Quick hits: Using a pay phone; hated Halloween candy; oral health is part of overall health; dude ranches for all

Finding and using a pay phone is a modern curiosity.
(Photo by Darin Epperly, Flatwater Free Press)

Smartphones may be the way of today, but pay phones still exist, and a call can cost a mere quarter. "Lane Handke called his wife to tell her he was bringing home the shelves they needed to finish their cabinet. The call cost him 25 cents," reports of Kevin Warneke of Flatwater Free Press. "Then, he phoned a friend just to say hello. . . . Handke made his calls from a pay telephone standing outside the Pierce Telephone Co. building. He felt drawn to this pay phone by curiosity. Pulled toward it by nostalgia." He told Warneke, “I hadn’t used a pay phone in decades. People were looking and wondering what I was doing. I thought it was kind of cool.”

While wind, solar, nuclear and fossil fuels are all part of the U.S. energy grid, geothermal power may be the next source to enter the mix. "The promise of new engineering techniques for geothermal energy – heat from the Earth itself – has attracted rising levels of investment to this reliable, low-emission power source that can provide continuous electricity almost anywhere on the planet," writes geophysicist Moones Alamooti for The Conversation. "That includes ways to harness geothermal energy from idle or abandoned oil and gas wells. . . . In the first quarter of 2025, North American geothermal installations attracted $1.7 billion in public funding – compared with $2 billion for all of 2024."

Do you know which Halloween candies are the most
disliked? (Adobe Stock photo)

As Halloween gets closer, adults and kids out shopping are met with store shelves packed with chewy eyeballs, glow-in-the-dark worms, bat-shaped candy bars, corn that's not real corn, and festive fall packaging. But some people find the  sweet, sticky world of Oct. 31 candy disgusting -- so much so, there's a list of the 10 most despised Halloween candies. Guesses go here.

Oral health and overall health are closely linked, and some "practitioners think dentistry should no longer be siloed," reports Lola Butcher for Knowable magazine. "Dentistry and medicine have operated as parallel fields: Dentists take care of the mouth, physicians the rest of the body. That is starting to change. . . . Dental hygienists have started working in medical clinics; physicians and dentists have started a professional association to promote working together; and a new kind of clinic — with dentists and doctors under one roof — is emerging. . . . The list of connections between oral health and systemic health — conditions that affect the entire body — is remarkable."

Triangle X Ranch, inside Grand Teton National Park, has been in the Turner family for nearly a century. 
(Triangle X Ranch photo via The New York Times)

Saddle up or relax at one of these six dude ranches. "All-inclusive guest ranches let you connect with nature, as well as your inner cowpoke, on the trail, around the campfire and under the starry skies," reports Ruffin Prevost for The New York Times. Whether honing horse skills, seeking majestic views, or simply wanting to leave technology and stress behind by heading out to the American West, Prevost's list offers suggestions and resources for a rural getaway.

Here a seed, there a seed, everywhere a company selling or consolidating to sell seeds. "Keeping track of [seed] brands — especially corn and soybeans — can be daunting," reports of Chris Torres of Farm Progress. "Knowing who owns what can provide crucial insights into what companies are behind the brands you buy, how they source and develop genetics, and what sorts of technology may be available to you." A compact seed chart and a listing of university variety seed trials are found here.

Each piano was tuned slightly differently to produce 11,000 Strings.
(Photo by Stephanie Berg via the Smithsonian)

When 100 pianos at the Hailun piano factory in China were all played together to test their performance before being shipped out, conductor Peter Paul Kainrath was there to experience the "massive sound," reports Ella Feldman for Smithsonian magazine. "The cacophonic scene left Kainrath so inspired that he called Austrian composer Georg Friedrich Haas to discuss its potential. . . .The next morning, Haas told Kainrath that if he brought him 50 pianos, he would compose a piece. The resulting composition is Haas’ 11,000 Strings."

As the battle over water fluoridation continues, rural Americans are at risk for higher rates of tooth decay

Thirteen states and the counties in gray don't report data on fluoride and drinking water to CDC.
(Map by Brett Kelman, Harvard University study from Census and CDC data)

As states consider banning tap water fluoridation mandates, rural America may be at risk for higher rates of tooth decay and its accompanying health problems. "Dozens of communities have decided to stop fluoridating in recent months, and state officials in Florida and Texas have urged their water systems to do the same," reports Brett Kelman of KFF Health News. "Utah is poised to become the first state to ban it in tap water."

