A new study by the Washington-based Pew Research Center shows there are shortages of dentists across the nation. Those shortages are limiting the access to dental care for children, but that’s not necessarily the case in Nebraska.
It’s a sound that can cause a person to cringe. Some liken it to a person scraping their fingernails on a chalkboard, only worse. It’s the sound of a dentist’s drill, and it can cause all sorts of reactions.
According to a new study by the Washington-based Pew Research Center, however, every year in the United States tens of millions of people never hear this sound. They can’t hear it, because they aren’t going to the dentist. What’s most concerning for some experts is many of the people not getting the treatment they need are children.
Photo Courtesy of Denture Solutions
According to the Pew Research Center, there are two types of dental shortages in the U.S. The first is a lack of practicing dentists in many areas, and the second is a lack of dentists who accept Medicaid.
“We’ve had a lot of emphasis and a lot of interest in pediatric dental training programs and getting better access for children and families for dental care,” Dr. Kim McFarland said.
McFarland is an associate professor at the University of Nebraska Medical Center College of Dentistry.
She said concern over access to dental care for children came to the forefront in 2007, after a 12-year-old boy in Maryland died when an abscessed tooth went untreated, allowing bacteria to seep into his brain.
“Unfortunately, it’s sad that we had to have this sort of terrible thing happen, but I think what it does is draws everyone’s attention to the importance of oral health,” McFarland said.
According to the Pew study, the lack of access to dental care across the nation is a complex problem, with two primary factors compounding the issue. The first is there is simply a lack of dentists in certain areas around the country.
The second factor is a relatively small number of dentists participate in Medicaid, meaning many low-income people are not receiving dental care, even if they live near a dentist.
So how does Nebraska come out in the Pew study?
When it comes to access to dental care in general across the state, the answer is “quite well”. According to the study’s results, just one tenth of one percent of Nebraska residents live in an area deemed to have a dental shortage.
McFarland said of Nebraska’s 93 counties, 20 counties have no practicing dentist.
“They’ve never had a dentist, and quite honestly we probably have more cows in those counties than we have people. It’s probably not economically viable that we can have a dentist locate in those counties and have the business survive,” McFarland explained.
McFarland added it helps having two dental colleges in the state, with the majority of students at UNMC College of Dentistry staying in-state after graduation.
When it comes to the number of children on Medicaid receiving dental care, however, the Pew study shows Nebraska has some room for improvement.
Even though the national standards set by dental and pediatric associations say kids should see a dentist every six months, 48 percent of children enrolled in Medicaid in Nebraska never saw a dentist in 2011.
That’s lower than the national average of 52 percent, but it still means many Nebraska kids aren’t getting the care they need.
Photo by Ryan Robertson, NET News
In an effort to meet the dental needs of children in underserved areas, Dr. Kim McFarland is advocating the use of more midlevel dental providers. Midlevel dental providers perform preventive care and routine restorative duties, such as filling cavities. However, in most states, it is illegal for them to work autonomously, and they have to be under the guidance of professional dentists.
According to McFarland, one way to meet the requirements of the law while still providing care to rural areas or patients on Medicaid, is expanding the role of technology in the field. McFarland says by using intra-oral cameras connected to devices like iPads, a midlevel provider could take pictures of a patient's mouth, and then send high-resolution images to a dentist for further consultation about how to proceed.
"So let’s say for example I have a dental hygienist who would like to do the screening at a local Head Start. He or she could go to that Head Start with the tablet and with the intra-oral camera," McFarland said. "If there were children that had some unusual thing, or some complex situation, or perhaps a situation where the dental hygienist thought there maybe needed a prescription for medication, they can dial up the dentist and show them the image and plan for the next step."
McFarland said by expanding the "dental office" beyond the four walls of a standard clinic or practice setting, the level of dental care could be greatly improved for many of the children who need it the most.
The numbers are in stark contrast when compared to children who are privately insured through their parents’ policy. According to the American Dental Association, in 2010, privately insured children were 30 percent more likely to get dental care than those who were on Medicaid or other government programs, even though low-income children are almost twice as likely to develop dental problems like cavities.
The Nebraska Dental Association lists around 1,000 practicing dentists in Nebraska, but only about a third of them accept Medicaid. So why the hesitation?
“The reimbursement rate is terrible, it’s low. You can’t just see everyone that walks in the door,” Dr. Fred Diedrichsen said. He’s been a dentist for 43 years, and his practice is located in the south central Nebraska town of Holdrege.
Diedrichsen does accept patients on Medicaid. However, he has to limit the number of Medicaid patients he sees, because while his out-of-pocket costs for treatment have increased, the money the state reimburses has remained flat. But he said he’s never turned a patient who was in pain away.
“You sort of swear to take care of the needy and the hurting, and I think it really carries over. If someone is in pain or has an emergency, you really don’t think twice about treating them,” Diedrichsen said.
Doug Hohman is another Holdrege dentist who accepts Medicaid, but he also had to make adjustments to the number of Medicaid patients he sees.
“We’ve gotten to the point where we don’t accept more Medicaid than we already have just because of the low reimbursement levels and some issues with appointments and making their appointments,” Hohman said.
“If it’s family of someone that’s already coming, we may go ahead and see them if we haven’t seen them previously, but the reimbursement issue has really made us change that policy,” Hohman added.
For residents who are on Medicaid but can’t find a dentist in their area to see, there are other alternatives for treatment, depending on where they live.
“There are some places where there are sliding fee scales and places where folks with limited resources can turn if they are in that vicinity,” Dr. Kim McFarland said.
The places McFarland referred to are Nebraska’s Public Dental Clinics, which are scattered around Nebraska. There are clinic offices in places like Chadron and Gering in the western part of the state, and Norfolk and Omaha in the east. Most of the clinics provide at least the basic level of dental services so many children are going without.
So while it may not be a thrill once they get there, McFarland said the vast majority of Nebraska’s low-income families do have at least some access to dental care; which is vital, because as she explained, a healthy mouth is the first step to a healthy body.
As McFarland put it, “The mouth is such a key part of total health. Your diet, what you’re able to eat. We tell people eat fruits and vegetables and a healthy diet, but if your teeth are broken down or abscessed and hurting, you can’t munch and crunch on that celery or those apples and all those good foods we’re supposed to be eating.”