By Carly Tamborski
The facts speak for themselves: too many Ohioans do not get proper dental care.
No insurance, low income, meth use, neglectful parents, forgetfulness — there are several explanations as to why many children and adults in the Appalachian region have gone for prolonged periods of time without proper dental care, and the same explanations often reveal how it can be so difficult to maintain teeth properly.
“There are plenty of children and adults in poverty in this region who are not receiving adequate dental care,” said David Little, public affairs consultant at Progress Ohio, a nonprofit that works on behalf of progressive causes in Ohio. “A lot of people are on Medicaid but there aren’t a lot of Medicaid providers out here. Additionally, if you have a situation that needs attention, the idea of driving 30 or 40 miles to a dentist you can’t even afford is problematic, so a lot of people in this community are going without dental services. Too many people in this Appalachian region can’t get affordable dental care in their communities, and the problem just keeps getting worse.”
And prolonged neglect or improper dental care can lead to additional problems, such as living with mouth pain, losing teeth, developing speech problems, missing school or work due to lack of care, and the possible development of life-threatening infections.
Little, who has been traveling around the Appalachian region of Ohio the past two weeks as a representative for UHCAN Ohio — a nonprofit organization working for higher quality, accessible, and affordable health care for all Ohioans, has been educating local communities about the organization’s Dental Access Now! program, described as a “uniquely Ohio solution to Ohio’s dental care crisis.”
Dental Access Now! is a statewide coalition working to bring quality dental care to every community. Representatives spend time educating the public about the lack of access to dental care and pursuing solutions that include alternative providers to reach under served communities.
According to David Maywhoor, statewide director of UHCAN Ohio and project director of Dental Access Now!, Dental Access Now! has been studying oral health workforce issues for more than a year, talking to community-based clinics, dental provider educators, hygienists, dentists, patients, people who cannot find a dentist or afford care, social workers, and other health care providers to get to the root of the dental care access problem. Maywhoor and his colleagues then formed a workgroup with representatives from those groups, and the next step was to address the barriers to Appalachian area dental care by visiting communities in every affected county.
After over a year of research Dental Access Now! found that the solution lies in revamping how four critical components of dental care are defined by dental practice laws: dental hygienists, Registered Dental Practitioners, Advanced Registered Dental Practitioners, and communities with the greatest need.
“Dental hygienists provide essential preventive oral care that preserves healthy teeth and gums and prevents decay and disease,” the coalition’s literature reads. “As compared to other states, dental hygienists in Ohio have unnecessary limitations on the services they can provide. After a specified number of hours of experience, hygienists should be able to practice to the full extent of their licenses including most dental hygiene services, such as applying sealants and fluorides, and other prevention services under the general supervision of a dentist.”
A Registered Dental Practitioner, or RDP, is described as a type of mid-level provider who is specially trained in preventative and routine dental care. And according to the coalition, dental teams should be expanded to allow new RDPs.
“Working under a dentist’s supervision, RDPs expand the reach of the dental care team, much like nurse practitioners do for the medical care team,” the coalition’s literature reads. “RDPs provide routine services including fillings and simple extractions. Based on successful programs tested over decades in many countries and recently in the U.S., this addition to the dental team will provide a community-based approach to help alleviate the dental shortage. Following the curriculum developed by the American Association of Public Health Dentistry and released in July 2011, RDPs will receive an associate’s degree. The training costs substantially less than that required for dentists and, as a result, will reduce costs for dental care and make it more accessible to people currently going without care. In addition, by allowing RDPs to perform these routine services, dentists’ time will be freed up to focus on the more complex cases or patients with multiple needs or health issues.”
As for Advanced Registered Dental Practitioners, or ARDPs, there are two ways to become one under Dental Access Now!’s solution: Hygienists can take additional training specific to the scope of practice of the RDP and RDPs can take additional training specific to the scope of practice of the hygienists. At the end of the instruction, the ARDP will be able to perform the scope of practice of both hygienists and RDPs.
The fourth component of the solution involves getting the word out in communities with the greatest need.
“To ensure that the new providers are deployed in communities with the greatest need, Dental Access Now! recommends that until 2020, RDPs and ARDPs be limited to practicing in Ohio’s dental provider shortage areas. Many of these communities already have health delivery services models that will accommodate RDPs and ARDPs into their settings. For example, many federally qualified health centers already have a dentist on staff who cannot meet the demand for services in a primary or satellite clinic setting. RDPs could expand the reach of the dentist by filling cavities and performing non-surgical extractions so the dentist could focus on more serious dental or health issues.”
The coalition’s proposal to create these types of dental practitioner positions to send to under served counties is currently in the Ohio House of Representatives for review and discussion.
“It’s in Committee and it has not come up for a vote yet, but I would expect a decision to be made before June,” Little said. “The dental practitioner legislation is in the Ohio House now and just as we have dental hygienists, this would be a new position called dental practitioners. They would be trained at Shawnee State, would be able to do some kinds of dentistry, and they would be placed in these under served areas. Dentists in this region will be able to hire one of these people because their salaries would be subsidized due to their location in these precise areas.”
Just like in real estate, adequate dental care is all about location, location, location.
“Where Ohio’s general practice dentists decide to set up shop makes a difference in who gets care,” reads Dental Access Now! literature. “Ohio has geographic areas and communities with severe provider shortages. In fact, as of August 2013, Ohio has 80 of them and that number is up from 56 in October 2009. These areas are geographic and population-based federally designated Dental Health Professional Shortage Areas that have high population to dentist ratios.”
Nearly 1.4 million Ohioans live in these HPSAs, and you’re one of them: Adams County is one of 29 counties throughout the state and one of 27 counties throughout the Appalachian region to experience countywide HPSA.
“Counties that are in southern and southeastern Ohio actually have the highest concentration of areas with dental shortages,” Little said. “And many of the counties in that area have the highest rates of working age-adults with no dental insurance. Unfortunately, the children in Appalachian counties disproportionately suffer the harmful consequences of untreated cavities and have a greater need for urgent dental care than children who may live in other counties.”
The People’s Defender will report developments of this story.
Have something to say about local dental access or care? Email Carly at firstname.lastname@example.org.