Clinic filling gap in kids’ dental care

Jennifer Knight

Friday, March 28, 2003 | 3:35 a.m.

WEEKEND EDITION: March 29, 2003

As strange as it may seem, Dakota Barnhill is lucky to be in a dentist's chair.

"Now am I done yet?" the 7-year-old boy asked Dr. Christina Madsen, a pediatric dental resident at UNLV's dental clinic.

Madsen calmly told Dakota to breathe through his nose before pulling his second abscessed tooth.

"Your tooth fairy is going to be rich," she told him.

Under normal circumstances, Dakota wouldn't seem lucky, but six months ago he would not have received the kind of help he needed. Now a new pediatric dental program run by the University of Nevada School of Medicine and operated out of University of Nevada, Las Vegas' Enterprise Dental Clinic is helping uninsured families gain access to specialized dental care.

Stephanie Barnhill, Dakota's mother, said that before finding out about the clinic, getting care for her two sons was a stretch.

"If (my boys) ever had any sort of pain before, I would just have to save up and pay for a dentist," she said, adding that she often had to have the tooth extracted because it was too expensive to fill a cavity. "This is really a help."

Health officials say programs like these are needed to serve thousands of kids without dental insurance, increase the number of pediatric dentists in Nevada and stem the tide of emergency room visits made by uninsured kids with dental problems.

State Sen. Ray Rawson, R-Las Vegas, a practicing dentist who pushed for the dental clinic and the new pediatric residency program, said there are about 3,000 kids in Nevada who suffer from toothache at any given time.

Rawson said experts estimate that 35 percent of children in this state do not have dental insurance. Consequently, dental problems were the seventh most common reason that children visited emergency rooms last year and one of the main reasons they miss school, he said.

Louise Helton, the program administrator for the pediatric dental residency program, said the clinic often gets patients who don't have the money for basics, including toothbrushes.

"We just had this huge, huge problem and this pediatric dentistry program is just one small step," Helton said.

With about 50 pediatric dental programs in the country training 150 specialists a year, there are few experts in this field. Las Vegas only has three pediatric dentists with credentials from the American Board of Pediatric Dentistry, said Dr. Robert Cooley, director of the pediatric dental residency at UNLV.

"What that has resulted in is that we have a shortage all over the nation in pediatric dentists, and it's even more acute in Las Vegas," Cooley said.

Right now, UNLV's dental clinic, which is part community outreach and part teaching facility, handles up to 75 patients a day; 60 percent are kids and all who come are either Medicaid patients or have no insurance at all.

"Most pediatric dentists can still maintain a healthy practice without ever taking (uninsured or Medicaid) patients," said Dr. Paul Schneider, who oversees the pediatric dentistry residency. "That's one reason why our waiting room is just packed full of people right now. We are overwhelmed with the number of people coming to this clinic."

Before the clinic was established three years ago, so-called "gap kids"--children whose parents earn too much to qualify for Medicaid and too little to afford dental insurance -- had no place to get help. Consequently, many of them suffered.

The Miles for Smiles program helped some. The mobile dental clinic equips a bus with a dental lab. Dentists travel visiting schools across the state to perform free checkups.

"We had one little guy (about 4 years old) who was on the bus and said, 'I just want to die. My mouth hurts.' " Helton said. "That guy had so many cavities, and they were all abscessed."

Helton said the boy's mouth was so swollen children made fun of him and "he saw no other way out other than to die," she said.

Rawson said he came across similar cases while traveling with the program. He found children whose parents waited so long to get care that tooth infections had become life-threatening in some cases. Many, he said, had to be placed under anesthesia and operated on to drain the infection.

"There's no reason in this country for a child to suffer like that," Rawson said. "I'd like to see a time when there is never an admission in the emergency room of a child suffering from these kinds of problems."

UNLV's dental clinic will eventually serve as a teaching facility for the school's 75 dental students. Those students, who started dental school last fall, won't be ready to start their internships at the clinic for another year. The pediatric residents this semester are officially the first students to work at the clinic.

The pediatric dental program takes medical school graduates and puts them through a two-year residency program that familiarizes them with the anatomy of a child.

Schneider said doctors must learn how children react to various medications, the anatomy of the mouth and stages of growth as well as the psychology of dealing with a child who is often anxious when coming to the dentist.

Like any busy program, expansion is always an issue. Rawson said that this year the program will survive off of donations from private agencies because the state is too overburdened to help out.

After Dakota left the dentist chair, Helton smiled and said, "You see, that's one less child that will cry himself to sleep tonight because of pain."