Wednesday, May 03, 2023

Dental deserts widen the gap in care for rural Americans; a look at Florida highlights reasons for the continued disparity

Implants, dentures, etc. (Photo by Jonathan Borba, Unsplash)
"Tooth decay is the most common chronic disease in children and adults in the United States," says the U.S. Office of Disease Prevention. While most dental diseases are preventable or treatable, even the most basic care is often not accessible for rural Americans. Reasons for care disparities range from the dental hygienist shortage to non-existent dental insurance and low Medicaid reimbursements to transportation limitations. Florida is an example of a state that has been unable to overcome these challenges,  reports Lauren Peace of the Tampa Bay Times.

"Every day, Adrienne Grimmett and her colleagues at Evara Health, a not-for-profit which serves Medicaid and uninsured patients in the Tampa Bay region, see stories of inequity in their patient's teeth, gums, and palates," Peace writes. "Marked in painful abscesses, dangerous infections, and missing molars are tales of unequal access to care. . . . All these ailments — which keep patients out of work. . . . and children out of school because they can't concentrate with rotting roots — are preventable. Annual dental checks are essential to overall health. But of the 67 counties in Florida, experts say, only one has enough dentists to treat all patients [and] Lafayette County, in north Florida, doesn't have a single one."

Grimmett, Evara's director of dental services, told Peace, "It's a social injustice. You will never be totally well if you don't have oral health." Peace reports, "About 6 million Floridians live in dental deserts, according to data from the Department of Health and Human Services. That's the largest state population living without basic dental care in the U.S. . . . Vulnerable and marginalized communities — already prone to higher rates of chronic disease and limited access to health care — are left behind in these dental deserts."

The U.S. does not have a dentist shortage; however, "The majority of [dental] graduates aren't practicing in underserved communities. . . . The issue is uneven distribution, said Joe Anne Hart, who's worked for the Florida Dental Association for nearly two decades. . . . And often, she added, there's a financial reason why dentists choose to practice in more affluent regions: student loan debt. . . .With fewer patients in mostly poorer rural communities, graduates flock to private practices elsewhere, seeking financial stability. . . . . Because Medicaid reimbursements for dental care are paltry, even in urban areas, most dentists opt not to serve Medicaid patients."

Even when a rural citizen has a dentist, the cost of the treatment can make it "unattainable." Peace spoke with 40-year-old Lisa Lambros from New Port Richey, pop. 17,000, who drive "90 minutes to Tampa for appointments at the county health department. She lost her teeth due to cancer three years ago and desperately needs dentures but hasn't been able to afford them. She feels bad for her kids, embarrassed when they bring friends home to meet her." Lambros told her, "I had perfect teeth until I got sick. Now people treat me differently. They look at me like I'm a bad person." Peace adds, "Lambros lives with daily pain that could be relieved with dental care."

Frank Catalanotto is a founding member of Floridians for Dental Access. "His organization is a partnership between nonprofits, individual dentists and medical centers working to improve health access in the state. . . He's motivated to close disparities," Peace reports. "Catalanotto stressed that teeth don't fix themselves. . . . Some minor ailments, such as colds and viral infections, can simply run their course. A minor dental ailment, he said, does no such thing. Oral disease is progressive and ongoing and ultimately leads to severe infections."

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