Millions are stuck in dental deserts, unable to access oral health care

Every day, Adrienne Grimmett and her colleagues at Evara Health in the Tampa Bay area see stories of injustice in their patients’ teeth, gums and palate.

They are tales of equal access to care in cases of painful abscesses, dangerous infections, and missing jaws.

All these diseases – which Keeping patients out of work because of illness or social isolation, and keeping children out of school because they can’t focus on the roots of decay – can be prevented.

Annual dental checkups are important for overall health. But among the 67 counties in Florida, according to experts Only one has enough dentists to treat all patients. Nine counties in Florida each have fewer than three dentists. Lafayette County in North Florida has none.

“It’s a social injustice,” said Grimmett, director of Dental Services, a nonprofit that serves Medicaid and uninsured patients in the Tampa Bay area.

“If you don’t have good oral health, you’re not going to be completely healthy,” she said.

In Florida and across the country, vulnerable and marginalized communities — already at risk of high rates of chronic disease and limited access to health care — remain in these dental deserts. There, patient volume exceeds provider capacity, or too few dentists are willing to serve those on Medicaid or the uninsured.

Limiting the pool of dentists is low – or non-existent – ​​reimbursement rates for services covered by state Medicaid programs. Meanwhile, expensive dental education discourages dentists from working in many rural areas.

About 6 million Floridians They live in the desert of teethAccording to data from the US Department of Health and Human Services. That’s the largest state population in the US without basic dental care.

The consequences can be dire as people try to navigate a health system with few providers willing to serve them and unaffordable costs.

They’re people like Mark Maggs, a 54-year-old Pinellas Park resident diagnosed with cancer last year. The doctors who delayed the treatment said that the tooth should be extracted first. His daughter has started a GoFundMe to raise $3,000.

It’s people like Lisa Lambros, a 40-year-old New Port Richey resident who drives 90 minutes to Tampa for an appointment at the county health department. Three years ago, she lost her teeth due to cancer and she desperately needed dental care, but she couldn’t afford it. She feels bad for her children when they bring her friends home to meet her.

“I had perfect teeth until I got sick,” Lambros said. “People look at me differently now. They see me as a bad person,” he said.

Lambros and Mags both live with daily pain that can be cured with dental care.

Health equity advocates are fighting for long-term investments in oral health at the local, state, and federal levels to close gaps in care.

Where are all the dentists?

Poor dental access is not the result of too few dental school graduates.

Nationally, enrollment continues to grow, with over 26,000 students attending the school last year. According to the American Dental Association, this is about one-tenth of the number of dentists practicing in the US.

But most graduates are not practicing in underserved communities and are not accepting patients who are uninsured or enrolled in federal health insurance plans.

The issue is uneven distribution, said Jo Ann Hart, who worked on it. Florida Dental Association For two decades.

Recruiting dentists to rural communities, where public infrastructure is often worse, can be challenging, Hart said.

And often, she adds, there’s a financial reason dentists choose to practice in more affluent states: student loan debt.

In the year As of 2020, new graduates have left dental school The average debt is $300,000According to the American Dental Association.

With fewer patients in mostly poor rural communities, graduates flock elsewhere to private practices in search of financial stability. But rural residents aren’t the only ones struggling to get care. Because Medicaid pays less for dental care, even in urban areas, most dentists choose not to serve Medicaid patients.

Nearly 8 in 10 Florida dentists report not accepting Medicaid patients, most recently Human resource study From the State Department of Health. More than 70% of respondents cited low Medicaid rates as the main reason.

In Florida, less than 5% of dentists work in publicly funded dental offices and community clinics. Most of the research found work in private practice.

“When you look at our dental Medicaid funding, we haven’t had an increase since 2012,” said Christopher Bulls, who practices in Hillsborough County. “We are at the bottom of the country.”

In the year In 2020, there was Medicaid reimbursement for pediatric dental services in Florida. Only 42.6% According to the American Dental Association, private insurance pays on average. That’s one of the lowest payout rates in the country. In Texas, for example, the rate is 70.3 percent. Arizona’s toll rate can be double that of Florida’s.

For standard adult services, such as preventive cleanings and imaging, there is no benefit in the Sun State.

Kimme Heller, a 38-year-old mother from St. Petersburg, lost her teeth after pregnancy after battling infectious diseases, a lucky result of genetics and a lack of preventative care. Her face began to change shape as her jawbone was damaged. It hurts to eat. She is looking for a dentist, but availability is limited. Even if she could get in, she couldn’t afford the procedures.

“The rich get their smiles. “Poor people get sick,” she said.

Representatives of the Florida Dental Association — the state that controls how much dental coverage is provided under Medicaid — should promote oral health care and increase coverage for at-risk patients.

The organization also advocates for programs that encourage dentists to care for underserved communities. One initiative floated would give dentists up to $50,000 a year in student loan relief to serve patients on Medicaid or work in underserved areas.

When lawmakers met in Tallahassee, the association asked for $1.8 million a year to fund a dental student loan repayment program. But with days to go, lawmakers have yet to act.

Expensive payment

The percentage of adults and children who visited a dentist in the past year is lower in Florida than in any other state.

“We’re talking about quality of life issues,” said Grimmett of Evara Health. “Every day we see patients who have not progressed through cancer treatment because they need it. Teeth cleaning They could not find it. We have seen patients suffering from chronic pain who cannot sleep or eat and need treatment. We see toothless people who need dentures.

More than $45 billion is lost to the U.S. economy each year—in lost jobs and lost job opportunities—due to untreated oral disease, according to the U.S. Centers for Disease Control and Prevention. Nearly 1 in 5 adults say oral disease affects their appearance and interferes with their ability to get a job. Some struggle to eat in pain.

And children miss class.

“I can’t tell you how many times I’ve had a call from a parent or the school nurse because a child can’t concentrate or learn because they’re sick,” he said. Jacinta LamontagneServing Medicaid patients near Pensacola.

In 2020, less than half People ages 1 to 20 on Medicaid receive dental care, such as annual checkups. In Florida, 67% of children on Medicaid did not opt ​​out.

They are black and Hispanic children. More likely Having untreated oral disease.

For people age 65 and older who use Medicare, dental care may remain out of reach. Medicare does not cover routine services such as cleanings and refills.

Frank Catalanoto He is a founding member of Floridians for Dental Access and former Dean of the University of Florida College of Dentistry. His organization is a partnership of non-profit, individual dentists and medical centers working to improve access to health care across the state.

It is motivated to close the differences – and not only those directly related to health. Oral disease also affects children’s academic performance.

“The literature clearly shows that if you’re sick now, you’re going to miss school more often than other kids, and you’re not going to be able to learn,” Catalanoto said. “You will have social problems, because if you have broken teeth, children will make fun of you.”

Catalanoto said there was also a financial loss. When people can’t find local providers and feel sick, they often go to the emergency room.

In the year In 2020, Florida hospitals billed nearly $330 million for more than 100,000 emergency room visits from preventable oral health problems, according to an analysis of hospital data by the CareQuest Institute for Oral Health, a national nonprofit that focuses on health equity.

Much of the burden is on taxpayers.

And while access to health care is limited in medicine — not just in dentistry — Catalanotto stressed that teeth don’t fix themselves.

Some minor illnesses, such as colds and viral infections, can easily run their course. A simple toothache won’t do anything, he said.

Oral disease is gradual and persistent and eventually leads to serious infections.

Until more people have access to preventive services, the most vulnerable will continue to get sick unnecessarily.

“We have a crisis in Florida,” Catalanotto said. “This is very clear.”

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