The state program tackling the high tooth decay rate among Hawaii's children will be terminated with layoffs scheduled for November.

Dr. Mark Greer, chief of the state Health Department's Dental Health Division, said the Dental Hygiene Branch will be dismantled with 11 layoffs. Three other employees retired, he said.

“;We're very concerned because we still have among the highest tooth decay rates in the country,”; he said.

Medicaid dental benefits for adults also were reduced Aug. 10 by the state Department of Human Services to cover only emergency services, he said, pointing out this affects the frail elderly, developmentally disabled and people with mental illness, cardiac and cancer conditions.

“;The big concern is the impact all of this is having on our public health system,”; he said. “;The ability of the private and public sectors to respond to community needs is really being crippled.”;

Dental Hygiene Branch activities are geared toward prevention, with hygienists reaching about 40,000 people a year, said branch chief Susan Tengan.

They see children one on one in schools, treat their teeth with fluoride and teach them how to brush and care for their teeth, she said. Screening is done if needed to identify decay areas and inform parents, she said.

Most activities are in elementary schools, but Lanai and Hana, Maui, high school students receive services because they are isolated, Tengan said.

The state hygienists also go into long-term care facilities to train caregivers, and they provide education to many parent-child, preschool and senior citizen groups, she said.

State Health Director Chiyome Fukino said, “;We recognize this has been a really valuable program to children in our state.”;

However, she said, more than 75 percent have some type of dental coverage, “;so we encourage children, parents and the dental community to work together so children in this state can make use of their dental insurance and get the services that are available to them.”;

Fukino also pointed out that Hawaii does not have fluoridated water except on military bases. “;We encourage the dental association to take the lead with us in working toward appropriate fluoridation of water supply to improve dental health of children.”;

Dr. Gary Umeda, Hawaii Dental Association president, said the Dental Hygiene Branch layoffs are “;of great concern. ... Nobody disputes the need to cut. We understand it's very difficult, but we need to invest in the health of our people.”;

The best way to save money is to provide preventive dental care for children, he said.

He said the association has worked hard for many years to increase access to dental care for underserved populations. Concerned dentists and organizations formed the Hawaiian Islands Oral Health Task Force in 2002, which identified barriers to dental health in Hawaii.

Recommendations to improve oral health included development of fluoridated community water systems and restoring dental benefits for adults participating in Medicaid/QUEST programs.

The task force succeeded in getting legislation approved in 2003 to allow dentists and dental hygienists with licenses from other states to work in the community health centers and native Hawaiian health care centers.

Beth Giesting, executive director of the Hawaii Primary Care Association, said nearly all health centers have dental services now or will by the end of the year. The centers also started pediatric dental residency programs last July because “;there are so many underserved kids,”; she said.

She said it is “;really ironic”; to eliminate the dental hygiene program because “;it's the dental division hygienists who go out and document the oral health status of our children. ... It's the kind of service that should be a priority for public health because they're targeting kids most at risk and doing preventative things that insurance doesn't cover.

“;Most likely, these families are not going to get that kind of prevention and education anywhere else,”; Giesting said.