More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health

More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)

"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized — and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.

UK students in national program to educate kids about oral health

A University of Kentucky undergraduate dental group was recently spotlighted by the National Children's Oral Health Foundation for their passion to share oral-health education with elementary and middle schools in Kentucky, according to a UK news release.

UK Students United with America's ToothFairy was founded in 2014 and is made up of more than 100 UK undergraduates interested in dentistry, who are also part of the UK Pre-Dental Society.

The America’s ToothFairy® program is the branch of the National Children’s Oral Health Foundation that works to prevent childhood dental disease through community-based prevention, education and treatment services.

"At a young age, these children can lose and permanently damage their teeth," Nabeela Rahman, a first-year UK College of Dentistry student and former UKPDS president, said in the release. "Being able to help these children, even slightly, was a very rewarding experience for me."

Already this year, UK's SUAT chapter has held six community outreach events reaching more than 500 students, targeting schools in Lexington and some rural Kentucky areas. It is considered one of the largest and more active chapters in the nation, the release says.

At each event, SUAT members share oral health and nutrition information and demonstrate proper tooth brushing and flossing. They also share information about the effects of tobacco on oral health and send the students home with toothbrushes, toothpaste and floss.

Tooth decay is the most common chronic disease in children and adolescents ages 6 to 19, according to the federal Centers for Disease Control and Prevention. And a 2001 Kentucky oral health survey found that 29 percent of third- and sixth-grade students screened had untreated tooth decay and 75 percent had not seen a dentist in more than a year, according to the release.

New partnership will provide children in Kentucky with a home for medical and dental care

Community Dental of Kentcky and the University of Louisville Pediatrics are partnering to provide Kentucky children in the Medicaid program with a medical, dental health care home through co-located facilities, says a press release from Gov. Steve Beshear's office.

“One of the most effective ways to combat chronic health conditions is to identify potential problems early and address them," Beshear said in the release. "This means ensuring that our children have easy access to the health care they need and deserve. This partnership seeks to meet that need, not just medical care, but also dental care. Through the creation of a health home for children, we believe we will be able to reverse some of the major health problems facing Kentucky.”

 Community Dental, an Alabama-based non-profit with a clinic in Louisville, is a full-service dental organization that provides health care in underserved communities with the goal of improving the overall health of the population, says the release. 

 “We are honored to partner with the Commonwealth and the University of Louisville,” Jeffrey Parker, chairman of Community Dental of Kentucky, said in the release. “Gov. Beshear has created the environment for preventive care as a major tool for combating the health care problems faced by the people in the state.”

Medicaid expansion boosts preventive care

More Kentuckians than ever are using preventive care services since the state expanded Medicaid on Jan. 1, reports FamiliesUSA, a lobby for federal health reform that included the expansion.

Recent data from the state Cabinet for Health and Family Services show a 37 percent increase in the use of preventive care services since 2013, report Andrea Callow, a Medicaid policy analyst and Katie Supko, a Medicaid intern for FamiliesUSA. Of particular note is that more Kentuckians are getting screened for diseases that kill so many of us.

In 2013, Kentucky ranked first in cancer deaths and sixth in all premature deaths. It ranked 41st in annual dental visits and 45th in overall health status.

Since the expansion, which has provided coverage to more than 450,000 Kentuckians, the cabinet reports a 30 percent increase in breast cancer screenings, a 3 percent increase in cervical cancer screenings, a 16 percent increase in colorectal cancer screening and a 37 percent increase in adult dental visits.

Screenings and check-ups allow medical providers to identify health issues before they advance, and improves the chance that treatment will be successful. For example, with early detection, the five-year survival rate for breast cancer, the leading cause of cancer death in women, is 90 percent, and the rate for cervical cancer is nearly 100 percent, the writers note. Screenings for colon cancer, the second leading cause of cancer deaths in the U.S., have a five-year survival rate higher than 90 percent if detected early, but only 40 percent of colon-cancer diagnoses are made during this early stage.

At least one study, over two years in Oregon, found no preventive health benefits from expanding Medicaid, but advocates say it will work in the long term. "Medicaid expansion makes preventive care possible," the authors write. "Kentucky’s decision to expand Medicaid will undoubtedly reap the state many benefits, from a drop in the uninsured rate to an increase in economic activity" by expanding health-care jobs. "But the access to critical preventive care services may be the benefit that gives Kentucky a much-needed boost in the health status of its residents."

State gives 5 health departments money for mobile dental-hygiene teams that will examine children at schools; 5 more next year

Using new money in the state budget, the state Department for Public Health has given five local health departments grants to launch mobile dental hygiene programs.

The one-year awards of $160,000 will pay for a full-time dental hygienist and assistant; portable dental equipment to set up two treatment areas; a transport vehicle and transportation costs; and dental supplies.

“Hundreds of thousands of children in this state don’t see a dentist regularly and many not at all,” Gov. Steve Beshear said. “The vast majority of both childhood and adult dental problems could be avoided through routine dental care and other preventive efforts.”

The hygienists and assistants will visit schools for "assessments, age-appropriate cleaning services, fluoride varnishes and dental sealants on permanent teeth for children at the beginning of the school year," says a release from the Kentucky Press News Service. "They can also serve local day care centers and Head Start programs. Hygienists will work with parents to facilitate any needed follow-up care with a local dentist."

The grants went to the Lincoln Trail District Health Department, which serves Hardin, LaRue, Marion, Meade, Nelson and Washington counties; the Purchase District Health Department, which serves Ballard, Carlisle, Fulton, Hickman and McCracken counties; the Pike County Health Department and the departments in Jessamine County, which will also serve Mercer County; and Lawrence County, which will also serve Martin County.

Three health departments – Madison County, the Barren River district, and the Northern Kentucky district – already have dental hygiene programs in place. Five more health departments are to get grants next year two for similar programs.

The legislature appropriated $1.2 million in the current fiscal year and $2.1 million in fiscal 2016 for the grants and other enhancements to the state oral health program, overseen by state dental director Julie W. McKee.

“Placing public health dental hygienists in the community where they can provide front-line support and services to our young people is a great leap forward in terms of not only being able to assess problems, but provide on-site cleanings and dental care,” McKee said.

Improving the oral health of Kentuckians is one of the goals of kyhealthnow, Beshear's plan to improve Kentuckians' health. It aims to reduce the percentage of children with untreated dental decay by 25 percent and increase adult dental visits by 10 percent.

Beshear has been more active on oral health than other recent governors. He launched an effort in 2009 to enroll all eligible children in state health insurance through the Kentucky Children's Health Insurance Program and Medicaid; authorized the "Healthy Smiles Kentucky" initiative, which includes training for general dentists on how to care for young patients; community oral health coalitions; and started the "Smiling Schools" program, which provided free protective tooth varnishes to school children in first through fifth grades in 16 Appalachian counties.