Dental caries, a cause of tooth decay and cavities, is the most prevalent infectious disease among American Children, and it’s something experts say can easily be cured by brushing and visiting a dentist. For kids in Kentucky, though, getting to the dentist can be a challenge.
Samuel Newton is ten years old and he’s getting his teeth checked at a free clinic at the University of Louisville. His last cleaning was more than two years ago.
That’s more frequently than many Kentucky kids. Some of the other 350 elementary schoolers at this clinic have never been to a dentist. Dental students at the university say it’s not uncommon to see children with 20 teeth and a cavity in each one.
“The main problem with Kentucky kids getting dental care is access to dentistry,” says Dr. Julie Watts McKee, Kentucky’s Dental Director.
McKee says on average Kentucky has one dentist for every 1,800 people. That’s below the national average, which McKee says is too low itself. But Kentucky’s access problem is regional. In cities like Louisville and Lexington, there’s a dentist for every 1,200 or so people. In rural areas, where teeth tend to be worse, there’s one dentist for every 2,600 people.
Lots of kids in those areas are on Medicaid, too. McKee says that’s a big reason why dentists are scarce.
“Dentists aren’t accepting Medicaid to meet the needs of the young patient, and a lot of it is attributed to the reimbursement rates,” she says. “One of the things the Department of Public Health is going to look at in the future is what does it cost a private dentist to see a Medicaid patient?”
“A standard dental chair is very expensive, it costs $15,000,” says Dr. Christian Rahn. Rahn is among the 75% of Kentucky Dentists who don’t accept Medicaid.
Rahn says it takes about one hour to treat a child and it cost about $600 an hour to keep his practice running. Medicaid pays less than forty dollars per child. Therefore, he can’t afford to treat Medicaid patients.
“There’s no way to do quality dentistry, in my opinion, if you take Medicaid,” says Rahn.
Across the river, Indiana had this same problem in the 1990s. The state eventually increased Medicaid payouts for dental work. Kentucky has slightly increased its payouts, but Dr. McKee, the Kentucky dental director, says that exposed another problem involving Medicaid patients.
“One of the things we know is the average Medicaid population has a much larger no show rate on their appointments than private pay or third party coverage,” she says.
For reasons McKee can’t explain, many Medicaid patients in Kentucky just don’t show up for their dental appointments. That wastes time, increases costs and provides one more reason for dentists to avoid working in Kentucky.
Indiana keeps dentists in the state in part by offering student loan forgiveness. Kentucky doesn’t have a statewide program for dentistry student loan forgiveness. Lawmakers are considering one, but McKee says it’s uncertain how it will do given the current budget shortfall.
And Rahn says loan forgiveness and affordable dentistry will only help so much. He says there’s one thing schools, dentists, parents and the state can do…teach prevention.
“This boils down to making sure the parents understand what they need to do and follow through with it,” says Dr. Anne Greenwell, the head of pediatric dentistry at the University of Louisville.
According to the Surgeon General, Kentucky adults have the second worst teeth in the nation. Greenwell says kids follow suit, despite recent studies that claim dramatic side-effects of poor oral health.
“Kids with large cavities have been shown to demonstrate symptoms of attention deficit disorder,” says Greenwell.
“Dementia has been linked to dentistry,” says Dr. Rahn. “Everything from heart disease to diabetes to premature birth. All that has been linked to the bacteria in your mouth.”
Doctors Rahn, Greenwell and McKee all think better education – for kids and parents – will lead to better dental care at home. That care will lighten the Medicaid burden, improve dental care in rural areas, and lead to better overall health for children.