As a child, my parents ensured I went to the dentist twice a year. I was lucky enough to have braces (only one round) and all of my professional employment opportunities as an adult have provided access to dental insurance. I take my oral health seriously and I know it’s a privilege to have that coverage, but it shouldn’t be.
Oral and overall health connection
So often people don’t consider how the health of their mouth impacts their overall health. Perhaps it’s because the medical and dental systems were divided so long ago. We get our teeth cleaned and we visit our medical provider, but the two are always separate. This is strange, given that a person’s mouth is the entry to their digestive and respiratory tracts. Poor oral health can contribute to heart disease, premature birth, low birth weight, and pneumonia. In return, Alzheimer’s disease, osteoporosis, and diabetes can affect oral health outcomes. They’re connected; and why wouldn’t they be? The mouth is part of the body.
These past few months it’s become even more apparent how a mouth serves as a gateway to a person’s system. We’re wearing masks to protect ourselves and others during a global pandemic. By covering up a third of our face we’re helping to ensure we don’t expose our system to others.
On the front end of quarantine, dental offices were largely shut down unless they were providing emergency care, in order to keep patients experiencing tooth pain and infection out of hospital emergency rooms. Due to a shortage of personal protective gear, routine dental screenings and cleanings were deemed non-essential. Dental health practitioners were grouped with elective medical providers and personal service providers, including hair salons and tattoo shops.
I was scheduled to see my dentist the week after the shutdown started. I’m still trying to coordinate with the office to get back in for a cleaning. They’re catching up working rescheduled patients into their current schedule, while also expanding time between appointments to properly follow safety measures. The good news is since July, dentistry has been recovering at a steady pace, with 98% of dental offices open and patient visits at 73% of pre-COVID-19 levels, according to data from the ADA Health Policy Institute impact of COVID-19. The bad news is these results are also trending toward potential reductions in dental safety net capacity. About 6% of private practice Medicaid providers have dis-enrolled since the start of the pandemic and about 22% intend to dis-enroll by the end of the year.
Oral inequities mirror COVID-19 disparities
It’s no surprise that the inequities of oral health care delivery are mirrored in the COVID-19 disparities. Lower income Coloradans are more likely to have reduced access to health insurance and health care. In Colorado, as in many other states, the state budget required massive cuts in response to shortfalls in sales and income tax due to COVID-19. The Joint Budget Committee reduced the dental benefit for adults on Medicaid to be $1,000 in dental services per fiscal year. There was also a $1 million reduction to the Senior Dental Program and a 1% cut in the amount of money Medicaid providers would be reimbursed for each procedure. Still, Medicaid is one of the best options for low-income adults utilizing oral and overall health care. It’s projected that more than a half a million Coloradans will enroll in Medicaid between April and December, the biggest surge in the state’s history. This is due to the economic fallout of the pandemic.
The Colorado Health Institute data from 2019 reports that almost 30% of Coloradans with incomes at or below the poverty line report fair or poor oral health and 28.2% of Coloradans report having no dental coverage. Utilization rates rose most likely due to expansion of the Medicaid dental benefits for adults in 2014. Still, those who had public insurance report visiting a dentist less often than those with private insurance — 60% compared with 74%.
There are many options to help bridge the medical-dental gap: shifting payment and clinical practice models, telehealth options, and combined electronic data records. The options can help reduce barriers to accessing health care for low-income Coloradans most in need of these services. Then when we get back to living life without mask, we can all enjoy a healthy smile.
Amy Maillet is the Communications Manager at Delta Dental of Colorado Foundation. Our mission is to elevate the well-being of all Coloradans by advancing oral health equity. We are improving access to comprehensive oral health care, promoting systems and support services that prevent tooth decay, and emphasizing the vital connection of oral health to overall health. Learn more at: https://www.deltadentalcofoundation.org.