Health-care law addresses the most common chronic health problem in children, tooth decay, by requiring coverage for kids

Tooth decay is children's most common chronic health problem, and the 2010 federal health-care law addresses this problem by requiring insurers to cover pediatric dental services. But some advocates are concerned that the new benefits may not be sufficiently comprehensive or affordable, Michelle Andrews writes for The Washington Post.

She notes that by the time children enter kindergarten, more than a quarter of them have decay in their baby teeth. As they age, the problem gets worse and nearly 68 percent of those age 16 to 19 have decay in their permanent teeth, according the the Centers for Disease Control and Prevention. 
   
Beginning next year, the Affordable Care Act requires individual and small-group health plans cover pediatric dental services, unless a plan has a specific exemption under the law. Those services are already part of the Medicaid benefit package, but most Kentucky dentists don't accept Medicaid.
For the expansion to private insurance, "Coverage requirements will be determined by each state within guidelines set by the federal Department of Health and Human Services," Andrews writes.

Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services, said Kentucky is awaiting the publication of the final rule from HHS, which will define essential health benefits for each state and provide further guidance relating to coverage of benefits. Although no specific publication date for this rule has been announced, she said its release is expected within the next several weeks to allow insurers to modify existing health plans to be made available to individuals and small businesses for purchase through health exchanges by Oct. 1. (Read more)

Effort to boost oral health in nursing homes gets tangled up with industry's attempt to insulate itself from lawsuits; both bills die

A bill to get nursing-home residents better dental services "appears to be dead after the Senate added language from another bill designed to shield the nursing-home industry from litigation," Deborah Yetter reports for The Courier-Journal.

House Bill 510 would have created a pilot project for the state's two dental schools to create "a program to provide better oral-health services to nursing home residents," Yetter writes. "But on Wednesday, the Senate Health and Welfare Committee added language from another bill that had stalled in the House that would require people who want to file malpractice lawsuits against nursing homes to first submit the complaint to a 'medical review panel'." (Read more) 

FDA wants to reduce standard for fluoride in public drinking water

Lowering the amount of fluoride in drinking water, as proposed in January by the Food and Drug Administration, will increase medical expenses and harm the poor and the poorly educated the most, a mother writes in an op-ed piece in the New York Times.

Jane E. Brody delves into the concept of fluoridation, pointing out its benefits. "In the early years, rates of tooth decay among the young dropped by 60 percent in communities that adopted fluoridation," she writes. "Every $1 invested in fluoridation saves approximately $38 in dental treatment costs."

Though fluoride was initially thought to become incorporated into developing teeth, it was later found that its benefit is topical, meaning it works on teeth already formed. "Fluoride, which is present in saliva and concentrates in dental plaque, inhibits the action of acid on tooth minerals," she writes. "It also promotes remineralization by sticking to tooth surfaces, where it attracts calcium ions present in saliva."

Still, there remains controversy about whether or not fluoride is safe, with the substance being accused of causing everything from heart disease to Alzheimer's disease. "None of these supposed risks has ever been established in scientifically valid studies," Brody writes. "The only proven risk, a condition called fluorosis, which results in white and sometimes brownish markings on the teeth from too much fluoride, rarely results from a normal intake of fluoridated water."

Since fluoride is also available in other substances, like toothpaste, the FDA proposed reducing the amount of fluoride in public drinking water to 0.7 milligrams per liter, from a range from 0.7 to 1.2 milligrams. Brody feels the move is a mistake: "Fluoridation confers the greatest benefit to those who need it most: the poor and poorly educated and those with limited access to regular dental care," she writes. "In the years ahead, removal of fluoride from drinking water will almost certainly cost taxpayers millions of dollars in increased Medicaid expenditures." (Read more)

In Kentucky, there is 100 percent fluoridation in public drinking water systems, though perhaps half a million residents get their water from wells, springs or cisterns.