Louisiana may bar dentists from schools

The Louisiana Dental Association (LDA) is lobbying to keep dentists from taking their services into schools, according to newspaper reports and the head of a mobile dentistry group.

"It's a horrible thing," said Gregory Folse, D.D.S., of Lafayette, LA, whose Big Smiles organization triggered the initiative when it began making dental visits to Louisiana schools. "We're seeing kids that nobody else would see."

Dr. Folse, who also specializes in bringing dentistry to nursing home patients, said he had recruited 15 dentists who each work one day a week treating children in their schools. Big Smiles pays the dentists involved by filing through Medicaid, for which nearly all the children are eligible.

He estimated that 432,000 children in Louisiana have not seen a dentist in the past year, and Big Smiles has treated 4,000 of them so far, he said.

The LDA has asked legislators to pass a law prohibiting dentistry in schools, Dr. Folse said. The LDA did not respond to a request for comment, but according to an article in the Monroe, LA, News Star newspaper, some Louisiana dentists have raised questions about the health and safety of the practice.

"While in-school dental treatment programs seem helpful on the surface, these programs actually open the door for a lack of quality care, a potential lapse in infection control, a lack of parental supervision, as well as informed consent," stated Kirt Touchstone, D.D.S., in a news release, according to the newspaper.

Dr. Folse said he has already addressed such concerns. "We are fully OSHA [Occupational Safety and Health Administration]-compliant and use the best equipment there is," he said. "We have digital, handheld x-rays, electric handpieces, high-speed and low-speed suction, an emergency kit, everything." Big Smiles never treats a child without obtaining the parents' signatures on informed consent forms, Dr. Folse said. And he said he has arrangements with other dentists whose offices are within 25 miles of each school to provide emergency backup care if needed.

Setting up at the schools, the dentists address the children's comprehensive oral health needs, Dr. Folse said, including providing pulpotomies, stainless steel crowns, primary tooth extractions, prophylaxis, and sealants. "One of the most important things we do is teach these children hygiene. We spend 10 or 15 minutes with each one teaching them to take care of their oral health," he said.

The group does not extract permanent teeth or do root canal therapy in them.

Dr. Folse contends that the real issue is that the dentists who oppose Big Smiles are concerned they will lose patients. He cited a petition circulating among Louisiana dentists that, according to the News Star, reads, "This will alter the patient flow of every dentist who now sees Medicaid (patients). New patients will dry up and recalls will be taken away. In two to three years most kids will be seen in the schools and dental practices that see kids will be in trouble. Every practitioners' [sic] income and livelihood will be threatened. The opportunity for every dentist who wishes to improve his or her income will be taken away."

The concerns are unfounded, Dr. Folse said, because the children his group is treating are not likely to visit dentists. Of the 4,000 students treated so far, Big Smiles has referred 400 to specialists.

Though Big Smiles operates on a for-profit model, it's not making big money, Dr. Folse said. "Some days we make money, some days we lose a bunch. It's not about making money, it's about providing care. I've been serving the vulnerable since 1992. Until last year, my net dental income has never been over $80,000."

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