Nearly 30 percent of Americans across all income levels say dental problems affect the quality of their life, with low-income adults most affected.
Cost is the reason nearly 60 percent of Americans have not visited a dentist in the past year, according to a Harris poll conducted among 15,000 adults last summer on behalf of the American Dental Association Health Policy Institute and Families USA.
The report, Oral Health & Well-Being in the United States, calls for a national discussion about improving health care access, citing data linking oral health to physical, social and economic well-being.
“People delay treatment because of finances,” said Dr. Drew Agnini of Lakeland, president of the Polk County Dental Association. “We see it with low-income patients because the funds are not there but high-income patients may not want to spend discretionary funds because of teeth.”
Oral health is not isolated from overall health, said Dr. Karen McKenzie, director of dental service for Central Florida Health Care, a federally qualified community health center with clinics in nine communities in Polk, Hardee and Highlands counties.
For example, McKenzie said, any systemic disease, such as diabetes or COPD, is exacerbated by poor oral health; those who have difficulty chewing and eating suffer intestinal problems and gastric reflux; and periodontal disease affects heart valves.
“Lack of dental care is definitely impacting people’s quality of life and their health. We see it all the time,” McKenzie said.
Shirley Ethridge, 67, of Auburndale is among those who delayed care because of cost. After an accident, bouts of pain-management medication left her with dry mouth, which started impacting her teeth.
“My teeth were all breaking,” she said.
There is no doubt it has affected the quality of her life, she said. When she chewed, she felt as if she was choking; she suffered from heartburn. And she was in pain because of infection in her gums and “that messes up your thinking and everything about your life,” Ethridge said.
Two dentists examined her, and both told her it would cost at least $3,500 — an amount unaffordable on her Social Security income. She was given antibiotics to deal with the infection but nothing to treat the underlying problems.
Ethridge finally got help through Central Florida Health Care’s dental program in Winter Haven.
When asked about whether the appearance of their mouth and teeth affects their ability to interview for a job – 23 percent of Floridians said yes. By income levels, that amounted to 31 percent of low-income, 29 percent of middle-income and 12 percent of high-income Floridians.
And, 10 percent of all Floridians – but 14 percent of those with low income – said the condition of their mouth caused them to take time off work.
Other key findings among Floridians was about how frequently the condition of their mouth and teeth impact their life. The percent answering very often or occasionally were:
▪ Experience pain – 27 percent overall, 49 percent among low-income people.
▪ Difficulty biting and chewing – 35 percent overall, 59 percent among low-income.
▪ Problems sleeping – 21 percent overall, 31 percent among low-income.
▪ Reduce social participation – 15 percent overall, 30 percent low-income.
▪ Have anxiety – 24 percent overall, 39 percent low-income.
▪ Avoid smiling – 29 percent overall, 51 percent low-income.
Agnini said it is a misnomer to call employer dental plans insurance.
“We call them dental benefits because it is not necessarily insuring you against anything,” he said.
“Many assume dental plans work like medical insurance — you meet a deductible then insurance picks up the rest,” Agnini said. “But for dental they give you a yearly maximum. It varies by company, but it rarely goes above $2,000 and it has not gone up in relative amount in decades.
“From an insurance perspective, for a crown on a tooth the average price is $1,000. If someone has not had any dental care for several years and needs cleanings, multiple fillings and other work that $2,000 plan would cover only a minor amount,” Agnini said.
“That is a problem with low, middle and high income. It is always a battle: what is covered vs. my needs,” Agnini said.
While the Affordable Care Act changed many aspects of the nation’s health care and extended health insurance coverage to millions of previously uninsured people, it does not include dental care, the report points out.
Medicare does not provide dental benefits. And Medicaid coverage varies by state. In Florida, Medicaid has provided some dental coverage since 2009 but Medicaid mostly covers children from low-income families and very-low incomes adults who are either too disabled to work or are elderly.
Medicaid beneficiaries can pick among various plans and exactly what is covered varies by plan, said Doug Harvey, dental administrator for the Florida Department of Health in Polk County.
The better Medicaid plans cover fillings, extractions, cleanings, sealants and fluoride treatments as well as routine exams, Harvey said. Other plans don’t cover fillings and extractions.
In some counties, not enough in Medicaid payments were coming in to support dental clinics and they closed. But, Harvey said, Polk is in a better position specifically because it can supplement the Medicaid payments with money from the Polk Healthcare Plan, the local half-cent sales tax that provides health care for the uninsured poor. That same sales tax also boosts services for Central Florida Health Care’s dental program and for dental programs operated by other nonprofit groups.
Voters will be asked on the November general election ballot to extend for 25 years the half-cent sales tax for indigent health care. The tax was approved in 2004 and runs through 2019.
“The need is great,” said Dr. Stephen Ebner, dentist at the Health Department’s Lakeland clinic. “People who have not had regular access to dental care usually need one or two extractions, plus fillings.”
Health Department dental staff treat patients at the Lakeland, Auburndale, Haines City and Bartow clinics. Many of the patients are on Medicaid, others are very-low income adults who qualify for the Polk Healthcare Plan, and others pay on a much-reduced cash basis, Harvey said.
“No. 1 for us is treating pain, swelling and infection,” Ebner said.
When looking at the hierarchy of human needs, pain most impacts quality of life, Ebner said.
“If you want people to be employable, you have to get them out of pain,” he said.
People who have not had access to dental care for many years may end up at a hospital emergency department, where they will get prescriptions for antibiotics to fight infection and for pain relief but nothing to treat the underlying problem, Ebner said.
After alleviating pain, the Health Department works to provide a dental home with regular exams, cleanings and preventive care, Harvey said.
After pulling bad teeth and clearing up infections, the Health Department provides patients needing dentures with a list of providers who accept Medicaid payments, Ebner said, explaining, “we don’t want to use our limited resources for five appointments to provide dentures when we have people coming here in pain.”
Demand for services
Although the need for services is high, half of Florida dentists are not busy enough and can see more patients, the report said. The problem is not that there are too many dentists, but that policies prevent many patients from accessing care.
Much like the dental staff at the Health Department, staff at Central Florida Health Care dental clinics “are always skating, trying to see as many patients as possible,” McKenzie said. Typically, each team of a dentist and hygienist sees 25 to 30 patients a day.
“We are trying to get dental in all our clinics,” said Ann Claussen, chief executive officer of Central Florida Health Care.
Central Florida Health Care’s Winter Haven, Frostproof and Lake Wales clinics operate dental programs that see both adults and children; the Mulberry clinic sees pediatric dental patients but on Sept. 1 will expand to also serve adults, Claussen said.
And work is under way to bring in two more dentists by Oct. 1 to see more adult patients at the Winter Haven clinic, she said.
“Our goal is to add dental services in Lakeland and to include dental at a full-service medical clinic we hope to open in Haines City,” Claussen said.
On Thursday, Claussen received word that Health and Human Services had approved a federal grant of $350,000 to add dental services to the Avon Park facility in neighboring Highlands County.
“We are trying to get dental in all our clinics because there is such a huge need,” Claussen said.