fluoride from dental products (toothpaste and mouth rinses), fluoride supplements, and fluoride applied in the dental office.

For the full report of the new recommendations see:

New regulations in Massachusetts require that preschools add toothbrush time to the school day.  Children who eat a meal at day care or attend for more than four hours will be supervised brushing their teeth and  educated about oral health.   The Massachusetts Department of Early Education and Care established the regulations to help prevent dental disease.  According to a 2003 study, one in four Massachusetts kindergartners have tooth decay.

So, brushing at school sounds good in theory.  But in practice?  How do two teachers help 30 four year olds without the motor skills to brush correctly?  How do they maintain sanitation? How do the children spit out? Avoid spreading germs?  Keep the brushes clean and replaced when worn? Avoid swallowing toothpaste?  Seems ill advised to me.  How about focusing on what the children eat for lunch instead?  Perhaps if the children ate an apple for dessert instead of Hostess Cupcakes they would not have so much plaque and dental decay.

More on children’s dental health on my website.

Parents often ask when their children should have their first dental visit.  I like to tell them to bring the children to our office when the parents have a checkup visit so the children become familiarized with the office. Our East Setauket dental office is child friendly. Don’t wait until your child is in pain or has a problem before seeing the dentist.

Your child should see the dentist when their first tooth comes in. You can clean your baby’s gums with a clean, damp cloth. Help your toddler brush his/her teeth and only use a pea-size dab of toothpaste. Get your child accustomed to flossing. Don’t put your child to sleep with a bottle or let them fall asleep while they are nursing.  Children should eat healthy foods – fruits, vegetables – and limit sugars and starches, sodas and juices.

Regular dental visits are the best prevention. We place sealants to protect young teeth from decay. We also make mouthguards for children who are active in sports.

Children who consume a syrup with the naturally occurring sweetener xylitol develop fewer cavities than children who don’t consume xylitol. A recent study at the U. of Washington School of Dentistry concluded that exposure to 8 grams of xylitol per day in a twice-daily topical oral syrup prevents up to 70% of decayed primary teeth. The study was conducted in the Republic of the Marshall Islands where childhood decay is a serious public health concern. More research is needed, but it appears that xylitol is a cost-effective preventive measure for populations with high rates of tooth decay.
For more information on children’s dentistry visit


I just read about a dentist, Dr. Julian Haszard, who is passionate about mountain climbing as well as about helping people to achieve dental health. Sound familiar? I also enjoy the mountains, but for me, 4,000 feet will do fine rather than the 14,000 feet he climbs!

Dr. Haszard formed a dental aid charity called SmileHigh to service Nepalese children. Because of a radical change in diet, especially a huge increase in refined sugar, there is enormous dental decay among Nepalese children, especially among those of remote communities that have no dental services.

This summer a group of dental professionals will travel to Nepal to volunteer their dental services in conjunction with an expedition to climb Mount Manaslu. The purpose of the climb is to raise money for SmileHigh. The dentists will provide dental treatment and dental education in the Samagon region of Nepal for two weeks. Their website is How fabulous!


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Last week I participated in Career Day at the Nassequegue Elementary School, near my East Setauket Dental Office. I spoke to third to sixth graders about Dentistry as a career. I explained how to become a dentist and what my work is like. I talked about the technological advances in dentistry and about the uses of computing and photography.

They were very attentive and asked excellent questions. I was impressed by their knowledge; they knew about palatal expanders and athletic guards! I told them that they didn’t have to go to dental school, that they sounded like they were already dentists! I asked them how to keep their teeth healthy and they quickly responded: brush after meals, eat healthy foods, and visit the dentist twice a called wanda a download

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