Advocates for banning water fluoridation often cite "a government report last summer that found a possible link between lower IQ in children and consuming amounts of fluoride that are higher than what is recommended in American drinking water," Kelman explains. "The report was based on an analysis of 74 studies conducted in other countries, most of which were considered 'low quality' and involved exposure of at least 1.5 milligrams of fluoride per liter of water — or more than twice the U.S. recommendation."

Even as the battle over fluoridation continues, rural Americans already struggle to access basic dental care. Kelman reports, "Republican efforts to extend tax cuts and shrink federal spending may squeeze Medicaid, which could deepen existing shortages of dentists in rural areas where many residents depend on the federal insurance program for whatever dental care they can find."

Removing fluoride from rural water sources could exacerbate dental decay and the numerous other health problems it causes. "Dental experts warn that the simultaneous erosion of Medicaid and fluoridation could exacerbate a crisis of rural oral health," Kelman writes. "The changes could reverse decades of progress against tooth decay, particularly for children and those who rarely see a dentist."

Rural America already has large pockets with few dentists and unfluoridated water. A Harvard study "identified over 780 counties where more than half of the residents live in a [dentist] shortage area. Of those counties, at least 230 also have mostly or completely unfluoridated public drinking water," Kellman explains. "That means people in these areas who can’t find a dentist also do not get protection for their teeth from their tap water."

Several peer-reviewed studies give a glimpse into what ending water fluoridation could look like. Kelman writes, "Studies of cities in Alaska and Canada have shown that communities that stopped fluoridation saw significant increases in children’s cavities when compared with similar cities that did not."

Many Americans favor fluoridation, but "a sizable minority does not," Kelman notes. "Polls from Axios/Ipsos and AP-NORC found that 48% and 40% of respondents wanted to keep fluoride in public water supplies, while 29% and 26% supported its removal."

Dental care for low-income rural residents often out of reach

Dr. Jessica Meeske of Hastings, Neb., works on a patient.
(Photo by Laura Beahm, Flatwater Free Press)

Toothaches can cause a lot of pain and make eating difficult, so it's important to see a dentist as soon as possible. But what if no dentist in your area will accept you as a patient--even if you have state Medicaid insurance? You suffer and search for options even hundreds of miles away, which is what many rural residents in Nebraska are doing, reports Destiny Herbers of Flatwater Free Press.

Arline Morris desperately needs oral care, but she lives in Stratton, Neb., more than 200 miles from any dentist that will take her Medicaid insurance, Herbers explains. "She can’t eat much and struggles daily with constant pain while taking medication that makes her teeth even more fragile. . . . She’s been offered appointments at Omaha and Lincoln. . . . [But] It’s an eight-hour round trip, plus hours of dental work. . . John Morris, Arline’s husband and sole caretaker, spends his days calling around for help, working around the spotty cell phone signal at their home. He’s talked to more than 50 dentists’ offices with no luck."

Over the past five years, "the total number of dental providers reimbursed after treating at least one Medicaid-eligible patient dropped by 37%," Herbers writes. "The problem is especially pronounced in western Nebraska. Only two dozen dentists west of Kearney have been paid for treating a Medicaid patient this year. Forty-three Nebraska counties, many in the state’s western half, have zero dentists helping low-income Nebraskans."

Why does Nebraska have low-income dental deserts? "Because it doesn’t pay," Herber reports. "State government reimbursements for this dental work have fallen 'far below market levels,' said Dr. Jessica Meeske of Hastings. They fail to cover the overhead costs of most procedures, leading to what Meeske calls a 'crisis level' with large numbers of patients unable to get care. . . . Meeske, a pediatric dentist at Pediatric Dental Specialists of Greater Nebraska, said her clinic turns away 15 families a day because they are 'overloaded and booked out.'"

Nebraska isn't the only state with dental Medicaid woes. The Rural Blog spoke to Gabriella Fryer in Orono, Maine; she and her husband, Cody, have three children ages 3 to 9, all of whom qualify for "Mainecare," the state's Medicaid program. Fryer described their experience: "There are very, very few dentists that accept Medicaid, even for kids, and ones that do have such [long] waitlists that you never get seen. A dental hygienist comes to schools, and that's the only way kids get seen and get referred to a dentist for cavities and whatnot." Fryer noted she and Cody opted to pay out-of-pocket to see a private-practice dental hygienist for preventative care, hoping to avoid dental problems in the first place. She adds, "That's not an option for everyone. . . . Mainecare says it "offers" dental care--but not really."

Florida is another state where low-income rural residents have limited dental care options because few dental school graduates choose to live in those areas, reports Lauren Peace of the Tampa Bay Times. "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."

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."

