Ohioans face challenges when accessing dental care

the following article Originally published in Ohio Capital Magazine and published on News5Cleveland.com under a content sharing agreement.

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, a dentist at 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 county health rankings, Ohio will have 7,580 dentists by 2023, compared with just two dentists each in Harrison and Monroe counties.

But Dr. Frank Beck, dean of the new College of Dentistry at Northeast Ohio Medical University, said Ohio still lacks 627 dentists.

“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. The HPSA designation is used to identify areas with a shortage 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 that provide clinical dental services, often run 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 — meaning more dental providers will be able to see Medicaid patients.

Gov. Mike DeWine recently vetoed the reimbursement plan, saying that putting the rates into statute would limit the Ohio Department of Medicaid, the Ohio Department of Developmental Disabilities and the Ohio Department of Aging from “appropriately administering Medicaid. Program Policies and Costs”. This approach benefits Ohio consumers and complies with federal regulations,” he said in his veto message.

However, David Owsiany, executive director of the Ohio Dental Association, said he is directing departments to implement the proposed legislative rates, which would mean an increase in dental Medicaid reimbursements of $103.74 million this fiscal year and $207.58 million in fiscal 2025.

“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 were reimbursed less than 40 cents on the dollar, forcing some providers to stop accepting Medicaid patients entirely.

“We are in crisis mode,” Oceani said. “Clinics are closed. Dentists are having to limit the number of patients they can accept on Medicaid.

Dr. Hal Jett, a dentist who has his own practice in Lawrence County, agreed with Oceani.

“Providers cannot fully participate in the Medicaid system because it has become a huge 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 provide. 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 can be a challenge for underserved patients,” Oceani 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 find 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 impacts a person's ability to learn, be employed, form social relationships, and can complicate many chronic conditions,” Morse said.

Poor oral hygiene can lead to gum disease, which has been linked to diabetes, heart disease, pregnancy complications and some cancers. Poor dental health has also been linked to Alzheimer's 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, with a third dental school at NEOMED expected to launch in 2025.

According to the Education Data Initiative, the average dental school graduate owes $293,900 in student loan debt, and the average private school dental graduate owes $354,900.

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 remain in Ohio and work in selected underserved areas of the Dental HPPSA.

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 since its inception in 2003, and about two-thirds of them are still working in the same or similar areas of Ohio, according to the ODA. ODLRP dentists served more than 165,000 patients during the contract period.

“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

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 at Hopewell Health Center in New Lexington, Perry County, nestled in the rolling Appalachian Mountains.

Hopewell Health Center provides comprehensive behavioral health care, dental health care and primary health 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.

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