Community Efforts to Expand Dental Services for Low-Income People

Barriers Include Low Rates of Dental Insurance, Limited Public Coverage and Lack of Dentists Willing to Treat Low-Income Patients

News Release
July 24, 2008

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Recognizing the difficulties low-income people face in getting dental care, many communities are attempting to provide more dental services to vulnerable residents, according to a study released today by the Center for Studying Health System Change (HSC).

Lack of dental care is the key contributor to oral health problems, with low-income people and some racial and ethnic minorities receiving fewer dental services than higher-income people and whites, according to the Agency for Healthcare Research and Quality. Poor oral health may contribute to other health problems, including heart and lung disease, stroke, and premature births. Abscessed teeth can cause severe infections and even death, as exemplified in 2007 by the widely publicized case of Deamonte Driver, a Maryland boy who died from a tooth infection that spread to his brain.

Along with state efforts to increase dentists’ participation in Medicaid and the State Children’s Health Insurance Program (SCHIP), hospitals, community health centers, health departments, dental schools and others are working to expand dental services, according to the HSC study.

"Community efforts to meet the dental needs of low-income residents face an uphill battle because demand for services far exceeds available resources," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded in part by the Robert Wood Johnson Foundation, which funded the study.

State Medicaid and SCHIP policy plays a significant role in access to dental services. Although states are required to provide comprehensive dental coverage to children enrolled in Medicaid, dental coverage for children in SCHIP and for adult Medicaid enrollees is optional and coverage for adults is often limited.

"Even when Medicaid and SCHIP provide dental coverage, low reimbursement rates often impede dentists’ participation," said HSC Health Researcher Laurie E. Felland, M.S., coauthor of the study with HSC Health Research Assistant Johanna Lauer, and HSC Senior Fellow Peter J. Cunningham, Ph.D.

The study’s findings are detailed in a new HSC Issue Brief—Community Efforts to Expand Dental Services for Low-Income People—is available here. The study is based on HSC’s 2007 site visits to 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1996.

Other key study findings include:

• The safety net for dental care is considerably less extensive than the safety net for medical care more broadly, with few dental providers focusing on serving low-income people.
• Hospital emergency departments (EDs) serve as de facto dental care providers. ED directors in Lansing, Miami and Seattle, in particular, reported high demand for dental services, but most EDs do not have the staff or equipment to provide dental services and often can only provide pain relief. However, some EDs in Syracuse, northern New Jersey and Boston benefit from having dental residents on call through their hospitals’ oral surgery or general practice dental residency programs.
• A number of communities provide preventive care and general dental education to schoolchildren, as such efforts are relatively low cost compared with the cost of treating future dental problems, and providing services at school removes some of the barriers associated with scheduling appointments.
• Federally qualified health centers and other community clinics are increasingly offering dental services, including preventive, restorative, emergency and, in some cases, rehabilitative services. However, health centers report that expansions to date do not approach the level of need, and waits for appointments remain long. Respondents in northern New Jersey and Seattle reported that the wait for an adult to see a dentist is often two to three months, even for extractions of diseased teeth.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.