“Critical but often overlooked,” Ohioans face challenges when accessing dental care • Ohio Capital Journal


Dr. Darcy Cook will never forget one particular patient whose teeth she tried to save.

The patient was a recovering drug addict who frequently missed appointments, which only made her dental problems worse.

But the patient did not oversleep or intentionally be absent. Instead, she was homeless, had to pay by phone, and had only one vehicle in her life.

She can't go to the dentist if her phone runs out of time or her friend doesn't show up.

“My heart breaks for her,” said Cook, the dentist. Hopewell Health Center in New Lexington. “You never know what someone is dealing with. I definitely learned from that experience.

Many Ohioans face barriers to accessing dental care—transportation issues, insurance restrictions, cost, anxiety about going to the dentist and a lack of knowledge about proper dental care.

Ohio also has a shortage of dentists and a shortage of dentists who accept Medicaid, making finding a provider difficult.

Not getting proper dental care can lead to a host of health problems, from gum disease to cardiovascular disease to Alzheimer's disease.

This is a vital but often overlooked part of overall health,” said Marla Morse, executive director of the Ohio Oral Health Center.

Dentist shortage

According to statistics, by 2023, Ohio will have 7,580 dentists, while Harrison and Monroe counties will have only two dentists each County Health Ranking.

But Ohio is still short of 627 dentists, said Dr. Frank Beck, president of the hospital. Northeast Ohio Medical University's new dental school.

We have a shortage of dentists, hygienists and dental assistants,” said Susan Lawson, director of oral health services for the Ohio Association of Community Health Centers. “To the point where many of our health centers are looking at training their own dental assistants because there aren’t enough dental assistants out there.”

Ohio has 58 federally qualified health centers located at nearly 500 locations in 76 counties. Lawson said of the 58 centers, 43 have dental centers.

“We have a serious traffic problem in Ohio,” she said. “So our health center is a safety net.”

Baker said there are 172 dental health professional shortage areas (HPSAs) in Ohio, which disproportionately represent the state's Appalachian counties. HPSA name is used for Identify areas with shortages of health professionals.

According to county health rankings, 10 of Ohio's 32 Appalachian counties have fewer than 10 dentists. Five other counties (except Appalachian) also have fewer than 10 dentists.

Ohio also has 170 safety net dental care plans Provides clinical dental services, usually operated by local health departments and hospitals.

Dental Medicaid Reimbursement

Although dental Medicaid reimbursements were removed from the state's two-year operating budget, they were increased for the first time since 2000— This means more dental providers will be able to serve Medicaid patients.

Gov. Mike DeWine recently vetoed reimbursements on an itemized basis, saying incorporating rates into regulations would limit reimbursements Ohio Department of Medicaid, Ohio Department of Developmental Disabilities and “Appropriately manage Medicaid policies and costs in a manner that benefits Ohio consumers and complies with federal regulations,” he told the Ohio Department of Aging. his veto message.

Governor Mike DeWine explains discussions on the 2024-2025 fiscal year operating budget. (Photo by Nick Evans, OCJ.)

However, He directed departments to implement the proposed legislative rates — which would mean a $103.74 million increase in dental Medicaid reimbursements and a $207.58 million increase this fiscal year Fiscal Year 2025, said David Owsiany, executive director of the Ohio Dental Association.

“This will allow Ohio’s most vulnerable citizens to access dental care without having to wait in long lines or travel long distances because there will be more providers in the community who can accept Medicaid patients,” he said.

Dentists have got Reimbursements were less than 40 cents on the dollar, forcing some providers to stop taking Medicaid patients entirely.

"We are in crisis mode," oat explain. “Clinics are closed. Dentists are having to limit the number of patients they can accept on Medicaid.

Dr. Hal Jeter is a dentist with his own practice in Lawrence county seat, echo Oceani's thoughts.

“Providers have not been able to fully participate in the Medicaid system because it has become a big financial burden from a business model survival perspective, and while in our hearts we want to help, we have to be smart about how much we can help and how much we can help. choose between.

Owsiany said ODA is working with ODM to calculate data for the new rates, which are scheduled to take effect on January 1.

barriers to care

Ohioans face many challenges when it comes to accessing dental care.

Transportation is probably the biggest one, as not everyone owns a vehicle or has access to reliable transportation.

“Travel is a challenge for underserved patients,” Orsini said.

Kelly Carey, state director of public affairs for the Ohio Association of Community Health Centers, said FQHCs provide transportation services to patients to help bridge that gap.

