Kentucky Department for Public Health Title V fact Sheet Access to Dental Care



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Kentucky Department for Public Health

Title V Fact Sheet



Access to Dental Care
Access to dental care is one of the barriers in Kentucky to better oral health status. There is a maldistribution of dentists, with the majority of dentists locating in urban areas. This makes receiving dental care in rural areas very difficult.
Size of the Problem:

  1. In Kentucky, the ratio of dentists was 5.6 per 10,000 population (2006), which is lower than the American Dental Association’s national projected ratio of 6.0 professionally active dentists per 10,000 population.

  2. Total of 77 pediatric dentists in Kentucky, of which 65 are practicing in the metro areas. Only 28 of Kentucky’s 120 counties have a pediatric dentist.

  3. There are 25 Dental Health Provider Shortage Areas (DHPSAs) in Kentucky. Owsley and Robertson counties have no dentists at all.

  4. The Appalachian region has the fewest dentists at 3.8 dentists per 10,000 population, western KY at 4.1 dentists per 10,000 population, northern KY at 4.6 dentists per 10,000 population 1.


Seriousness/Impact:

Clinical impact – Lack of treatment is shown to be associated with the lack of access or insufficient number of dental health providers 3.If left untreated, oral diseases lead to complications affecting the overall health of the adult or child. The Medicaid benefits plan for adults is limited to basic services and does not include dentures and advanced restorative care 2. Many dentists in Kentucky do not treat children or pregnant women, and many do not participate in Medicaid.



Economic Impact – Dental offices contribute largely to the local and national economy. It provides increased economic activity, employment and tax revenues. Not only does it sustain the local economy, but it also drives the sales in industries and businesses that sell to the dental offices 4. Children with untreated dental disease have increased absences from school, and adults with untreated dental disease miss work more than other workers.
Disparities – In Kentucky, dentists are concentrated in and around the metro areas. Most of eastern Kentucky is located in the mountainous region of the Appalachia. These rural areas face challenges such as inadequate services, lack of transportation, lack of knowledge/oral health education, lack of affordable dental insurance, etc (MCH forums and Kentucky Licensed Dentists count 2009).
Capacity/Resources:

There are two dental schools in Kentucky, at the University of Kentucky and University of Louisville. At an average, 55 students enroll into each of the schools every year. As part of their training, the students treat patients during their second, third and fourth year of school. However, many of these students leave the state when they go out into practice. In addition to the dental schools, there are six dental hygienist programs in Kentucky, located in Bowling Green, Henderson, Louisville, Lexington, Paducah and Prestonsburg. Also, there are 20 Federally Qualified Health Centers in Kentucky, 11 of which provide dental services.


Interventions that Work:

Medicaid pilot study in Maryland has increased the number of patients receiving at least one dental visit by 360% and the number of dentists participating in the pilot study by 2000%. This was achieved by increasing re-imbursements and decreasing the administrative work for the participating dentist. In Indiana changes such as increased and timely re-imbursements, removal of pre-authorization for most procedures and freedom to choose from any dentist participating in the Medicaid program were made. After these changes, the total number of dentists accepting Medicaid jumped from 751 in 1997 to 1,443 in 2001 and Medicaid recipients of dental services during this period went from 94,815 to 250,354 5, 6. The Washington Dental Service Foundation’s ABCD program has increased the number of young Medicaid children in Washington receiving dental care by 16% (from 21% to 37% in the last 10 years) and increased the number of children who receive care before their second birthday by nearly 14% (from 3% in 1997 to 16.7% in 2007) 7.


Recommendations:

  1. Medicaid should consider simplifying enrollment for dentists in order to decrease the administrative work for the dentist.

  2. Encourage all the federally qualified health centers to provide dental services.

  3. Better recruitment of the dental students at both the dental schools of Kentucky from underserved regions of Kentucky to return to their hometown and provide dental services 8.

  4. Investigate establishing a dental school for the mountainous regions of Kentucky9.




References:

  1. Melanie R. Peterson, John N. Williams, Charles Mundt. Kentucky Dental Provider Workforce Analysis: 1998-2006

  2. National Academy for State Health Policy. www.nashp.org

  3. House DR, Fry CL, Brown LJ. The economic impact of dentistry. J Am Dent Assoc. 2004 Mar; 135(3):347-52.

  4. David A. Nash and Ron J. Nagel. Confronting Oral Health Disparities among American Indian/Alaska Native Children: The Pediatric Oral Health Therapist. American Journal of Public Health. August 2005, Vol 95, No. 8

  5. Reforms in Indiana’s Medicaid Dental Program

  6. St. Mary’s County Pilot Dental Program

  7. Access to Baby and Child Dentistry. www.abcd-dental.org

  8. PB Osborne and JE Haubenreich. Underserved region recruitment and return to practice: a thirty-year analysis. J Dent Educ. 67(5): 505-508 2003

  9. A Medical School for the Mountains: Training Doctors for Rural Care. Appalachia, September–December 2001; by James E. Casto




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