A national report out this week shows Wisconsin near the bottom of the list for access that poor children have to dental care.
A new report from the Pew Charitable Trusts shows that more than 71% of children enrolled in Medicaid in Wisconsin did not see a dentist during 2011. Only one state - Florida - fared worse in the study.
Moreover, the state may soon have a shortage of dentists at hand - the state ranked seventh in the nation in the number of dentists approaching retirement age.
Jane Koppelman is research director for children's dental policy for the Pew Trusts. She described the national landscape for access to dental care for poor children.
"We consider it a crisis, the surgeon general last year also considered it a crisis," she says. "What we see is that there are millions of low income children who go without dental care each year because we have a system that doesn't have the capacity to treat them."
She says the lack of access comes in part from a shortage of dentists in high population areas. The federal government's figures for 2012 show 45 million Americans living in areas with too few dentists.
Even if a patient can find a dentist, Koppelman says the other part of the problem is there are fewer dentists participating in Medicaid and accepting new patients.
"It's an interesting irony: Low income children are more likely to have dental coverage than children than higher-income children, but they are less likely to get care," she says.
The combination of dentist shortages in rural or inner-city areas with a lack of Medicaid acceptance is creating this crisis for children.
"Medicaid has become kind of like a hunting license for dental care," Koppelman says. "It kind of gives you the opportunity to try to find a dentist who will treat you or your children and that can be a trial."
She also adds that the problem of accessing dental care is an issue for the general population as well. Dental coverage is a mandated benefit for low-income children - but not necessarily for adults.
One possible solution to the dentist shortage is to allow midlevel practitioners do limited dental work; right now, only dentists can do basic restorative care like filling and drilling. Koppelman says about 15 states are considering offering more training for dental hygienists that would them to provide such care.
Alternatively, in Minnesota and Alaska, new positions called dental therapists are trained to do such fill-and-drill procedures. Koppelman says they are the equivalent of a nurse practitioner or a physician's assistant for dentists. The hope is that these positions would increase the number of providers who can care for more people.
Fifty-two countries have adopted the dental therapist model to expand care, and Koppelman says many are put in schools.
"It's a cost effective way to get kids early and treat their tooth decay at an early stage," she says.