Poor oral health in children isn't just from too much sugary food; education, income and environment play a role

CDC photo

While brushing your teeth is important to maintaining good oral health, dental-health experts say it's not the only thing responsible for poor oral health, especially when it comes to children in Appalachia, where sugar is usually blamed.

"It’s a common misconception that consuming sugary foods and beverages is the only cause of tooth decay. While that is undoubtedly a problem, there’s much more to good oral health," Daniel W. McNeil and Mary L Marazita write for The Conversation, a site for journalistic writing by academics. "It includes consistent brushing and flossing; eating healthy foods, like fresh fruits and vegetables; avoiding tobacco products; and wearing mouth guards while playing certain sports. Regular visits for dental care are also critical, as they provide an opportunity for cleanings and preventive care." 

McNeil and Marazita, who run the University of Pittsburgh's Center for Oral Health Research in Appalachia, say the region's poor oral health stems from a combination of factors beyond tooth brushing and other personal hygiene.

Poor oral health, they write, is more common among "people who have less formal education or lower incomes, marginalized ethnic and racial groups and those living in more rural areas, such as Appalachia," which has one of the highest rates of oral health problems in the nation. And among these groups, oral health issues tend to show up at younger ages. 

Other than education, behavioral and social influences, reasons for poor oral health can include genetic influences that dictate a preference for sweet foods, mouth bacteria that can lead to oral diseases, environmental factors such as air quality, access to healthy foods, the cost of dental care, access to transportation to and from the dentist, access to school-based programs, water quality and whether one lives in a community with fluoridated water, which can keep cavities from forming.

McNeil and Marazita note that cavities are the most common chronic disease in children, despite being preventable and that "more than 40% of children have tooth decay when they start kindergarten. . . . Dental problems in kids can lead to missed school, pain and embarrassment about visible decay, and missing or crooked teeth." 

They write that parental and caregiver role modeling can greatly influence children's oral health habits. Examples include drinking water instead of sugary beverages, eating a healthy diet, practicing good dental hygiene habits and expressing a positive attitude about going to the dentist. 

The article offers several other suggestions to improve oral health, saying one of the best things parents or caregivers can do is to take their child to the dentist.  

"The American Academy of Pediatric Dentistry and other professional health organizations recommend that children see an oral health care provider before age 1 or at the emergence of the first tooth," they write. "Access to dental treatment, especially preventive care, has been shown to improve oral health in families and their communities."

McNeil and Marazita also call for system-level changes that ensure routine dental care is affordable and accessible to everyone. They also call for integrating oral health practices into schools and educational programs, saying this will benefit all children regardless of their family's socioeconomic status.

Quick hits: Some rural right-wingers converting to Russian Orthodoxy; Silas House remembers Naomi Judd

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email us at heather.chapman@uky.edu.

In a recently aired segment, right-wing cable network One America News Network admits there was no widespread voter fraud by Georgia election workers in the 2020 presidential election. The segment appears to be part of the recent settlement of a defamation lawsuit two election workers brought against the network. Read more here.

A new generation of female country music singers is bringing new listeners to the genre and gathering critical acclaim, but old-guard industry insiders and fans are pushing back against them and questioning whether they're "country" enough. A new book from journalist Marissa Moss contrasts the phenomenon against a well-researched history of country music. Read more here.

One Michigan farm is a cautionary tale of the dangers of PFAs (often called "forever chemicals") and the sewage sludge fertilizer that brings them to farms. Read more here.

"She had the most beautiful handwriting, and she often dotted her i’s with hearts. Naomi loved dogs, and bodies of water, and Mary Oliver poems," writes Kentucky author Silas House in a moving and intimate tribute to his friend, the late Naomi Judd. Read more here.

An abandoned mine reclamation project is making some headway in Appalachia, but many long-term challenges remain. Read more here.

Some right-wing Americans—including in rural West Virginia—are converting to Russian Orthodoxy, drawn to its conservative stances on social issues. A scholar who researched the phenomenon (and wrote a book about it) noted that converts tend to admire Russian president Vladimir Putin, and show sympathy toward white nationalism and authoritarian government. Read more here.

Republican primary candidates are increasingly trying to dodge journalists, even barring them from free and public campaign events. Read more here.

The Rural Health Information Hub has updated toolkits and information guides on rural suicide prevention and rural oral health.

If you want a slice of rural life in the Upper Midwest, visit a Cenex station, writes a columnist and musician. Read more here.

