Your teeth matter.
That’s the message Dr. Jana Winfree, the Oklahoma State Department of Health’s dental director, wants to spread. Poor oral health impacts social, mental and physical health and is associated with diabetes, depression, heart disease, stroke and other health problems. And Oklahomans are struggling gaining access to consistent, affordable and available dental care.
Dental diseases are almost entirely preventable, but Oklahomans lack dental insurance at roughly double the national rate. Only 57 percent of adults between 18-64 visited a dentist last year, which ranks second to last in the U.S. (above only West Virginia).
Oklahoma Dental Foundation Executive Director John Wilguess said barriers between Oklahomans and oral health care range from accessibility to cost to education. While several state nonprofits have worked hard to shoulder the load of providing emergency restorative and preventative care to the Oklahomans who need it the most, little will change until dental care is perceived as vital to an individual’s health.
Access to Oral Health Care
Even well-populated areas like Oklahoma and Tulsa counties don’t have enough dentists, according to the state health department. Travel to rural parts of Oklahoma, and the ratio of patients to dentists drops to 3,000- or 4,000-to-1, Wilguess said. Stephens County, for instance, has 18 dentists to serve approximately 48,000 people. Blaine, Cimarron, Cotton, Dewey, Grant, Harmon and Jefferson counties have none.
But even metropolitan counties suffer from a lack of dentists.
“It’s odd to think geography is a problem — even in metro areas — but it really is,” he said. “You have a lot of folks stuck in their circumstances: children who have parents who don’t have a history of going to the dentist, or seniors who can’t drive or get a ride to one.”
Norman dentist Dr. Gabriel Bird, a graduate of the University of Oklahoma College of Dentistry, said more dentists retire each year than begin the profession. While that issue doesn’t affect just Oklahoma, it contributes to accessibility issues.
“We are still in a deficit of the baby boomers retiring. In 2007, the year I graduated dental school, roughly 2,000 new dentists graduated across the country, around 6,000 retired,” he said. “As the baby boomers retire, they also add to the patient base.”
The state has attempted to solve this shortage by offering incentives for dentists who are willing to work in rural communities for two to five years. The Oklahoma Dental Loan Repayment Program has been in place for a decade and provides at least $25,000 per year for dentists who agree to teach at the OU College of Dentistry or provide dental care in shortage areas to pay off school loans.
The focus of the program is to “increase the number of dentists caring for those dependent upon Medicaid for dental services,” according to Winfree. Dentists practices in specific areas and need a minimum of 30 percent of their patients to be enrolled in the state’s Medicaid network, SoonerCare. In fiscal year 2016, 33,650 Medicaid patients were treated by the program’s dentists. Since 2007, 53 dentists have participated in the program, costing the state $3.8 million.
“This predominantly benefits low-income children, because Oklahoma has extremely limited Medicaid services for adults,” Winfree said.
The cost of oral health care
The cost of dental care is the next barrier facing Oklahomans. Roughly 14 percent of Oklahomans don’t have health insurance; that number increases to 20 percent when examining adults ages 18-64. Nationally, nine percent of the total U.S. population and 11 percent of U.S. adults between 18-64 are insured.
The number of Oklahomans without dental insurance is more difficult to calculate, but Winfree said nationally it’s approximately twice the number of uninsured adults — about 20 percent. SoonerCare and Insure Oklahoma, an insurance plan subsidized by the state and employers, provides basic dental benefits for people under the age of 21. For people older than that, dental services paid for by Medicaid are primarily limited to emergency extractions.
“The enrollment for SoonerCare and Insure Oklahoma is in excess of 800,000 persons. With very few exceptions, Medicare insurance, for people who are 65 or older, does not cover dental procedures,” Winfree said. “Because so many Oklahoma children qualify for Medicaid dental coverage, it is critical to have dental providers welcoming SoonerCare patients. The willingness of dental providers to care for SoonerCare patients is affected by reimbursement rates for dental procedures.”
Budget cuts have impacted much of the state government, and Winfree’s office is no different. Staff numbers have been slashed, according to Wilguess, and the state recently killed a dental health education program that reached more than 90,000 children last year. The state health department did operate several free dental clinics across Oklahoma, but today the only one is held at the Cleveland County Health Department. Two days a month, Winfree travels to Norman to provide free dental work for children and pregnant women.
Nonprofit organizations have stepped up to fill the gap. Oklahoma Mission of Mercy (OkMOM), which is supported by the Oklahoma Dental Foundation, sends out fourth-year OU dental students with their Mobile Smiles unit more than 40 weeks a year into the heart of underserved Oklahoma communities. OkMOM hosts an annual two-day free clinic that draws thousands of people from across the region.
The Mobile Smiles unit treats about 2,600 Oklahomans a year. Mission of Mercy connects with local community organizations like churches and civic clubs to find individuals who truly need help, meeting people where the need is, Wilguess said.
“At one place we frequent near Norman, we set up in the middle of a field surrounded by cows,” he said. “Churches, food banks, everything you can imagine. We were in Watonga two weeks ago, and a lady who is undergoing treatment for breast cancer walked a mile and a half to come to us. When we found out, we, of course, drove her home.”
The two-day clinic, OkMOM, has treated almost 13,500 people and donated $10 million worth of dental supplies since 2010. It takes thousands of volunteers — including dentists, dental hygienists and dental assists, as well as non-medical professionals organizers — approximately 2,000 hours per event. The events begin before dawn Friday morning and continues through the day Saturday.
“Our last event we held in Woodward in February. People came from Colorado, Texas, Kansas and Oklahoma,” Wilguess said. “It is, without question, the most humbling two days you will ever experience. When you see thousands of people working together, it’s like this waltz: dental professionals getting things set up to triage people, then treat them, then volunteers connect them with other services they might need. There were more than 1,000 people in line at 4 a.m., not angry, shoving or demanding something — just asking to be seen and treated. There’s a gentleness to it that is really remarkable.”
Remote Area Medical’s Oklahoma chapter also hosts dental and vision clinics throughout the state. Their most recent, held at State Fair Park in Oklahoma City, treated more than a thousand people.
According to Winfree, most dental disease is preventable. But that’s a hard reality for some to realize. Bird said almost everyone has heard the importance of regular visits to the dentist, brushing, flossing and avoiding high-sugar diets. Some don’t take that to heart.
Many patients in their late 20s Bird treats haven’t been to the dentist since their parents last scheduled an appointment for them in high school. Preventative work, much of which gets done during the teenage years, has a shelf life, and it often starts to fail at the same time.
“It’s not that there is somebody to blame, you just see people in those stages of life start to have a disconnect,” Bird said. “Instilling the value of going to the dentist is hard to do, especially for someone who has had access to dental health since they were a kid. To them, warnings about tooth decay begin to sound like a myth.”
Wilguess said there should be a more dedicated oral health education system in place at the public school level, supported by state policy makers.
“There has to be some recognition among policy makers and school leaders that dental care is not about a pretty smile, but about vital care for Oklahomans,” he said. “The education piece is just so hard, because so many parents go back to what their parents did for them. It’s not unusual in our Smile program to see children whose parents treat them by sticking a cotton ball in a bottle of whiskey and putting in their mouths until it stops hurting.”
Oklahoma General and Pediatric Dentists Per County
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