By Mary Otto
More than one-third of Americans face “serious challenges” in obtaining dental care, for reasons that include high cost and lack of insurance, too few providers accepting Medicaid patients and a variety of mobility and transportation problems, according to a recent report sponsored by Pew Charitable Trusts.
The following is some background and other resources that may aid you when developing stories in your area about this important social determinants of health issue.
The Dental Therapist Controversy
Dental therapists – often compared to nurse practitioners are trained to deliver a range of services that can include screenings, cleanings, preventive care, fillings and extractions. They work as members of a dental team, but often travel to remote and underserved communities to deliver care, staying in touch with supervising dentists electronically.
Dental therapists have been providing care in Alaska Native communities for more than a decade. Variations of the model are also in use in Minnesota and have been approved in Maine.
In January, leaders of Swinomish Indian Tribal Community, a Puget Sound-based tribe in Washington state announced they had hired an Alaska-trained therapist to work in their clinic.
Organizations including Community Catalyst, the W.K. Kellogg Foundation and the Pew Charitable Trusts have worked to expand the model. Legislation and pilot programs are at different stages in different states. Supporters defend the model as a safe and cost-effective approach to expanding care. But dental therapists have been strongly opposed by dental organizations such as the American Dental Association. These professional groups contend that only dentists have the necessary training to perform “irreversible surgical procedures” such as drilling and extracting teeth.
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Is a lawmaker or group supporting such efforts in your state?
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What is the position of your state dental association on dental therapists?
It is also a good idea to check with your state dental hygienists’ association. The American Dental Hygienists’Association favors a hygiene-based dental therapist model that could potentially enable hygienists to expand their scope of practice.
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What do hygienists in your state think?
In terms of state-to-state variations in adult dental benefits under Medicaid, this factsheet from the Center for Health Care Strategies offers a useful overview. But because adult dental benefits are not mandated by Medicaid, they are subject to change. Make sure to check with your state to see what benefits are currently covered. Don’t forget to ask if there plans to expand or cut the benefits are under consideration.
In its report “The Oral Health Care System: A State-by-State Analysis” the American Dental Association Health Policy Institute analyzed government and industry data to assess each state’s dental system on a number of measures, such as the percentage of children receiving a dental visit in recent years, the number of children receiving preventive dental sealants, and the percentage of the state’s population with access to fluoridated water.
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Check on how your state did, based upon these measures may offer an angle for a story.
Research has shown that dental sealants are effective at reducing tooth decay, but often the children who need them most miss out on receiving them. The Pew Charitable Trusts has monitored state programs that aim to get dental sealants to high-risk children. In reports such as “States Stalled on Dental Sealant Programs” the philanthropy has graded the states on the effectiveness of these programs.
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How is your state doing?
It is also worth checking into how dental benefits are being handled – and how they are selling – at your state’s health insurance exchange. Barbara Feder Ostrov of Kaiser Health News recently took a look at Covered California’s decision to include adult dental benefits on its exchange.
About 1.4 million individuals are enrolled in stand-alone dental benefits purchased on the federally-facilitated health insurance marketplace and state-based marketplaces, according to a 2015 report from the U.S. Department of Health and Human Services.
In terms of America’s elderly, Medicare does not cover routine dental benefits and needs among many seniors are great. The nonprofit Oral Health America tracks oral health disparities among older Americans in periodic State of Decay reports.
In its most recent report, issued in 2013, the group concluded that by its measures, more than half of the country received a “fair” or “poor” assessment in meeting minimal standards affecting dental care access for older adults. Two states with large elderly populations, Florida and Arizona, ranked in the bottom five states due to a shortage of oral health coverage, a strained dental health work force, and deficiencies in prevention programs.
- While the report is dated, it might be worthwhile to find out how your state did, and to see if efforts have been made to address any problems identified.