CDC: Three of seven rural adults went without dental care before pandemic, especially men, non-whites and the poor

Dental visits in 2019 by adults aged 18 to 64 (CDC chart)

Dentists were forced to shut down during the early months of the pandemic, leaving Americans unable to get appointments for routine dental care. But even before the pandemic, nearly half of rural adults went without it, according to the Centers for Disease Control and Prevention.

In 2019, the CDC says, 42.4 percent of people aged 18 to 64 in nonmetropolitan counties did not visit a dentist that year, compared to 33.3% of metropolitan residents. Rural residents who did see a dentist were more likely to go there for more serious treatment, such as oral surgery. 

Some groups were less likely to visit the dentist in both rural and urban populations, though the disparities were wider in rural areas: men, non-white residents, and the poor. Rural disparities were likely wider because of transportation problems, dentist shortages, and lack of overall health care. 

The report matters because dental care is correlated with overall physical health, and regular preventative care can keep small dental problems such as cavities from becoming large, expensive problems that threaten health and require more invasive treatment.

Toolkit aims to help rural communities plan, create and fund early childhood health promotion programs

The Rural Health Information Hub has launched a toolkit to help rural communities learn how to plan, create and fund early-childhood health promotions.

The toolkit has seven detailed modules that break down how to create, develop and implement a program, evaluate its effectiveness, plan for long-term sustainability, and best practices. 

The toolkit is designed to supplement and expand on other rural community health toolkits dealing with food access, health promotion and disease prevention, obesity prevention, oral health, services integration, social determinants of health, telehealth, tobacco control and prevention, and rural transportation.

From the website: "For more information about rural community health programs, including how to develop and implement a program, please visit the Rural Community Health Toolkit. Visit the Rural Health Promotion and Disease Prevention Toolkit for information about implementing a health promotion program for people of all ages."

Rural America has too few dentists, partly because it has too few patients or Medicaid programs that can pay

Dr. Lynnel Beauchesne's clinic in Preston County, West Virginia,
at lower right. (Photos by Ricky Carioti for The Washington Post)

Efforts to recruit dentists to rural towns, and expand state scope-of-practice laws to allow basic services to be delivered by dental therapists, have long been regarded as two of the best ways to improve oral health in rural America, where 43 percent of residents lack access to dental care. But because the care is so expensive, those efforts may sometimes be counterproductive, Anne Kim, domestic policy director at the Progressive Policy Institute, writes for The Washington Post.

"People don’t go to the dentist if they can’t afford to, no matter how many dentists there are," Kim writes, citing Richard Meckstroth, chair of the department of dental practice and rural health at West Virginia University. "Recruiting more providers into shortage areas can compound the problem, said Meckstroth, putting local dentists into tougher financial straits by increasing competition for a relatively small pool of paying patients. The dentists who arrive under loan forgiveness programs also tend to leave after their two-year obligation is up, what Meckstroth calls a 'revolving door' that deprives patients of continuity of care."

Beauchesne and 15-month-old daughter, Landyn, in the office

And in states like West Virginia, where poverty is widespread and Medicaid doesn't cover adult dental care except for extractions or infection treatment, even dentists can have it tough. Kim's object example is Dr. Lynnel Beauchesne of Preston County, who "keeps prices barely above costs. The office charges $90 for a cleaning, an exam and bitewing X-rays — about half the national average fee and a third of what many big-city dentists would charge for the same services."  Beauchesne tols her, “I try to keep my prices in the realm of what people can afford and so they will want to come. I don’t want people to come just for extractions. I want them to come for cleanings and to keep the teeth they have.” The closest dentist is 30 miles away.

"Poor oral health has an impact beyond mere toothache," Kim reminds us. "A landmark 2000 report by the U.S. surgeon general found that oral health is intimately linked to people’s overall physical health and is often associated with serious systemic conditions such as diabetes and heart disease, as well as the likelihood of complications in pregnancy. Nevertheless, some 74 million Americans had no dental coverage in 2016, according to the National Association of Dental Plans, putting the dentally uninsured rate at nearly four times the rate for the medically uninsured." A 2014 report from the American Dental Association said nearly 20 percent of adults under 65 "said they’d foregone needed dental care in the past 12 months, with the most common reason being “they couldn't afford it.”

Which brings us back to recruiting dentists. "Patients’ inability to afford care is one reason younger dentists — many facing up to $250,000 in school debt — are reluctant to settle in rural areas and why dentists like Beauchesne find themselves working hard to keep their doors open," Kim writes, adding, "The dental-care crisis in rural America is closely linked to the broader economic challenges in the parts of the country that have not yet caught up in this recovery." As Meckstroth told her, “How you improve access in rural America is to get people jobs.”

