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The Gap in Oral Health Care

July 31, 2012 By Sasha Hulsey, Policy Associate

America: land of opportunity, land of plenty, land of poor oral health? Even with the Patient Protection Affordable Care Act (PPACA), there are very few provisions that would improve Americans dental coverage.

In 2010, over 100 million Americans had no dental coverage. On average, those surveyed without coverage said they go to the dentist once every three years even though the surgeon general recommends a teeth cleaning and check-up once every six months. People without dental insurance are more likely to develop serious health problems such as an increased risk of heart disease, diabetes, and stroke. Lack of dental coverage affects all Americans, but there is a serious inequality for citizens who are low- income, racial or ethnic minorities, those with disabilities, and those living in rural areas. 

One contributing factor is a low number of dentists in America. In 2006 there were almost 200,000, and this number is decreasing every year. According to a U.S. Senate Subcommittee for Primary Care and Aging a report, we need around 9,500 more dentists to meet current oral health requirements. Dentists are also disproportionately dispersed around the country, with the majority present in suburban communities rather than the urban and rural communities that require more attention. Adding to the problem is that many dentists are in specialty areas, outside general dentistry.

The U.S. Department of Health and Human Services attempted to identify shortage areas in 2006 and found that there are about 1,480 areas in the United States that can are recognized as having dentist shortages, More than 33.3 million Americans live in these “dental deserts.”  

Dental care is also difficult for most Americans to obtain because of the rising expenses of a visit. Medicaid only requires states to offer dental care to children and leaves rules for adult coverage up to states. In Minnesota, Medical Assistance covers most low-income adults. However, due to budget cuts those funds are disappearing in many other places. In addition, many dentists do not accept patients with this form of coverage, and wait lists for publicly supported dental clinics are often too long for patients with time sensitive cases. 

Dentistry, like many industries, has turned into a capitalist venture. In some states, the company Groupon has partnered with dental clinics to offer deep discounted deals on services such as teeth whitening, teeth cleaning, and x-rays. Deals such as these can bring dentists new clients, and can serve as a way for those without dental coverage to have a chance at affording some dental services. But, that doesn't solve the lack of urban and rural dental providers?

Oral healthcare today is the worst America has seen in over twenty years. With the adoption of the Affordable Care Act and advancements in medicine and technology, this situation can and needs to be remedied, starting with a surge of new dentists. The number of dental schools in the United States that have closed since the 1980s is higher than the number opened, leaving a shortage of graduating dentists since that time. By encouraging more students to enter the dental profession, especially those from more diverse backgrounds we can attempt to fill the dental workforce shortage.

Minnesota passed 2009 legislation to create a new position in the dental profession: dental therapists, who can prescribe basic treatments and perform certain procedures for a lower cost than dentists. Encouraging all health care providers to give preventative oral health services can help patients who may not seek out specialized dental care, or those in a dental desert, before it becomes too late.

Finally, revisiting state Medicaid and Medicare programs and the erosion of these services and challenges to dental care coverage and dentists acceptance of this coverage can help those Americans more vulnerable to the effects of dental disease. Encouraging dentists to treat patients with subsidized health care coverage can help close the gap in unequal oral health between low income and minority families and middle to upper class families.

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