WATERLOO - Mya Lee, normally a talkative 2-year-old, fell silent in the dentist's room at Peoples Community Health Clinic.

Despite the promise of Dora the Explorer stickers, she wriggled her body and shook her head as she was nestled face-up in the lap of the doctor.

Mya resisted the invading toothbrush with all her might; pursing her lips, then wailing in discomfort.

Her mother, though, was grateful to just find someone to see her daughter.

Margaret Lee called four different dentists in the Cedar Valley before turning to the nonprofit clinic that provides low-cost health care.

"I was surprised by how many times I had to call a dentist to get her seen. They said she's too little or too young. One didn't take Medicaid at all," she said, referring to the government health insurance program for low-income Americans.

As part of a broader effort to improve the dental health of Iowa's children, a new law took effect this summer that requires parents to show proof of a dental screening when their children enroll in school.

But public health officials say compliance is a problem for a variety of reasons, ranging from a lack of interest or awareness, to a lack of access to dentists.

Lee, eager for someone to see her child, encountered two of the biggest access barriers facing families.

In Black Hawk County, 40 percent of dentists accept Medicaid patients, according to figures compiled by the county health department. Only 13 percent see children younger than three. The numbers are even more pronounced in rural counties.

That's a problem, said Amy Goetsch, oral health coordinator for Black Hawk County, because public health professionals have targeted children on Medicaid in their efforts.

Their reasoning: Eighty percent of dental problems are found in the poorest 20 percent of Americans.

"We get our biggest bang for our buck by working with Medicaid families," Goetsch said.

Yet many dentists do not accept patients on Medicaid, she said, because they say it pays too little money.

But fixing the problem - which the state health department says is the No. 1 access barrier - is no easy task.

Without revamping the nation's entire health care system, it requires increasing funding to Medicaid to pay a rate that competes with private insurers.

So instead, health professionals focus on a slightly less arduous task: Shifting the attitudes of medical professionals.

American Pediatric Care of Dentistry recommends children see a dentist before turning 1. However, Goetsch said, old habits die hard in the medical community, where a majority of dentists still only see young children if there are problems.

Public health officials also hope more general physicians - like Dr. Jamie Petrie, the doctor who checked Mya's teeth - will learn what to look for in oral health during routine physicals.

Many doctors simply don't bother looking at children's teeth, said Bob Russell, dental director for the Iowa Department of Public Health.

"Many lift the lid (open the mouth) and go straight for the throat," he said.

So the state has worked with the University of Iowa to provide continuing medical education, he said.

But data measuring the effectiveness of the new dental screening law won't come out for at least another year, he said, so public health officials will have to wait to see if their efforts produce more pearly whites.

Contact Jens Manuel Krogstad

at (319) 291-1580 or

jens.krogstad@wcfcourier.com.