By Susan Tebben - May 3, 2021
One of the leading health care needs in the state of Ohio is one that’s most neglected, especially when it comes to low-income communities.
As dental director at the Cincinnati Health Department and as part of the CincySmiles dental clinic program, Dr. Larry Hill’s major task was making sure low-income and high risk populations had access to oral health services, something he says isn’t enough of a priority in the state.
“It’s been a decades long battle to try to do something about this,” Hill said. “Oral health is…connected to everything else (in health), but it’s been forgotten in most state and national health policy.”
Hill said it’s hard to understand how dental care has been overlooked by state legislation, federal measures and insurance companies alike, when the small area of the mouth makes so much of a difference in overall health.
According to the Harvard Medical School, those with gum disease are more likely to have other medical issues, such as high blood pressure, rheumatoid arthritis and osteoporosis.
Infections in the oral cavity can make diabetes worse, impact the cardiovascular system, and can even create adverse pregnancy outcomes, something Ohio already struggles with when it comes to people of color.
Health disparities that impact low-income communities and people of color extend to dental care as well, Hill said.
“The system hasn’t responded to the needs of these populations,” Hill said. “The system is there for people who have insurance and who can afford to take time off work.”
An Ohio Department of Health screening of more than 3,000 third-grader’s oral health from 2017-18 showed nearly half of the children screened had a history of tooth decay.
According to the study, while 84% of the third-graders reported having a dental visit within the past year, 20% had at least one untreated cavity. Parents of children in the study cited several difficulties in getting dental care for their children.
“The cost of dental care was the factor most often cited by parents as a barrier to care, followed by the lack of dental insurance,” the study stated.
The study also found that lower-income families, those covered by Medicaid, and uninsured children “experience more tooth decay and have a more urgent need to see the dentist because of pain or infection.”
“However, these children are also those who are less likely to see the dentist on a regular basis,” according to the study.
Part of the problem, statewide and nationally, with getting access to dental care is a shortage in dental health professionals, and a shortage in those professionals who accept Medicaid. For that reason, David Maywhoor, executive director of the Ohio Public Health Association says the industry needs to be more open to a different way of caring for community dental care: dental therapists.
Dental therapists are trained in oral health care, usually in specific procedures like X-rays or cavity filling, but work under the supervision of dentists. Typically, dental therapists work in facilities or communities that understaffed or without the resources to have full-time dental care.
“When it works best, young people from communities of need go into an education program, come back out and begin working in communities of need,” Maywhoor said. “When a child is sitting in a (dental) chair…they’re seeing a person that looks like them.”
Maywhoor said it’s been a struggle having the nation embrace dental therapists because of “misinformation” claiming therapists have less training and less supervision than dentists, despite taking some of the same classes and dental students and being supervised by licensed dentists.
“I don’t know if it’s a question of control, or fear of the unknown,” Maywhoor said.
In 2017, Ohio state Sens. Peggy Lehner, and Cecil Thomas introduced a bill to establish the licensing of dental therapists in Ohio, but the Health, Human Services and Medicaid Committee only held two hearings on the bill, and it was never put up for a vote.
But with legislation passed in Minnesota and Connecticut, and several other states reviewing legislation on dental therapy, Hill said it’s time for Ohio to move forward, especially with a pandemic spotlight on public health.
“Every day that we don’t do this, people aren’t getting the care that they should be able to get,” Hill said.