Head Start helps rural families with more than child care

The federally-funded Head Start program helps low-income families across the U.S. with child care, but in rural areas it can be a critical resource for much more. "In 2015-16, 68 percent of rural families with a child enrolled in Head Start received a family service, including job training, parenting education, and substance abuse prevention through the program," Jackie Mader reports for The Hechinger Report, which says it "covers inequality and innovation in education."

A new report by the Center for American Progress found that, in some states, Head Start accounts for one-third of all child-care centers. In rural areas, it is sometimes the only available source of child care for families, enabling parents to go back to work or work more hours. That means the program has a big impact on rural economies, too.

The program also helps children's health. "Mississippi’s Head Start centers provide each child with five screenings when they enroll, including a vision, hearing and dental screening, to ensure no health issues are standing in the way of learning. Many children in the state’s rural or low-income communities would not get these screenings if not for Head Start," Mader reports. "The centers also work with each parent to create a plan for short and long-term goals and connects families with resources that can help parents meet their goals and services that can help children with any developmental delays that arise."

Rich-poor divide in oral health forces low-income folks to choose extraction over costly repairs

The rich-poor divide is causing many impoverished rural residents to forgo dental health care, or resort to having teeth pulled rather than pay for costly fixes, Mary Jordan and Kevin Sullivan report for The Washington Post. The rate of Americans who have lost all their natural teeth is higher in rural areas in every age group, and 20 percent of all Americans over 65 do not have a single real tooth remaining. (CDC graphic: National Health Survey 2010-12 results of of people who have lost all their natural teeth)

Toothless rates among those 65 and older are especially high in the South. According to Kaiser Family Foundation data from 2014, 33.6 percent of West Virginia residents 65 and older have had all their natural teeth extracted. Second is Kentucky, at 23.9 percent, followed by Mississippi and Oklahoma (22.5), Tennessee (22.4), Alabama (22.2), Arkansas (22) and Louisiana (20.5). (CDC graphic: Where people 65 and older have lost all their teeth, by region)

More than 50 million Americans "live in areas officially designated by the federal government as Dental Health Professional Shortage Areas," reports the Post. "A great many of them are working poor. In these rural areas, even the water can work against people." Many people rely on well water that is not fluoridated, which helps reduce tooth decay. The Centers for Disease Control and Prevention says 25 percent of Americans are not connected to a fluoridated water system. Another problem in rural areas is a shortage of dentists.

While rich people can afford the luxuries of the best oral health care, poor people often resort to standing in line at free clinics, reports the Post. "High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth." The problem is that emergency rooms are not typically equipped to fix dental problems. That means they prescribe painkillers, which can lead to addiction, which destroys teeth, and dry mouth, which leads to more cavities.

Dental therapists in Minnesota leading to increased care in rural and underserved areas

Kassie Scott works as a dental therapist in
Minnesota (Times photo by Dave Schwarz)

Minnesota's goal to increase dental care to rural and underserved areas is beginning to pay off, but still lacks enough qualified workers, Stephanie Dickrell reports for the St. Cloud Times. In 2009 the Minnesota Legislature authorized the licensing of dental therapists "to expand access to dental care to more state residents, especially those with low incomes or who live in rural areas where dentists may be rare." Minnesota "has some of the lowest reimbursement rates for pediatric dental care services in the nation. As a result, dentists say they can't afford to treat any or many Medical Assistance patients."

The first class of dental therapists, who "perform routine dental work, including fillings, while the dentist concentrates on more complicated cases," graduated in 2011, Dickrell reports. "A 2016 study by the University of Minnesota found that dental therapists saw up to 90 percent of uninsured patients or patients on public assistance."

Having dental therapists is also leading to shorter waiting times for appointments, Dickrell writes. A study in 2014 by the Minnesota Department of Health, "showed that almost one-third of all patients saw a reduction in wait times to get an appointment, especially in rural areas. Time with a provider increased by 10 minutes."

Using dental therapists is also saving money, Dickrell reports. Sarah Wovcha, executive director of Children's Dental Service, a nonprofit clinic that treats low-income, uninsured and diverse kids and pregnant women, said "while a dentist might make an average of $75 an hour for a filling, a dental therapist would make half that for the same work." Wovcha said that leads to weekly savings of $1,200 and annual savings of $62,400, "or the cost of another full-time dental therapist."

One problem is that Minnesota only has two programs to train dental therapists, producing about 20 graduates per year, Dickrell writes. The health department said there are currently about 70 licensed dental therapists in Minnesota, which accounts for only 1 percent of the state's dental workforce.

