MUSC craniofacial genetics expert shares views on access, special needs dentistry

“America is the richest country in the world,” Carlos Salinas, DDS, DMD said before explaining the difficulty of poor and special needs patients gaining access to dental and medical care. “We should be able to apply this wealth to the health and well-being of the most vulnerable among us.”

Salinas is a Professor and Director of the Division of Craniofacial Genetics in the Department of Pediatric Dentistry and Orthodontics at the Medical University of South Carolina (MUSC). As a seasoned dental professional who has practiced all over the world, he thoroughly understands access issues and how they vary based on health care systems. “Comparing health care systems across borders further illuminates the issues faced in the United States,” said Salinas. Access to quality health care has been defined more by who is impacted—low-income, uninsured and marginalized populations—and less on system deficiencies until recently. A study released by The Commonwealth Fund revealed findings of glaringly discrepant access and affordability issues in the U.S. compared to 10 of its industrialized contemporaries. This telling report found that “U.S. adults are significantly more likely than their counterparts to forgo health care because of cost, to have difficulty paying for care even when they have insurance, and to deal with time-consuming insurance issues.” With these findings came surprising news: three out of four U.S. adults feel their health care system needs fundamental change or a complete overhaul.

According to Salinas, the snail’s pace of payment system reform has led to more barriers to special needs and poor patients accessing quality medical and dental care services. It is doubly difficult for special needs patients to get the health and dental care they require. Problems aren’t unique only to the U.S., though. Marginalized populations in low and middle-income countries, too, have difficulty accessing needed health care where culture and religion play major roles in how healthcare decisions are made. Payment systems, however, are different and do not always work as expected. “A breakdown in Medicaid can cause a simple tooth extraction to evolve into a more expensive, debilitating condition, and in some cases death,” explained Salinas, referring to a story reported in the Washington Post in 2007. A Medicaid coverage lapse kept a child from receiving a tooth extraction that led to “meningoencephalitis” and “subdural empyema.” The child accrued close to $250,000 in medical bills before dying in the hospital—the cost of the initial extraction would have been about $80.

States are required to cover dental services for children eligible for Medicaid and the Children’s Health Insurance Program (CHIP). This coverage remains active as long as the system holds up (parents are educated on the application, processing, and financing of Medicaid programs). States have the option to extend these benefits to Medicaid-eligible adults. “South Carolina increased the fee-for-service to attract more dentists to the low-country to alleviate the shortage of dentists serving Medicaid and special needs patients,” Salinas said. Salinas developed a dental directory to help patients find dental professionals in South Carolina who offer services by special health care needs (diabetes, asthma, autism, blindness, etc.). The South Carolina Directory for Individuals with Special Health Care Needs, currently in its twelfth year, received initial funding from The Duke Endowment. “This is no universal solution,” Salinas admits. “But it is a step in the right direction to increasing access for special needs patients in South Carolina.”

Beyond his work in South Carolina, Salinas has served as a guest lecturer and researcher at the Dental School of Benemerita Universidad Autonoma de Puebla (BUAP), in Puebla, Mexico. He has also advised countries on best practices for special needs patients and craniofacial malformations. In 2013 he was invited as editor of the Dental Tribune, Hispanic and Latin American Edition in an issue dedicated to assessing the Latin American situation of special patients. His work with BUAP led to a formal relationship with MUSC that has existed since 1999. This partnership continues to support training and research programs for craniofacial genetics both at home and abroad. Salinas has recently been awarded the Outstanding National Institute of Dental and Craniofacial Research (NIDCR) Award for his dedicative work in dentistry, oral health, and craniofacial research across the globe.

Salinas has also been recognized for his service in spreading awareness to the global community about special needs dentistry. Salinas received a commendation for his leadership, guidance, and global advocacy for special needs dental care at the Dental Program for the Diagnosis and Treatment of Individuals with Special Needs’ fifteenth annual seminar. Although Salinas is a decorated and experienced healthcare professional, he remains humbled by his experiences looking forward to the next generation of practitioners. “We have to assure ourselves that when we become medical and dental professionals we’ll be able to work with patients from all backgrounds,” said Salinas. “This is how we should strive to practice: unconditionally.”

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