CBS News
Doctors take on dental duties to reach low-income and uninsured patients
DENVER — Pediatrician Patricia Braun and her team saw roughly 100 children at a community health clinic on a recent Monday. They gave flu shots and treatments for illnesses like ear infections. But Braun also did something most primary care doctors don’t. She peered inside mouths searching for cavities or she brushed fluoride varnish on their teeth.
“We’re seeing more oral disease than the general population. There is a bigger need,” Braun said of the patients she treats at Bernard F. Gipson Eastside Family Health Center, which is part of Denver Health, the largest safety-net hospital in Colorado, serving low-income, uninsured, and underinsured residents.
Braun is part of a trend across the United States to integrate oral health into medical checkups for children, pregnant women, and others who cannot afford or do not have easy access to dentists. With federal and private funding, these programs have expanded in the past 10 years, but they face socioeconomic barriers, workforce shortages, and the challenge of dealing with the needs of new immigrants.
With a five-year, $6 million federal grant, Braun and her colleagues have helped train 250 primary care providers in oral health in Colorado, Montana, Wyoming, and Arizona. Similar projects are wrapping up in Illinois, Michigan, Virginia, and New York, funded by the federal Health Resources and Services Administration’s Maternal and Child Health Bureau. Beyond assessment, education, and preventive care, primary care providers refer patients to on- or off-site dentists, or work with embedded dental hygienists as part of their practice.
Kate Ruder for KFF Health News
“Federally qualified health centers have a long history of co-locating dental services within their systems,” Braun said. “We’re taking that next step where care is not just co-located, meaning, say, we’re upstairs and dental is downstairs, but we’re integrated so that it becomes part of the same visit for the patient.”
Having doctors, nurses, and physician assistants who assess oral health, make referrals, and apply fluoride at community health centers is critical for the many children who lack access to dental care, said Tara Callaghan, director of operations for the Montana Primary Care Association, which represents 14 federally qualified health centers and five Urban Indian organizations.
“Providing these services during medical visits increases the frequency of fluoride application,” Callaghan said, and “improves parents’ knowledge of caring for their child’s teeth.” But obstacles remain.
Because of Montana’s large geographic area and small population, recruiting dental professionals is difficult, Callaghan said. Fifty of the state’s 56 counties are designated dental shortage areas and some counties don’t have a single dentist who takes Medicaid, she added. Montana ranks near the bottom for residents having access to fluoridated water, which can prevent cavities and strengthen teeth.
Pediatric dental specialists, in particular, are scarce in rural areas, with families sometimes driving hours to neighboring counties for care, she said.
Embedding dental hygienists with medical doctors is one way to reach patients in a single medical visit.
Valerie Cuzella, a registered dental hygienist, works closely with Braun and others at Denver Health, which serves nearly half of the city’s children and has embedded hygienists in five of its clinics that see children.
State regulations vary on which services hygienists can provide without supervision from a dentist. In Colorado, Cuzella can, among other things, independently perform X-rays and apply silver diamine fluoride, a tool to harden teeth and slow decay. She does all this in a cozy corner office.
Braun and Cuzella work so closely that they often finish each other’s sentences. Throughout the day they text each other, taking advantage of brief lulls when Cuzella can pop into an exam room to check for gum disease or demonstrate good brushing habits. Braun herself takes similar opportunities to assess oral health during her exams, and both focus on educating parents.
Medical and dental care have traditionally been siloed. “Schools are getting better at interprofessional collaboration and education, but by and large we train separately, we practice separately,” said Katy Battani, a registered dental hygienist and assistant professor at Georgetown University.
Battani is trying to bridge the divide by helping community health centers in nine states — including California, Texas, and Maryland — integrate dental care into prenatal visits for pregnant women. Pregnancy creates opportunities to improve oral health because some women gain dental coverage with Medicaid and see providers at least once a month, Battani said.
In Denver, housing instability, language barriers, lack of transportation, and the “astronomical cost” of dentistry without insurance make dental care inaccessible for many children, the migrant community, and seniors, said Sung Cho, a dentist who oversees the dental program at STRIDE Community Health Center, serving the Denver metro area.
STRIDE tries to overcome these barriers by offering interpretation services and a sliding pay scale for those without insurance. That includes people like Celinda Ochoa, 35, of Wheat Ridge, who waited at STRIDE Community Health Center while her 15-year-old son, Alexander, had his teeth cleaned. He was flagged for dental care during a past medical checkup and now he and his three siblings regularly see a dentist and hygienist at STRIDE.
One of Ochoa’s children has Medicaid dental coverage, but her three others are uninsured, and they couldn’t otherwise afford dental care, said Ochoa. STRIDE offers an exam, X-rays, and cleaning for $60 for the uninsured.
