Pr. George's Boy Dies After Bacteria From Tooth Spread to BrainBy Mary OttoWashington Post Staff WriterTwelve-year-old Deamonte Driver died of a toothache Sunday.A routine, $80 tooth extraction might have saved him.If his mother had been insured.If his family had not lost its Medicaid.If Medicaid dentists weren't so hard to find.If his mother hadn't been focused on getting a dentist for his brother, whohad six rotted teeth.By the time Deamonte's own aching tooth got any attention, the bacteria fromthe abscess had spread to his brain, doctors said. After two operations andmore than six weeks of hospital care, the Prince George's County boy died.Deamonte's death and the ultimate cost of his care, which could total morethan $250,000, underscore an often-overlooked concern in the debate overuniversal health coverage: dental care.Some poor children have no dental coverage at all. Others travel three hoursto find a dentist willing to take Medicaid patients and accept the incumbentpaperwork. And some, including Deamonte's brother, get in for a toothcleaning but have trouble securing an oral surgeon to fix deeper problems.In spite of efforts to change the system, fewer than one in three childrenin Maryland's Medicaid program received any dental service at all in 2005,the latest year for which figures are available from the federal Centers forMedicare and Medicaid Services.The figures were worse elsewhere in the region. In the District,29.3percent got treatment, and in Virginia,24.3 percent were treated, although all three jurisdictions say they havedone a better job reaching children in recent years."I certainly hope the state agencies responsible for making sure thesechildren have dental care take note so that Deamonte didn't die in vain,"said Laurie Norris, a lawyer for the Baltimore-based Public Justice Centerwho tried to help the Driver family. "They know there is a problem, and theyhave not devoted adequate resources to solving it."Maryland officials emphasize that the delivery of basic care has improvedgreatly since 1997, when the state instituted a managed care program, and1998, when legislation that provided more money and set standards for accessto dental care for poor children was enacted.About 900 of the state's 5,500 dentists accept Medicaid patients, saidArthur Fridley, last year's president of the Maryland State DentalAssociation. Referring patients to specialists can be particularlydifficult.Fewer than 16 percent of Maryland's Medicaid children received restorativeservices -- such as filling cavities -- in 2005, the most recent year forwhich figures are available.For families such as the Drivers, the systemic problems are often compoundedby personal obstacles: lack of transportation, bouts of homelessness anderratic telephone and mail service.The Driver children have never received routine dental attention, said theirmother, Alyce Driver. The bakery, construction and home health-care jobs shehas held have not provided insurance. The children's Medicaid coverage hadtemporarily lapsed at the time Deamonte was hospitalized. And even withMedicaid's promise of dental care, the problem, she said, was finding it.When Deamonte got sick, his mother had not realized that his tooth had beenbothering him. Instead, she was focusing on his younger brother, 10-year-oldDaShawn, who "complains about his teeth all the time," she said.DaShawn saw a dentist a couple of years ago, but the dentist discontinuedthe treatments, she said, after the boy squirmed too much in the chair. Thenthe family went through a crisis and spent some time in an Adelphi homelessshelter. From there, three of Driver's sons went to stay with theirgrandparents in a two-bedroom mobile home in Clinton.By September, several of DaShawn's teeth had become abscessed. Driver beganmaking calls about the boy's coverage but grew frustrated. She turned toNorris, who was working with homeless families in Prince George's.Norris and her staff also ran into barriers: They said they made more thantwo dozen calls before reaching an official at the Driver family's Medicaidprovider and a state supervising nurse who helped them find a dentist.On Oct. 5, DaShawn saw Arthur Fridley, who cleaned the boy's teeth, took anX-ray and referred him to an oral surgeon. But the surgeon could not see himuntil Nov. 21, and that would be only for a consultation. Driver said shelearned that DaShawn would need six teeth extracted and made an appointmentfor the earliest date available: Jan. 16.But she had to cancel after learning Jan. 8 that the children had lost theirMedicaid coverage a month earlier. She suspects that the paperwork toconfirm their eligibility was mailed to the shelter in Adelphi, where theyno longer live.It was on Jan. 11 that Deamonte came home from school complaining of aheadache. At Southern Maryland Hospital Center, his mother said, he gotmedicine for a headache, sinusitis and a dental abscess. But the next day,he was much sicker.Eventually, he was rushed to Children's Hospital, where he underwentemergency brain surgery. He began to have seizures and had a secondoperation. The problem tooth was extracted.After more than two weeks of care at Children's Hospital, the Clintonseventh-grader began undergoing six weeks of additional medical treatment aswell as physical and occupational therapy at another hospital. He seemed tobe mending slowly, doing math problems and enjoying visits with his brothersand teachers from his school, the Foundation School in Largo.On Saturday, their last day together, Deamonte refused to eat but otherwiseappeared happy, his mother said. They played cards and watched a show ontelevision, lying together in his hospital bed. But after she left him thatevening, he called her."Make sure you pray before you go to sleep," he told her.The next morning at about 6, she got another call, this time from the boy'sgrandmother. Deamonte was unresponsive. She rushed back to the hospital."When I got there, my baby was gone," recounted his mother.She said doctors are still not sure what happened to her son. His deathcertificate listed two conditions associated with brain infections:"meningoencephalitis" and "subdural empyema."In spite of such modern innovations as the fluoridation of drinking water,tooth decay is still the single most common childhood disease nationwide,five times as common as asthma, experts say. Poor children are more thantwice as likely to have cavities as their more affluent peers, researchshows, but far less likely to get treatment.Serious and costly medical consequences are "not uncommon," said NormanTinanoff, chief of pediatric dentistry at the University of Maryland DentalSchool in Baltimore. For instance, Deamonte's bill for two weeks atChildren's alone was expected to be between $200,000 and $250,000.The federal government requires states to provide oral health services tochildren through Medicaid programs, but the shortage of dentists who willtreat indigent patients remains a major barrier to care, according to theNational Conference of State Legislatures.Access is worst in rural areas, where some families travel hours for dentalcare, Tinanoff said. In the Maryland General Assembly this year, lawmakersare considering a bill that would set aside $2 million a year for the nextthree years to expand public clinics where dental care remains a rarity forthe poor.Providing such access, Tinanoff and others said, eventually pays for itself,sparing children the pain and expense of a medical crisis.Reimbursement rates for dentists remain low nationally, although Maryland,Virginia and the District have increased their rates in recent years.Dentists also cite administrative frustrations dealing with the Medicaidbureaucracy and the difficulties of serving poor, often transient patients,a study by the state legislatures conference found."Whatever we've got is broke," Fridley said. "It has nothing to do withaccess to care for these children."