More than 100 million prescription opioids for dental surgery unused by patients, study projects

Fifty-four percent of prescription painkillers—more than 100 million pills—prescribed each year for surgical tooth extraction remain unused after three weeks, says a study by the University of Pennsylvania’s Perelman School of Medicine and School of Dental Medicine published in Drug and Alcohol Dependence. Researchers say the surplus is troubling, because studies show that people who abuse opioids often use leftover pills that were prescribed to friends and erlatives.

The study, of 79 patients prescribed prescription painkillers after dental surgery, found that only five took all the pills they were prescribed. "The majority of patients (94 percent) received a prescription for an opioid medication to manage pain, with 82 percent also receiving a prescription-strength nonsteroidal anti-inflammatory drug (NSAID), and 78 percent received a prescription antibiotic. On average, participants who did not have post-surgical complications (93 percent) received prescriptions containing 28 opioid pills, but three weeks following surgery had only used 13, leaving more than 1,000 unused opioid pills."

Researchers say most patients stopped taking the pills within five days because they were no longer in pain. When asked to rate pain on a scale of 1 to 10, patients reported an average score of 5 only 24 hours after surgery, 51 percent said from zero to 3 on the second day, and 80 percent reported no pain after five days.

Co-author Elliot V. Hersh wrote: “Research shows that prescription-strength NSAIDs, like ibuprofen, combined with acetaminophen, can offer more effective pain relief and fewer adverse effects than opioid-containing medications. While opioids can play a role in acute pain management after surgery, they should only be added in limited quantities for more severe pain.” (Read more)

Rural Iowa had 13% fewer dental practices in 2013 than in 1997; average age of dentists increasing

The average age of dentists in Iowa continues to increase, while the number of dentists in the state's rural areas continue to decline, statistics that need to be addressed to prevent a serious dentist shortage in the future, says a study by researchers with the University of Iowa Public Policy Center, Hayley Bruce reports for Iowa Now. From 1997 to 2013 the number of dentists in the state 55 or older increased from 23 percent to 42 percent. During the same time the number of dentists practicing in rural areas decreased from 49 percent to 36 percent. One-third of the state's dentists practice in three metro counties that account for 27 percent of the state's population. (University of Iowa map: Number of private-practice dentists in each county in 2013)

The study also shows that oral health in Iowa has shifted from solo practices to group practices, "with the proportion of Iowa dentists who work in solo practice declining from 59 percent in 1997 to 43 percent in 2013," Bruce writes. Raymond Kuthy, University of Iowa professor of preventive and community dentistry, told Bruce, “These changing demographics are likely to impact overall practice patterns, as well as the geographic distribution of Iowa’s dentists. People who go into group practice tend to wind up in larger communities because it provides them with a larger patient pool, better emergency coverage in the dentist’s absence, and the ability to vary their work hours." (Read more)

Rural N.D. lacks dentists; ADA's chief economist says some rural residents don't see a need for care

While a 2014 report from the Center for Rural Health highlights a serious shortage of dentists in North Dakota's rural, under-served and Native American communities, some health professionals deny there is a problem or blame rural residents for lack of care, John Hageman reports for the Grand Forks Herald. The report found that 67 percent of all North Dakota dentists practiced in the state's four most-populated counties, where about 52 percent of the state's people live. That meant that in 2014, 12 of the 53 counties did not have a dentist, nine had only one and nine had two (data were unavailable for five counties). North Dakota ranks 48th in population but 19th in land area, making it difficult for many rural residents to travel to see a dentist.

Rob Lauf, a dentist in Mayville in rural Traill County, just outside Grand Forks, said he doesn't consider the eastern part of the state to have a dental shortage, Hageman writes. Lauf told him, "Either way, you have to have a full schedule. There are some counties that don't have a dentist, but they also don't have the population to support a dentist." The eastern part of the state includes two rural counties adjacent to Grand Forks and Traill counties—Nelson and Steele—that do not have a dentist, according to the Center for Rural Health report. (Center for Rural Health map: Dentists in North Dakota in 2014)

At the same time, an "American Dental Association survey showed that less than 10 percent of general and specialist dentists in North Dakota reported they are not busy enough and could see more patients in 2013, which was the lowest percentage of the 36 states included on the survey and well below the national average of roughly 35 percent," Hageman writes. Marko Vujicic, chief economist with the American Dental Association, "said the main reasons people don't seek dental care are cost and 'a perceived lack of need' rather than an inability to get a dental appointment scheduled."