In the past year, Cho has seen an influx of migrants and refugees who have never seen a dentist before and need extensive care. Medical exams for refugees at STRIDE increased to 1,700 in 2023 from 1,300 in 2022, said Ryn Moravec, STRIDE’s director of development. She estimates the program has seen 800 to 1,000 new immigrants in 2024.
Kate Ruder for KFF Health News
Even with growing needs, Cho said the Medicaid “unwinding” — the process underway to reexamine post-pandemic eligibility for the government program that provides health coverage for people with low incomes and disabilities — has created financial uncertainty. He said he worries about meeting the upfront costs of new staff and of replacing aging dental equipment.
At STRIDE’s Wheat Ridge clinic, two hygienists float between dental and pediatrics as part of the medical-dental integration. Yet Cho said he needs more hygienists at other locations to keep up with demand. The pandemic created bottlenecks of need that are only now being slowly cleared, particularly because few dentists take Medicaid. If they do accept it, they often limit the number of Medicaid patients they’ll take, said Moravec. Ideally, STRIDE could hire two hygienists and three dental assistants, Moravec said.
In 2022, Colorado enacted a law to alleviate workforce shortages by allowing dental therapists — midlevel providers who do preventive and restorative care — to practice. But Colorado does not have any schools to train or accredit them.
Before age 3, children are scheduled to see a pediatrician for 12 well visits, a metric that medical and dental integration capitalizes on, particularly for at-risk children. As part of Braun’s program in the Rocky Mountain region, providers have applied more than 17,000 fluoride varnishes and increased the percentage of children 3 and younger who received preventive oral health care to 78% from 33% in its first 2½ years.
Callaghan, at the Montana Primary Care Association, witnesses that on the ground at community health centers in Montana. “It’s about leveraging the fact that kids see their medical provider for a well-child visit much more often and before they see their dental provider — if they have one.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
The number of people killed and/or wounded in shootings over the Fourth of July week in the U.S. dipped this year, making it the fourth year in a row gun violence around July 4 has dropped, according to a tally by the Gun Violence Archive.
From July 1 to July 7, 340 people were killed and 756 were wounded for a total of 1,096 shooting victims across the U.S., according to the Gun Violence Archive. In 2023, the week of July 4 in the U.S. saw 451 people shot and killed and another 1,130 wounded. These numbers exclude those who died by suicide.
The archive also recorded 20 mass shootings —which it defines as a shooting in which four or more people are shot and/or killed, not including the shooter— over Fourth of July week this year. That was down from 28 a year ago.
Chicago, which saw a spike in gun violence this year, had the most shootings and deaths over the 2024 holiday, with more than 100 shot and 19 killed since Wednesday, according to the Chicago Police Department. That was a 91% increase in shooting victims compared with last year.
In 2022, the Illinois suburb of Highland Park was the site of a devastating mass shooting in which seven people were killed and dozens more were wounded when a gunman opened fire on the city’s Fourth of July parade. That parade returned this year for the first time since the shooting.
Gun violence in Chicago made Illinois have the most individual shooting incidents of any state over the holiday week this year. California also saw a fairly high number of shooting incidents this year, which is unsurprising given that it is the nation’s most populous state.
The number of shooting victims over the Fourth of July week has been dropping every year since 2020, but they still remain above 2019 levels. That year, there were 1,177 total victims, with 318 deaths and another 859 people wounded. The numbers then spiked in 2020, when 536 people were killed and 1,172 were wounded, for a total of 1,708 gunshot victims.
The Gun Violence Archive also recorded 34 mass shootings in 2020, the highest number over the last six years and a leap up from 18 in 2019.
The U.S. has also seen a slight dip in gun violence overall in the first half of 2024 compared with last year. From Jan. 1 through June 30 of last year, 9,683 people were killed and 18,630 people were wounded in shootings. Over that same period this year, 8,539 were killed with another 16,192 were wounded.
— Erin Cauchi and Anna Schechter contributed reporting.
CBS News
The best Apple AirPods deals ahead of Prime Day 2024 offer great audio at record low prices
Apple
When it comes to headphones, Apple AirPods are massively popular. These crowd-pleasing earbuds pair easily with Apple devices (like your iPhone) and sound great, too. If you’re ready to see what all the fuss is about, you can save some serious cash on each model of the customer-loved earbuds right now, thanks to some must-see early Amazon Prime Day deals.
The second-generation AirPods Pro are Apple’s premium earbuds, with excellent noise cancellation, spatial audio, and waterproofing that makes them ideal candidates for wearing at the gym. There are also the more affordable AirPods that are great for casual listening. For Apple users wanting high-end over-ear headphones, AirPods Max are great for immersive sound.
Not sure which type of AirPods will work best for you? Be sure to check out our in-depth AirPods buyer’s guide for all the info you need to make a purchasing decision before these pre-Prime Day deals go away.
