Fluoridating Billings water would be the best way to begin addressing a dental “crisis” in the area, said dentists, nurses and school officials during a dental summit Friday at Deaconess Billings Clinic.
Only 14 percent of Yellowstone County’s low income residents saw a dentist last year, according to a community survey presented at the summit. Only four of 53 Billings dental practices surveyed said they would accept new Medicaid patients.
Low income residents say their health is suffering because of a lack of access to dentists. With no where else to turn, hundreds go to the emergency departments of local hospitals — St. Vincent Healthcare saw 742 patients with “severe” dental problems in the first six months of the year, according to the survey.
Dentists say they are trying to help, but many would rather work for free than deal with the federal bureaucracy that handles Medicaid, said Billings periodontist Scott Manhart. Local dentists gave away $200,000 in free care last year, he added.
The investigation and attempted prosecution of a local dentist last year for felony Medicaid fraud sent a chill across the local dental community, Manhart said. The case prompted some dentists to begin refusing new Medicaid patients.
Dentists also say that Medicaid patients are three to four times as likely to skip appointments.
The problems will only get worse as dental schools across the nation have been closing and the average age of dentists in Billings is 49, according to the community dental survey, which was conducted by St. Vincent Healthcare.
People over 50 are also keeping their teeth longer and Billings continues to grow, Manhart said.
“It has been difficult to keep up with increasing demands,” he said.
The approximately 50 summit attendees discussed a variety of potential solutions — tax credits for dentists, a dental residency program in Billings, outreach workers to ensure patients make it to appointments, better legal protection for retired dentists giving charity care — but adding fluoride to Billings’ water supply would do the most good for the least cost, said Billings dentist Victor Gorder.
“We could take care of 20, 30 or 40 percent of the problem just by fluoridating the water,” he said.
Fluoridation efforts failed twice before in Billings, most recently in the early 1980s. Summit participants said the third time could be the charm, so long as the effort was led by not only dentists, but with support from physicians, nurses and other health officials.
“If the community is serious about eliminating some of the dental problems we have, this is one way of addressing it,” said Billings dentist James Hanna.
A growing body of research — including an August report from the Centers for Disease Control and Prevention — supports the use of fluoride in city water supplies and refutes some of the traditional arguments against its use, such as a belief that fluoride causes bones to become brittle.
Montana is one of 12 states in the nation where less than half the public water systems are fluoridated, according to the CDC. Six municipal water systems in the state add water, according to Cheri Seed, with the Montana Department of Public Health and Human Services.
Adequate fluoride in the water reduces cavities in children by 18 to 40 percent and costs about 72-cents per person annually, the CDC reported. Fluoride continues to provide teeth protection to adults.
The natural fluoride level in the Yellowstone River averages about 0.4 parts per million. The CDC recommends doubling, or even tripling this amount.
Adding fluoride would cost Billings about $35,000 per year, said Carl Christensen, public utilities director.
“If that’s something the community wanted, we would have no objecting to doing it,” Christensen told summit participants.
Relief could also come from additional dental hygienists. The Legislature and federal government recently set aside funds for the state’s first hygienist training program in at Montana State University’s Great Falls College of Technology. Montana is the last state in the nation without such a program. Nearly a third of the state’s dentists do not have a hygienist, according to Billings hygienist Judy Harbrecht.
The program is expected to begin taking students next fall, she said.
“We could be a major part of the solution,” she said.