As COVID Limits Options, School-Based Dentists Fear Impact On Kids

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BINGHAMTON, NY (WSKG) — Most dentists in New York were able to fully reopen their practices last June, but those who work in school-based health centers are still waiting on state clearance to do the same.

Bassett Healthcare Network’s school-based health centers aim to make care more accessible for rural families by placing physicians’ and dentists’ offices directly in school buildings. Costs to families for services in these offices are covered by insurance providers and New York State.

Those services couldn’t be reached when schools closed last spring, leaving gaps in many rural areas without nearby clinicians.

Doctors and mental health workers have since returned to schools with a combination of in-person and online visits, but New York State Department of Health guidance still in place from April prevents dentists from getting students back in the chair.

Bassett’s school-based health centers serve more than 7,100 students across 21 schools in rural Chenango, Delaware, Otsego and Schoharie Counties. It’s the largest rural program of its kind in the state.

Of those students, 2,200 are enrolled in the centers’ dental programs, overseen by Leah Carpenter, Bassett’s Chief of Dental Services.

Dr. Leah Carpenter shows a young student proper brushing technique in the Laurens School-Based Health Center. (Provided by Bassett Healthcare Network)

Carpenter said the students she serves are among the least likely to be able to seek care elsewhere, and many lack dental insurance entirely.

“Pre-COVID, there just weren’t a lot of dentists in the area accepting Medicaid and state insurances,” Carpenter said. “That’s only decreased with the COVID pandemic.”

Approximately one million Medicaid-enrolled children nationwide depend on schools for basic preventive dental care. Before Bassett hired its first pediatric dentist and began servicing the school-based health centers, Carpenter said she was customarily referring kids to dentists in Binghamton, Syracuse and Albany, the nearest sites for pediatric practices that accept Medicaid and other state insurances.

“It’s a hardship for families to access dental care in our area to begin with,” Carpenter said, “but to then ask those families to travel two or three hours for their kid to get needed healthcare is really a big ask for these families.”

With the suspension of the program’s in-school dental care, convenient access to free services has become even more scarce. According to a national poll by the C.S. Mott Children’s Hospital, one-third of parents say the pandemic has made it harder for them to get their child dental care. Roughly 40 percent have avoided seeking dental care at all since the pandemic began, citing fear of COVID-19 exposure, office closures and cost.

Bassett’s staff adapted to the pandemic’s restrictions by helping families find dental care locally at one of the hospital network’s clinics and through video and phone calls, but that limits who’s seen and what dentists can do.

“It’s through those outreach calls and those tele-dental visits that we are finding a lot of kids that are having acute issues because they’ve gone without regular preventative care for so long,” she said.

The four-county area Bassett’s school network serves lacks a regional fluoridated water source, which can reduce cavities in children and adults by about 25 percent and is recommended by the World Health Organization.

Many of the students Carpenter has seen over telehealth in recent months are experiencing the familiar progression of tooth decay: pain and swelling that can lead to permanent tooth loss. Once the pain begins, Carpenter said it’s likely the tooth can no longer be saved.

Carpenter said decay is among the problems she can only address in-person.

“Restorative dentistry is pretty stuff-intensive,” she explained. “I can talk to a kid on the phone, but I can’t fix their tooth unless I see them in person.”

The state’s guidance for school-based health centers, issued on April 2, 2020, asked staff to postpone all non-urgent dental care until further notice. As of Monday, Carpenter said no changes have been made since.

“The school-based health centers, by and large, have remained open throughout the pandemic for medical care and mental health care,” Carpenter said. “Dental’s really been excluded because of this DOH guidance.”

The NYS Department of Health did not return a request for comment.

Last week, Carpenter began setting up her site at Laurens Central School in Otsego County to resume urgent care. It’s a step in the right direction, but she fears that won’t address the root of the problem the way regular preventive care can.

“Integrating oral health care with overall healthcare has been my charge,” Carpenter said. “I hate to see us sliding backward during this pandemic with our school-based population.”