Editor’s Note: The American Dental Association is proud to announce that the U.S. House of Representatives will vote the week of April 4 on the Ensuring Lasting Smiles Act (ELSA), HR 1916. The ADA has been lobbying with our colleagues for years for this issue with the American Association of Oral and Maxillofacial Surgeons (AAOMS) and many other dental organizations. Most recently, this was one of the topics that dentists and students advocated during Lobby Day in March 2022. Please click here to message your representative and encourage other dentists you know to message as well.
dr. Mark Horner was born in 1961 in suburban Maryland with a full bilateral cleft lip and palate.
A fissure occurs when body parts and structures do not fuse during fetal development. Fissures can involve the lip and/or the palate, which consists of both hard and soft palate.
He had nine surgeries when he was very young, making incremental progress as he grew. There was orthodontic treatment (braces) at age 5 and again in his teens. At age 10, an additional surgery called a “tongue flap” was used to close the remaining hole in the roof of his mouth. This failed after 10 years and had to be redone. At age 17, a fixed bridge was placed to replace the missing teeth and cover the misshapen and misshapen teeth. (Techniques to treat cleft lip and palate have improved over the intervening 50+ years, and today fewer surgeries may be needed.)
The mother of Dr. Horner recalls receiving minimal guidance on caring for Mark. Every time she finished feeding, it was almost time to start over. She said that even with good medical insurance, she was hesitant to take Mark to Johns Hopkins Hospital because she was concerned about the affordability of the treatment. The orthodontics and dental bridge were paid out of pocket because they were not covered by health insurance and there was no dental coverage.
After five decades, this medical condition is still not “cured” for Dr. horner. At age 51, his 34-year-old dental bridge had to be removed along with two extra teeth due to root failure and bone infection. He then needed bone grafts to support an implant, crowns and a new removable device. He was told that due to the challenging nature of his case, the work required to prepare his mouth for a new bridge might not yield the most satisfactory outcome. In addition, after childhood orthodontics, his back teeth gradually tilted toward the center of his mouth, and this too was risky to correct.
The Ensure a lasting smile Act(S. 754/HR 1916) or ELSA, introduced in Congress in 2019, children with conditions like Dr. Horner can help. “It is extremely important to help people with birth defects because these conditions are not just cosmetic procedures. Medical and dental procedures are performed to help patients eat, breathe and chew normally,” explains Dr. Horner. As a result, they must be performed in a timely manner. If these problems are not fully corrected, it can lead to lifelong physical and psychological scars, as children may not ‘fit in’ and become victims of bullying and ridicule.”
dr. Horner continues: “There is no time for parents to negotiate with insurance companies about medical necessity for their children’s ailments. We cannot allow patients to begin rehabilitation only to delay or discontinue treatment due to insurance denials and financial difficulties. That’s just not right!”
“My personal experience and medical history certainly sparked my interest in dentistry,” explains Dr. Horner out. “I was fortunate that my parents lived close to beautiful hospitals and were able to afford the comprehensive treatment I needed.”
As a general dentist in a suburban community, he saw far fewer involved cases of birth defects that should be covered by this law. “I am committed to moving this bill forward,” said Dr. Horner “all dentists should be advocating for patients who are totally ignorant of how ELSA might help.”
Editor’s Note: The article by Dr. Horner originally appeared in the New Dentist Now blog on August 19, 2019.