Reports show progress in access to dental care

A recent report from the National Center for Health Statistics shows a significant decreasing trend in the prevalence of dental caries for youth in the United States from 2011-12 to 2015-16. According to the report, based on data from the National Health and Nutrition Examination Survey, 43 percent of children ages 2 to 19 showed the presence of tooth decay – either treated or untreated – which compares favorably to 50 percent in 2011-12. The report also said the data showed recent declines in “untreated dental caries.” In 2015-16, 13 percent of youths in the U.S. ages 2 to 19 had untreated tooth decay, which was a significant decline from 2013-14 when 18 percent were found to have untreated dental caries.

This national report is consistent with what we have seen here in Ohio as well. The recently released “State of Ohio Health Assessment” found that “the percent of children with unmet dental-care needs decreased,” continuing a trend that began in 2012. Specifically, the “State Health Assessment” found that the percent of children ages 3 to 17 with unmet dental care needs decreased from 6.8 percent in 2010 to 5.4 percent in 2012 and 4.6 percent in 2015, a more than 30 percent decline over the five year period. Moreover, the Ohio Department of Health’s most recent third-grade oral health survey found that the percentage of third-graders with untreated cavities has decreased steadily from 26 percent in 2004-05 to 17 percent in 2013-15.

One of the lead researchers of the national report, Dr. Eleanor Fleming of the U.S. Centers for Disease Control and Prevention, told “US News” that it is not clear what is causing the decline in tooth decay. She noted that brushing with fluoride toothpaste and flossing every day, limiting sugary drinks, and regularly visiting the dentist all play a role in cavity prevention.

In Ohio, the ODA, its member dentists and other partners, including The Ohio State University College of Dentistry, Case Western Reserve University School of Dental Medicine, Nationwide Children’s Hospital, community health centers, safety net clinics, local dental societies, and others have made a concerted effort to address access to dental care issues. By engaging in a multipronged approach that includes volunteer programs like Give Kids A Smile Day, enhanced coordination between providers, a push to extend oral health education and prevention services into underserved communities and loan repayment and other incentives for dentists to provide care in professional shortage areas, significant progress is being made to improve access to dental care in Ohio.

For example, according to the third-grade oral health survey, the percentage of children who had visited the dentist within the past year was 80 percent in Ohio, which is well above the national target of 49 percent. Moreover, the percentage of children with one or more dental sealants was 49 percent in 2013-15, which is significantly higher than the 35 percent sealant rate in 1998-99 and well above the current national target of 28 percent.

While these national and state reports are encouraging, more needs to be done. The national and state reports indicate that while progress is being made in the areas of oral health, there are disparities based on race, income and geography. Hispanic and African American children were more likely to experience unmet dental care needs when compared to children who identified as white or other. Children living in suburban areas were less likely to experience unmet dental care needs than children living in rural and urban areas. Finally, the national report found that “the prevalence of total and untreated dental caries decreased as family income levels increased.”

The Future

The access to dental care infrastructure in Ohio has significantly expanded in the last decade. This larger infrastructure will allow for additional innovative approaches to extend dental care throughout the state.

The recently enacted state budget (House Bill 49) effectively doubles the capacity of the Ohio Dentist Loan Repayment Program, which creates incentives for dentists to provide care to underserved populations in designated dental professional shortage areas in urban and rural communities.

The ODA is also working with the General Assembly (House Bill 184) to update Ohio’s laws to permit dentists to utilize tele-dentistry to extend the reach of the dental team into underserved communities to provide valuable prevention and other oral health services and to expand the ability of existing dental team members to provide care to the fullest extent of their training. Under House Bill 184, the expansion of the use of Silver Diamine Fluoride, which is a simple, inexpensive and non-invasive tool for arresting dental disease, could have a dramatic positive impact on the oral health of underserved Ohioans. The bill will also target scholarships in the Choose Ohio First Program for dental students who agree to practice in designated underserved areas in Ohio upon graduation.

As part of its major new building renovation, The Ohio State University College of Dentistry is in the process of expanding its class size by nearly 10 percent. These new seats – approximately 10 in each incoming class – will be reserved specifically for Ohioans from designated dental professional shortage areas. These students will receive additional training and special programing to help prepare them to successfully provide care to underserved populations upon graduation. These students will also receive tuition assistance to help reduce their educational debt, making it more likely that they will provide dental care for communities in need.

Moving forward, many of these solutions – loan repayment, scholarships, expansion of the dental school class at the Ohio State University College of Dentistry, better use of tele-dentistry – will specifically help address those disparities in oral health care identified in the state and national reports.

There is one more solution that is absolutely critical for addressing access to dental care in Ohio: Medicaid reform. According to research from the American Dental Association’s Health Policy Institute, Ohio ranks 41st out of 50 states in terms of Medicaid reimbursement for dental services. On average, Medicaid reimburses at about 40 percent of a dentists’ regular fee for most procedures. Over the last 17 years, Ohio’s dental fees have only been adjusted once, in 2016, to increase reimbursements for extractions and denture repairs statewide and a 5 percent fee increase for all dental procedures in 52 rural counties. While this adjustment was welcome, Medicaid dental reimbursements have fallen to levels that make it extremely difficult for dentists to participate as providers in the Medicaid program.

This situation cannot continue if the dental Medicaid program in Ohio is going to remain viable. A recent ADA report found that only about a third of Ohio’s dentists participate in the Medicaid program. In states that have increased dental Medicaid reimbursements closer to market levels, more dentists treat Medicaid patients and Medicaid patients have demonstrably better access to care. For example, a recent study analyzing Medicaid utilization after reimbursement rate increases in Connecticut, Maryland and Texas concluded that “increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.” Ohio policymakers can largely resolve access to dental care issues by following the lead of those states that have fixed their dental Medicaid programs, including by raising fees closer to market rates.