Apple AirPods Pro 2nd Generation: $169 ($80 off)
Apple
With up to 30 hours of battery life via their charging case, the sleek Apple AirPods Pro 2nd Generation wireless earbuds deliver exceptional listening time.
These upgraded earbuds surpass the original AirPods Pro in every way. An improved wireless chip and enhanced active noise cancellation give you an immersive listening experience, and their attractive curves make them even more pleasing to the eye.
For anyone who appreciates lengthy battery life and the very best sound quality, these are a fantastic choice. With all the upgrades over the previous model, the AirPods Pro 2nd Generation represent Apple’s most advanced earbuds yet.
This version of the AirPods now comes with a USB Type-C charging case that also supports wireless charging. Another feature we love: the touch controls built into the stems.
Regularly $249, you can score Apple AirPods Pro 2 for $169 at the Walmart Deals sale or at Amazon as an early Prime Day deal.
Apple AirPods (2nd Generation): $69 ($60 off)
Apple
Though not the newest model, the second-generation Apple AirPods are still a popular choice when it comes to earbuds. Keep in mind, these are not the Pro model, but they’re still worth grabbing.
For Apple users, these are the most seamless earbuds around. They connect effortlessly whenever you need them. While they work with any Bluetooth device that generates audio, they function at their best when they’re paired with an Apple device, such as an iPhone, iPad, Apple Watch, iMac or MacBook.
With a wireless charging case providing more than 24 hours of battery life, one-tap setup for Apple devices, and a low-latency wireless connection for immersive entertainment, it’s easy to see why these earbuds are a hit and continue to sell out.
If you want an affordable option with broad appeal, this version of the AirPods make an excellent everyday wireless earbud option.
Right now, you can grab a pair of AirPods (2nd Generation) for just $69, one of the lowest prices we’ve seen.
Apple AirPods (3rd generation): $129 ($74 off)
Apple
If you don’t need the fanciest AirPods, but still want something new, check out the third generation of the original AirPods. These are perfect for staying current and for everyday use — without breaking the bank.
These AirPods come packed with features like spatial audio, dynamic head tracking and longer battery life. You can get about 30 hours with the included MagSafe charging case. They’re not as advanced at the AirPods Pro 2nd Generation, but they generate really impressive audio.
These AirPods still receive regular Apple updates, so you’ll still get most of the new goodies the other newer models get.
Apple AirPods Max (Pink): $450 ($99 off)
Amazon
If you want to indulge in a luxurious pair of premium quality headphones and you’re already an Apple user, look no further than the AirPods Max. These headphones look just as good as they sound. And in our coverage of the 11 best spatial audio headphones and earbuds for 2024, these were a top pick.
With lavish cushioned ear cups, booming audio, spatial audio with dynamic head tracking, and absolutely fantastic active noise cancellation, the AirPods Max make a bold statement. Everyone will know what you’re wearing — and they’ll probably be jealous, because these things absolutely bump.
Plus, transparency mode lets you tune into your surroundings when needed. And at 15 hours of playtime, these headphones keep your music flowing all day. Beyond performance, the AirPods Max make a fashion statement with a range of stylish color options.
These are the perfect option for anyone looking for a pair of excellent over-the-ear headphones who also wants something stylish.
Currently, only the Pink AirPods Max colorway is on sale at Amazon for $450, so keep an eye out for the other models if you’re hoping to get another kind.
Target tells its customers to expect more while paying less — but soon, its shoppers won’t be able to purchase anything at all with a once-popular form of payment.
The retail giant said in a statement that it will stop accepting personal checks as payment starting July 15. The change, which was earlier reported by Minneapolis TV station KARE, will take place after Target’s Red Circle week, a sales event that ends on July 13.
The change comes amid waning use of personal checks, a form of payment that 9 in 10 consumers used at least once a year as recently as 2009, according to research from the Federal Reserve Bank of Atlanta. But today, only about half of Americans write checks at least once a year, with many shifting to digital payments such as Venmo, Zelle or PayPal, GoBankingRates found.
Target pointed to the shift in consumer preferences as its reason to stop accepting personal checks as payment.
“Due to extremely low volumes, we’ll no longer accept personal checks starting July 15,” a Target spokesperson said in an email. “We have taken several measures to notify guests in advance to aid an easy and efficient checkout experience.”
Target will continue to accept cash; digital wallets; buy now, pay later services; and credit and debit cards as well as SNAP/EBT cards, it said.
A few other retailers don’t accept personal checks, including Aldi’s and Whole Foods, with the latter saying it doesn’t allow checks in order to speed up the checkout process.
Even though fewer Americans are writing checks today, they remain popular with older consumers, GoBankingRates found in its survey. About 1 in 5 people over 66 write several checks each month, while about half of people under 55 don’t write a single check the entire year.