Insurance is a big hurdle. Not everyone has dental insurance, and even if they do, there may be significant out-of-pocket costs. It's also difficult to find a provider with some kind of dental insurance — forcing people to sometimes drive across county lines to get care.

“Most people in Appalachia are on fixed incomes,” Cook said. “They only have a certain amount of money. If they have more serious health complications, dentistry often takes a backseat.

Lack of knowledge about proper dental care is also a barrier.

“Most people don't realize you should go regularly,” Cook said. “The most important thing you can do is brush out the ones you want to keep.”

The opioid epidemic is another challenge. Cook said she sees patients every week who are struggling with addiction or who have just completed the early stages of detox.

“Unfortunately, drug addiction can accelerate oral health problems,” she said. “By the time they get to me, it may be too late to save the tooth, but that's always the goal.

Dental Care Impacts Overall Healthcare

Dental care affects more than just your mouth.

“Dental health affects a person's ability to learn, be employed, form social relationships, and can complicate many chronic conditions,” Morse said.

Dental hygienist cleaning patient's teeth

Poor oral hygiene can lead to gum disease, which has been linked to diabetes, heart disease, pregnancy complications and some cancers.Poor dental health also linked to Alzheimer's disease disease.

Bad teeth mean difficulty chewing.

“If you don't have good teeth, you can't eat healthy foods,” Cook said.

Poor dental health can also have a negative impact on a person's mental health.

“A lot of people I see don't smile,” Cook said. “They don't leave home because they are ashamed of their poor oral health.”

Both Jeter and Cook said they often encounter patients who haven't seen a dentist in years and are in pain from dental problems.

“If you see your doctor regularly, you can preserve your teeth and prevent pain,” Cook says. “Then you’ll be healthier for the rest of your life—both mentally and physically.”

Lawson said providers often have long waiting lists to see a dentist, with wait times for cleanings at some FQHC dental centers around six weeks.

Cook is passionate about helping children understand what good oral hygiene looks like. She remembers shadowing an oral surgeon who had a 14-year-old patient who had to have all her teeth removed and needed dentures.

“She didn't have a toothbrush,” Cook said. “She drank Mountain Dew all day, every day like it was going out of style. Unfortunately, her teeth were beyond saving.

Ohio Dental Loan Repayment Program

Ohio currently has two dental schools, located at Ohio State University and Case Western Reserve University, A third project is underway at NEOMED and is expected to start in 2025.

Average debt owed by dental school graduates According to statistics, student loan debt is $293,900 and the average private school dental graduate debt is $354,900 Education Data Initiative.

The Ohio Dentist Loan Repayment Program and the Ohio Dental Hygienist Loan Repayment Program, through the Ohio Department of Health, attempt to attract dentists to stay and work in Ohio. Certain dental underserved areas HPSA.

Dentists and dental hygienists must participate in the program for at least two years, and they can receive $25,000 in loan repayments each year. The program has a maximum term of four years, and those continuing in the program's third and fourth years can receive loans of up to $35,000 per year.

At least 29 dentists have completed the program About two-thirds remain employed in the same or similar areas of Ohio since its launch in 2003, According to official development assistance.Served more than 165,000 patients ODLRP Dentist for the duration of the contract.

“Not only do you benefit from dentists who have practiced in underserved communities for four years, but sometimes they put down roots in those communities and stay,” Orsini said.

Hopewell Health Center

NEW LEXINGTON, OH – JULY 13: New Lexington Primary Care Clinic dental team (left to right), dental assistant Makinzie Hutchinson, hygienist Amanda Humphrey, dentist Dr. Darcy Cook, front desk staff Madi McIntyre, Amy Moore and Brittany Danielson, Dental Assistant, July 13, 2023, Hopewell Health New Lexington Clinic, New Lexington, Ohio. (Photo by Graham Stokes for Ohio Capital Magazine)

Cook, who is from Perry County, said it was important to her to return to her hometown after graduating from The Ohio State University School of Dentistry to help improve health care services.

“My main concern is to reach them through education and help them understand the importance of oral health to overall health,” the 42-year-old said.

She works in Hopewell North Perry County New Lexington Health CenterNestled in the rolling Appalachian Mountains.

Provided by Hopewell Health Center Comprehensive behavioral health care, dental care and primary care. They have 22 branches in 9 counties in southeastern Ohio.

Having empathy and establishing a line of communication helps Cook build trust with his patients. She works to help understand patients’ barriers to receiving care and provides resources where she can.

“A lot of times, I can walk right across the hall and learn about behavioral health during a dental appointment,” she said.

Follow OCJ reporters Megan Henry on Twitter.

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