North Dakota, which lacks a state dental school, has tried to recruit recent college graduates with loan repayment programs, Hageman writes. Legislation proposed last year allowing certified advanced dental hygienists to perform some procedures now done by dentists, a move designed to increase dental care needs in rural and Native Americans, was opposed by the North Dakota Dental Association and ultimately did not become law.

Report: Environment impacts health of rural children more than it does urban ones

Rural children are more likely than their urban peers to experience health problems based on "their environment, their socioeconomic status, their own and their families’ health behaviors, and their access to quality clinical care," says a report by the Department of Health and Human Services. The research, which included samplings of journal publications, found that rural children are more likely to be obese and live with someone who smokes.

Almost one in four rural children ages 4 to 17 has the potential for a mental health problem, but as many as 80 percent of those children live in areas that lack services, states the report. Another problem is access to dental care, with about 75 percent of areas with inadequate dental care located in rural areas. Rural women also lack access to prenatal and postnatal care. Rural counties average 2 obstetricians per every 1,000 women, compared to 35 obstetricians per every 1,000 women in urban areas. Some rural areas also lack hospitals with obstetric services. The report also looked at the effects of asthma on children in rural and urban areas.

The report offers suggestions to break down barriers for healthy living for rural children. It suggests that communities, schools and child care facilities can encourage healthier eating and increased physical activity through education and supportive environments. Telehealth and school-based health centers can provide greater access to behavioral health services. Oral health in rural children can be improved by increasing access to preventive treatments, such as by changing Medicaid reimbursement policies to increase the number of providers. Greater access to prenatal and postnatal can be increased through home visiting programs and telemedicine. Also, school and home-based programs can help address asthma.

Dental therapists are the key to improving oral health in underserved rural areas, advocates say

Dental therapists could be the solution for improving oral health in rural areas, Pew Charitable Trust's oral health advocates Julie Stitzel and Rebecca Singer Cohen report for Stateline. Of the 4,438 areas designated as having dental health professional shortages, 60 percent are in rural areas. The oral health deficiency is compounded by rural residents being more likely than urban ones to be poor, lack dental insurance, have poor water supplies and often have long distances to travel to the dentist.

Another problem is that only about one-third of dentists accept Medicaid or other public insurance, Stitzel and Cohen write. As a result, many patients skip dentists and go to the emergency room with oral care concerns. "In 2012, there were more than two million dental-related visits to hospital emergency rooms—most of them for preventable conditions that could have been addressed earlier in a dental office. The cost for this care was about $1.6 billion."

Midlevel dental providers—or dental therapists—are the solution, Stitzel and Cohen write. These professionals "have a proven ability to deliver cost-effective and high-quality preventive and routine restorative care—such as filling cavities, placing temporary crowns and extracting loose teeth—to a variety of underserved populations. The growth of dental therapy in recent years mirrors the rise of physician assistants and nurse practitioners in the mid-1960s during a time of physician shortages in rural areas and in primary care."

Minnesota was the first state to authorize dental therapists in 2008, with a therapist opening a private practice in rural Montevideo, Stitzel and Cohen write. "In the therapist's first year, new patients increased by 38 percent," and the therapist served 500 more Medicaid patients and made an additional $24,000 in profit. The American Dental Association has publicly criticized dental therapists, saying a in February statement: "The supply of dentists is adequate to serve America’s needs," and ADA "remains firmly opposed to allowing non-dentists to perform surgical procedures."

Ky. starts pilot program to help pay off loans of new dentists who practice in Appalachian Ky.

Kentucky officials have started a pilot program to forgive dental-school loans of new dentists who practice in Appalachian Kentucky, with preference given to economically distressed counties and students who return to their home county.

The program has only $500,000, enough to place just two to five dentists in the two-year pilot period, but it was endorsed by the chairman of the House Appropriations Committee, U.S. Rep. Harold "Hal" Rogers, whose 5th District covers the coal counties of Appalachian Kentucky, and it was announced immediately before an executive committee meeting of Shaping Our Appalachian Region, the nonprofit that Rogers and Democratic Gov. Steve Beshear created to lift the area's economy after massive layoffs in the coal industry.

"Rogers' endorsement of the pilot program suggests he may use it as the basis for federal appropriations or legislation to help other rural areas that need dentists or even doctors," Rural Blog Publisher Al Cross writes for Kentucky Health News.

Rogers said the program should send some new dentists back home to in his district, the nation's most rural. He said dental-care access in the region has been poor because "We've shipped out our talent for their education and the rest of their productive life" and given them little incentive to return. Meanwhile, more than half of Eastern Kentucky children aged 2-11 have tooth decay, he said.

