Volume 18, No.2, May 2008


Access to Oral Health Care

Contributors:
Tanna L Klein and Kristen Heitkamp
University of Missouri Extension (OSEDA)

Dental health is the most common unmet need among children.1 Nearly 59 percent of children experience dental caries, far more than the number who have asthma (11 percent) or hay fever (8 percent). 2 In a national health survey conducted in 2003, almost 68,000 children did not get all of the dental health care needed.

Table of percent who did and did not get needed care - weighted estimate

Access to dental providers and cost are two major factors that prevent Missourians from receiving adequate dental care. In a call for proposals issued earlier this year by the Missouri Foundation for Health, Oral Health Promotion and Access: Workforce Development (Word document), the background statement notes that “Oral health is consistently identified as an area of great need in Missouri; it is essential to general health and overall well-being throughout a person’s lifespan, and is an important indicator in measuring overall health status. However, the lack of dental providers and the lack of providers that accept Medicaid, along with an increasing number of low-income, uninsured and underserved populations which lack access to quality dental care services, combine to make oral health issues a priority to be addressed in Missouri.” This is the foundation’s effort to extend its Oral Health Promotion and Access (OHPA) to support focused funding for prevention and access programs to improve oral health in Missouri. The first phase of OHPA focused on supporting sustainable school-based and school-linked dental sealant and education programs (Smiles Across Greater Missouri – SAGMO).

According to the Missouri Coalition for Oral Health, Missouri’s shortage of dental health care providers is increasing over time. The lack of sources for new oral health professionals is problematic: Missouri has only one dental school, and despite an increase in dental and hygienist students, the school is unable to fill the gap. Annually, Missouri has approximately 70 dentists retire, compared to the approximately 40-50 dental graduates staying in state to practice. The supply in small remote rural areas is substantially lower than in urban areas. In Missouri the ratio of dentists per 100,000 population is 54.0. However, the ratio is 44.7 in metropolitan counties and only 29.6 in nonmetropolitan counties. Five counties in the state (Holt, Mercer, Ralls, Shannon and Worth) are currently without a single active dentist, resulting in 28,841 people without immediate access to a dentist in their area (see Table 1 and Map 1). (From Missouri Department of Economic Development, Professional Registration, April 10, 2008 http://pr.mo.gov/listings.asp. and Missouri State Data Center, April 23, 2008 http://mcdc2.missouri.edu/trends/estimates.shtml.

For those fortunate enough to have a dental provider in their community, affordable care still remains a significant barrier. Less than 40 percent of Missouri employees have dental health insurance.3 In addition, the elimination of adult dental coverage for Medicaid patients has left thousands more without dental coverage.

Number of Dentists per 100,000 Population, by County 2008

The Surgeon General’s “Call to Action to Promote Oral Health” recommends increasing the diversity of the dental workforce to meet community and patient needs, enhancing workforce capacity, and securing an adequate and flexible workforce.4 A recent New York Times article lauded clinics that provide basic dental care utilizing “dental therapists.”5 This type of clinic is only available in rural Alaska and only to Alaskan natives. Evidence of the effectiveness of this alternative appears favorable. “Early results are promising, according to dental experts studying the program.”

Oral health care in America is often viewed as separate from general health care; however, oral health affects a person’s overall health. The National Rural Health Association noted in a recent policy brief, “When they have focused on oral health, policymakers, health care providers and the general public alike have focused primarily on teeth, rather than the person around the teeth.”4 However, oral health represents a critical part of a person’s well being, affecting everything from physical appearance, self-esteem and systemic health to the ability to speak and eat. In the case of children, nearly 51 million school hours are lost nationally each year due to oral pain or disease.4

Conclusion
Policymakers have many options to consider for improving oral health for young children. Such options should include continued expansion of proven prevention strategies such as sealants and fluoridation, as well as studying new models that show promise for meeting the needs of young children and other underserved people, including the further study of the promising model of the training and utilization of dental therapists.

References

  1. P.W. Newacheck, D.C. Hughes, Y.Y. Hung, S. Wong, J.J. Stoddard, The Unmet Health Needs of America’s Children, Pediatrics 105(4 Pt 2) (April 2000): 989-97.
  2. National Institute of Dental and Craniofacial Research, National Institutes of Health, Oral Health in America: A Report of the Surgeon General (Rockville, MD: U.S. Dept. of Health and Human Services, 2000).
  3. Missouri Coalition for Oral Health Access. Oral Health in Missouri: Policy Recommendations for Prevention, Education and Access. May, 2002.
  4. U.S. Department of Health and Human Services, National Call to Action to Preserve Oral Health. Spring 2003, NIH Publication NO. 03-5303.
  5. Berenson, A. Dental Clinics, Meeting a need with no dentist. New York Times, April 28, 2008.

View this issue in Adobe Acrobat Format

This file last modified Wednesday August 19, 2009, 14:43:31

Questions/Comments regarding this page or this Web site are strongly encouraged and can be sent to
OSEDA, Office of Social and Economic Data Analysis     Telephone: (573)882-7396
240 Heinkel Building, Columbia, MO 65211