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2010 Fall Marillac Clinic Director's Corner

Including Oral Health in the Medical Home


Steve Hurd, PhD - Marillac Clinic Executive Director

Including Oral Health in the Medical Home: 

An Excellent Opportunity to Improve Quality and Reduce Costs


In 2007, Deamonte Driver, a young boy from Maryland, died from a brain infection caused by an abscessed tooth. His mother sought dental care for him when he had Medicaid benefits. However, she could not find a provider to treat him because Medicaid reimbursement was so low. If Deamonte had received oral health care throughout his young life, this tragedy would not have occurred. is young boy eventually received care in a hospital emergency room. He underwent two surgeries and died after six weeks of hospitalization. Not only did the family lose a child, but the cost of his hospitalization exceeded $250,000.

I would conclude now if this was a unique story from a distant state. Sadly, this story is prevalent in all 50 states, including Colorado.

The American Dental Association estimates that 59% of children and 85% of adults have a history of dental caries (cavities). The ADA estimates that 61% of young adults and 86% of adults older than 45 have one site of gum disease in their mouths. 

Nearly all of us will face oral health challenges during our lifetimes. Access to oral health is nearly impossible for some people living in our country.

Nationwide, 25% of our children have their first dental care experience in the hospital emergency room. Having a parent who has not completed high school or being born into a low-income household dramatically increases the risk for this child to develop dental disease. 80% of the dental disease burden in our country is carried by 20% of the people. 

What We Didn’t Learn in School: 

Oral health providers describe dental caries (cavities) as a chronic disease caused by colonies of bacteria (strep mutans) that thrive in a person’s mouth. This bacteria is easily transmitted from person to person, and is especially contagious within families. 

Caregivers and siblings can inadvertently transmit this bacteria to an infant through the affectionate gesture of kissing. 

As a young father myself, I had no idea how I introduced the bacteria from my saliva into the mouths of my sons. How many times did they stick their fingers in my mouth and then in their own? How many times did I lick the pacifier that had fallen on the ground, and cleanse it by “licking off the germs” before re-inserting it in my baby’s mouth? 

Poor oral health is highly associated with a large number of systemic medical diseases. Health providers understand that untreated dental disease aggravates diabetes, cardiovascular conditions, respiratory infections, osteoporosis, and HIV. Data also indicates that untreated dental disease is associated with premature and low birth-weight babies. 

The Problem: 

When private and publicly funded insurance plans were designed years ago, the benefit package was organized around the way providers were educated. People who read this column regularly have heard my message before – we have an outdated system that separates the mind, the body and the mouth and promotes fragmentation. Reimbursement systems followed the same path, carving the mind and the mouth away from the rest of the person. 

Many who manage health care costs believe that adding behavioral health and dental benefits will only increase our health care burden. How would Deamonte’s family and the Maryland taxpayers respond? Explain how spending $150 to treat an infected tooth is wasteful while spending $250,000 at a hospital helps contain costs. Does withholding dental care from a child (or adult) reduce overall health expenditures? 

My Question: 

If we had the opportunity to redesign the way providers are educated and reimbursed, would consumers ask for a delivery system that sends us to different places to receive care for our body, our mouth and our mind? Or would we prefer holistic care that addresses our everyday needs without making us “go through the right door” to receive the care we need.

The Good News: 

Dental disease is nearly always preventable. If a child’s mouth contains natural flora that prevents the colonization of bacteria on the surface of the teeth, the child will likely not develop a cavity. Unfortunately, this natural flora state doesn’t develop until the child has reached three years of age. Our society needs to communicate this information to parents, grandparents and other caregivers so they know the important role they have in preventing dental disease in their young loved ones. 

Fortunately, we live in a community that not only understands this but actually is doing something about it. Mesa County has a robust “B4Babies Program,” making sure that every pregnant woman in our county has access to essential primary care that includes oral health. 

Marillac’s experience is that nearly every mother wants to learn how they can help prevent their child from the experience of dental pain. 

Our community has a growing “Cavity Free by ree” Program, where pediatricians and family care providers learn to ask about oral health habits. During a medical visit, fluoride varnish is applied on a toddler’s teeth to make enamel more resistant to bacteria. 

Innovation and Leadership: 

Both care receivers and care providers benefit by living in this community. We share a vision: the need for a locally-driven system that works for all of us. is means we need to continue in our role as innovators to drive quality up and costs down. 

Our community understands how denying the right care results in hidden costs all of us will have to pay, including the poor and the vulnerable. 


Through your ongoing generosity, Marillac’s mission will continue in our community. On behalf of our staff and our patients, I express our sincere appreciation.