From the minute the doors opened at the Rice Regional Dental Clinic in Willmar, Minn., late in 2007, it was clear there was an overwhelming need for access to dental care, especially among low-income adults and children. The staff reported being inundated with phone calls for appointments.
For anyone who has ever visited the dental clinic or is familiar with the services it provides, it surely must have been no surprise when the Institute of Medicine issued a report this week on the state of oral health care for America’s low-income and vulnerable citizens.
The report’s main conclusion: Millions of Americans are not receiving necessary dental care because of “persistent and systemic” barriers. Children, seniors, minorities and the poor are especially affected.
Perhaps the most compelling point of the report is this: Although dental care is a basic need for people of all ages, it’s one of the areas in which disparities are the widest. The authors wrote,
More than half of the population does not visit a dentist each year. Poor and minority children are substantially less likely to have access to oral health care than are their nonpoor and nonminority peers. Americans living in rural areas have poorer oral health status and more unmet dental needs than their urban counterparts. Older adults, especially those living in long-term care facilities, have a high prevalence of oral health problems and difficulty accessing care by individuals trained in their special needs. Disabled individuals uniformly confront access barriers, regardless of their financial resources. The consequences of these disparities in access to oral health care have a strong influence not only on oral health but on overall health as well.
The report identifies multiple reasons for this troubling state of affairs. For one thing, the cost of dental care is an issue for many households. According to the IOM report, an estimated 4.6 million children did not receive needed dental care in 2008 because their family couldn’t afford it. Among older adults on Medicare, fewer than half have dental coverage.
What your smile looks like is in fact a dead giveaway of socioeconomic status, an observation that has been confirmed by several studies. Teeth that are discolored, crooked or missing are often a marker of poverty and/or inadequate dental care. The burden of oral diseases such as tooth decay also falls primarily on the poor.
Even having dental insurance doesn’t necessarily guarantee access to care, however. Many dentists don’t accept clients on publicly funded programs such as Medicaid or MinnesotaCare because the reimbursement is so low. And rural and inner-city regions of the United States have a shortage of dental professionals, period. I’ve seen projections indicating Minnesota’s dental workforce is aging and that it may be increasingly difficult to replace these professionals when they retire.
What can be done to change this? The IOM report makes several recommendations. Chief among them is increasing the reimbursement rate for Medicaid and the Children’s Health Insurance Program so dentists have a greater incentive to see these patients. Another recommendation is to give dentistry students more opportunities to gain skills in treating patients with special needs.
The report also calls for enlisting other parts of the health care delivery system to provide some aspects of oral health care. For example, mid-level professionals could do screenings for oral disease and offer basic preventive care. A measure that creates licensing standards in Minnesota for two new types of mid-level providers – dental therapists and advanced dental therapists - was passed by the Legislature in 2009.
This is a ground-breaking initiative that has the potential to make a difference. It’s too soon to know, however, whether it will truly help improve access to dental care, especially to those who are the most underserved. It should also be noted that many dentists have raised concerns about training and supervision of these mid-level professionals.
In spite of the deep disparities that exist in access to oral health care, there are a handful of bright spots – projects and programs that are creative, innovative and that help shrink the gulf of unmet needs. The IOM report doesn’t list them by name, but I’d like to single out one of them: the Rice Regional Dental Clinic in Willmar, a partnership between Rice Memorial Hospital and the University of Minnesota. Here, students in the university’s dentistry and dental hygiene programs gain hands-on experience with a wide variety of patients in a rural setting. In exchange, low-income and uninsured individuals in the region can receive much-needed dental care.
According to statistics collected by the dental clinic, the majority of patients are children and young adults. For many of these youngsters, it’s the first time they’ve ever been seen by a dentist. I’ve spoken to public health nurses in the region who have expressed hope that 10 years from now, or 20 years from now, dental decay among poor rural children in west central Minnesota will become much less prevalent as a result of the services the Rice Regional Dental Clinic is providing.
At the time the program was established, in 2007, it was believed to be the only one like it in the United States. As far as I’m aware, the Rice Regional Dental Clinic is still unique – proof that solutions are possible, especially when the right partners can come together.
For whatever reason, oral health doesn’t always receive the same level of attention as the rest of health care. It reminds me of a poster my dentist used to have in his office that read, “Ignore your teeth and eventually they’ll go away.” Oral health often tends to be ignored – but the need doesn’t go away, and the consequences are becoming too large to be overlooked anymore.
West Central Tribune photos: Rice Regional Dental Clinic