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With the exception of a two-week supply, the Sewerage and Water Board of New Orleans hasn't added cavity-fighting fluoride to the city's drinking water since Hurricane Katrina. This might not seem like a major problem, considering the city's myriad of issues, but it does contribute to bad oral hygiene, particularly in low-income children. In turn, bad oral hygiene can lead to more serious health problems for kids and affect their education. For adults, gum disease has been associated with an increased risk for cancer and heart disease. Dr. Robert Barsley, a dentist and director of Dental Health Resources at LSU Health Sciences Center talks about why dental care is so vital to overall health and how access to dental care has become one of the health-care challenges in post-Katrina New Orleans.

Q: Recently released figures from the Centers for Disease Control reveal that untreated tooth decay in America is rising. Why?

A: There are more people who need to be treated. At one time, Americans thought tooth decay was licked if you go back to the '60s with fluoridation and fluoride toothpaste. That was going to solve the problem, but it still is a fact that about 80 percent of the disease exists in about 20 percent of the population. That 20 percent is usually the lower socio-economic strata.

Q: What about the situation in New Orleans? Is there enough access to care?

A: You would get the most accurate figures — the number of dentists practicing — from the Louisiana Board of Dentistry. Originally after the storm, their indication was that they lost fewer than 20 dentists statewide. Some people from New Orleans had relocated to Baton Rouge and the Northshore. The net loss is now around 200. But Orleans Parish has probably lost the greatest (number). I know that the LSU Dental School just moved back into town. We opened our doors just around Labor Day and we have as many patients as we can handle. So clearly there are people who need care. I'm a consultant for the Medicaid department in Louisiana, and we see claims from all over the state, and there are fewer claims ... coming from dentists in New Orleans.

Q: Is it particularly bad for kids living in low-income families?

A: I don't want you to take this the wrong way, but dentistry costs money. It's about a hundred bucks for a cleaning, an X-ray, checkup and whatever work might need to be done. That's a significant amount of money to anyone, so the less disposable income you have, the more (significant) that becomes. Unless you have access to some type of care that is either subsidized, or, in the case of Medicaid for children, free to you, then that's a problem.

Q: What about the overall effect of bad oral hygiene on children?

A: The commonly quoted figure for dental disease in kids is that about 50 million school hours are lost every year. Dental hygiene plays a role in it; a kid that's 2 years old, 3 years old, cannot be expected to clean his or her teeth adequately — the parents have to take a role in that and it doesn't always happen. The dentist has to take a role in that: the application of fluoride, a bi-annual checkup and X-rays to see if anything's developed.

Q: Besides losing your teeth, gum disease is linked to a higher incidence of heart attacks, strokes, pneumonia and cancer. How so?

A: There are a number of studies in the last five to 10 years that link some of the biochemical mediators of any kind of infection or inflammation process to similar bad outcomes. Pregnancy is one and our state has addressed that. There are studies that show pregnant women who have moderate periodontal disease, which would be reflected by bleeding gums, have a higher incidence of low-birth weight, pre-term children. By allowing those women to have access to dental care during their pregnancy, studies have shown the rate of low-birth weight, pre-term children is reduced. Our state about four years ago initiated a program to allow mothers on Medicaid to access dental care. Any unchecked inflammation or infection in your body isn't good for you.

Q: What kind of steps can we take now to provide more dental care to the public?

A: As an effect of Katrina, we will graduate about five more Louisiana dentists every year than we have in the past. Our school accepts students from Arkansas because there's no school in Arkansas, but since Katrina, we've had very few Arkansas students accept our invitation to attend here. That opened up more spaces for Louisiana students. Hopefully, our students from other states will make contacts here and wish to stay in Louisiana.

Q: So is there a shortage of dentists in Louisiana?

A: There's probably a distribution problem. Most people want to live in the big city. Dental practice is a capital-intensive operation — it costs a dentist a huge amount of money to open their own practice. They have to essentially open their own mini-hospital. So they have to set up in a place where they're guaranteed to pay back their loans and support their families. In some places in Louisiana, you just can't realistically do that. There are people who aren't being seen that need care. You can't brush your way out of this problem.

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