"A lot of our graduates at UK and U of L really want to return home to practice," said Dr. M. Raynor Mullins, project leader of the Appalachian Rural Dental Education Project of the University of Kentucky Center for Oral Health. "I hear that from them every day, but high student debt is a real barrier." The University of Louisville, which has the state's other dental school, will also participate.

The shortage of dentists in Appalachian Kentucky is often cited as one reason the region and the state have such poor oral health. Another obstacle is that many dentists won't accept Medicaid, citing low reimbursements. Dentists in the program will be required to accept Medicaid.

More dentists than ever are needed to treat the hundreds of thousands of Kentuckians newly covered by Medicaid after the state's expansion of the federal-state program. State Health Secretary Audrey Haynes said 270,000 of the nearly 500,000 children enrolled in Medicaid visited a dentist last year.

Fewer dentists are practicing in rural America, but some states are trying to change that

The number of dentists in rural Nebraska keeps shrinking, and there is little interest among new dentists in setting up practice in the state's rural areas. States like Nebraska, Kentucky and Kansas are trying to lure more dentists to rural areas through incentive programs or by educating the area's youth about the benefits of becoming a dentist and practicing close to home. (Kansas Health Institute photo by Ann Williamson: Dental patients waiting at the Kansas Mission of Mercy Dental Clinic in Manhattan. The free clinics treat thousands who otherwise might not have access to dental care.)

Twenty of Nebraska's 93 counties don't have a dentist, and 31 counties only have one or two, the Fremont Tribune reports. Even worse, 39 percent of the state's dentists are nearing retirement, and there is little interest among recent college graduates in setting up practices in rural areas. Kim McFarland of the University of Nebraska told the Tribune she estimates that of the 45 new dentists entering practice in the state each year, only five or six go to rural areas.

Nebraska has an incentive program that gives a dental-school graduate up to $20,000 a year in tuition reimbursement for workign in underserved rural areas, the Tribune reports. But McFarland said students often graduate with $200,000 or more in debt. She told the Tribune, "We just need to make sure we're recruiting dental students from rural areas and giving them incentives to practice in rural areas." That won't be easy, because the state's two dental schools, at the University of Nebraska and Creighton University — are operating at capacity, McFarland said. (Read more)

Grants in Kentucky and Kansas are helping to raise awareness about the need for dentists in rural areas. Morehead State University received approval this week from the Appalachian Regional Commission for a $400,000 grant to initiate the Appalachian Rural Dental Education Partnership Program, MSU reports. Matching resources from Morehead and the University of Kentucky, which is partnering with Morehead in the program, brings the total to $514,437. 

"The program will increase awareness and support for dental careers among kindergarten through 12th-grade students in Eastern Kentucky; establish a new undergraduate predental curriculum at MSU with links to the UK dental school; and improve oral health conditions at MSU and in the surrounding region," MSU reports. "The strategic will ultimately improve access to dental professionals in underserved areas such as Appalachian Kentucky's distressed counties." (Read more)

In Kansas, in response to a 2011 report that 57,000 people in the state live at least 30 minutes from the nearest dentist, it was announced this week that "the DentaQuest Foundation has given a $100,000 grant to Oral Health Kansas to develop a plan for improving access to dental care," Jim McLean reports for the Kansas Health Institute. "The nonprofit group will work with several other Kansas oral health organizations to craft the plan and submit to the foundation for a  possible two-year implementation grant." (Read more)

Medicaid dental coverage is first to go when states can't tighten eligibility rules; has big rural impact

Many states have cut optional benefits for poor adults enrolled in Medicaid, rather than tighten eligibility requirements at a time when more people need the program, and dental services are often first to go. The problem likely won't improve under President Obama's health-care overhaul because it requires dental coverage just for children. The cuts probably affect rural residents disproportionately since many rural places are facing dentist shortages, according to the Pew Center on the States.

In about half the states, Medicaid dental care now covers only pain relief and emergencies, according to a recent Kaiser Commission on Medicaid and the Uninsured report. Other states cover preventative exams and cleaning, but not fillings and root canals, Abby Goodnough of The New York Times reports. Some states are also cutting vision, chiropractic and podiatry coverage, and requiring co-payments for prescription drugs. (Times photo by Gretchen Ertl)

Many adults on Medicaid are turning to community health centers for dental care. In Massachusetts, which has long been a state with very generous Medicaid, community clinics received 22,000 new dental patients in the first six months after dental coverage was dropped. And in states where Medicaid still covers dental care, "finding dentists who accept Medicaid can be next to impossible," Goodnough writes, because reimbursements have also been cut and dentists have dropped out of the program or refuse to join. (Read more)