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Will Minnesota improve access to dental services for the rural and underserved?

How is it possible in a state known for having some of the best health care coverage in the country that so many people are showing up for free dental services?

It is morning, and the sun is breaking over the horizon. An extremely long line of people winds around the block. At first glance, a person could presume the line is for the newest iPhone or Lady Gaga concert tickets. After a closer look, the diversity of age is apparent. Many are children, several are in wheelchairs, and some appear to have traveled a great distance. What is clear is everyone is looking with anticipation toward a building with a banner that says “Mission of Mercy.”

Angie Sechler

This was the scene in Moorhead, Minnesota, in 2016 when needy patients received more than 7,655 free dental procedures thanks to the Minnesota Dental Association and Minnesota Dental Foundation. Free dental-care events like these have occurred annually over the last five years with the help of volunteers from Minnesota’s oral health provider community. The purpose is to bring free dental treatment to underserved populations.

Events like these are often held in Minnesota communities for thousands of low-income children and adults, many who are unable to access dental services despite being promised care by the state’s public assistance programs. How is it possible in a state known for having some of the best health care coverage in the country that so many people are showing up for free dental services?

A silent epidemic

This problem, as described by two previous surgeons general, is the silent epidemic of oral disease in the U.S. affecting the most vulnerable. Low-income individuals have some of the greatest oral health disparities, experiencing higher rates of cavities and difficulty accessing dental services. According to the Kaiser Family Foundation, 42 percent of adults with incomes below 100 percent of the federal poverty level (FPL) had untreated cavities compared to 11 percent of adults with income above 400 percent FPL.

Residents of Greater Minnesota are at greater risk of being unable to receive dental care. Several factors contribute to this: 1) reluctance among dental providers to see low-income patients, particularly those receiving medical assistance, 2) fewer transportation options available to make a dental visit, and 3) an aging dentist workforce in short supply. As of 2013, only 10 percent of licensed dentists were practicing in isolated and small rural areas of Minnesota, and more rural Minnesotans end up forgoing dental care, placing their health at risk, according to the Minnesota Department of Health.

The majority of Minnesota’s Dental Health Professional Shortage Areas are in Greater Minnesota and designated as “low income,” meaning high numbers of people living in these areas have incomes at or below 200 percent FPL (see map). Making matters worse, dentists practicing in Greater Minnesota are older and closer to retirement, and newly graduated dental professionals simply are not arriving in numbers necessary to replace them. Many rural Minnesotans are likely facing the permanent loss of local dental services. Addressing dental disease in rural Minnesota starts with creating greater access.

Legislation would help

The 2017 Minnesota Legislature has an opportunity to improve access to preventive dental care for low-income Minnesotans, and especially for rural residents. Proposals in both the House and Senate (HF1712/SF1496) encouraging greater use of “collaborative agreements among dental hygienists and dentists” would increase direct access to dental care for underserved populations. As proposed, the legislation permits greater utilization of dental hygienists, allowing them to collaborate with dentists to bring preventive dental care to more Minnesotans. It is a solution widely supported by the oral health provider community, including the Minnesota Dental Association and Minnesota Board of Dentistry.

The passage of this legislation could be a pivotal moment for the both low-income and rural residents who wonder about the future availability of dental services in their communities.

Angie Sechler lives in St. Paul and is a graduate student in the Executive Public Health Administration & Policy program at the University of Minnesota.

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Comments (5)

You don't even have to be poor

Private dental insurance is a joke.

You pay $30-60 per month for a plan that covers maybe half the costs of expensive procedures but have a maximum annual benefit of $1000. Not much help if you've been given an estimate that is more than $2000.

It's no wonder that American retirees in the South like to travel to Mexico for dental care, since Medicare provides no coverage, and even the supplemental plans have inadequate coverage.

Early Childhood Dental Network helps increase dental access

Here in west central Minnesota, West Central Initiative--a regional public foundation--heard loud and clear the need for dental access in our predominantly rural region, particularly for families insured by MnCare and Medical Assistance. WCI brought together dental, health care and early childhood professionals and other community partners to form the Early Childhood Dental Network. The goals of the ECDN are to increase awareness and education to all children and their caregivers about the importance of oral health, and to increase access to dental care, specifically to the ages 0-5 population on Minnesota Health Care Programs or the uninsured.

One of the wonderful outcomes of the ECDN is the ever-expanding network of mobile dental outreach clinics. Apple Tree Dental, Caring Hands Dental and Children’s Dental Services are three nonprofit dental organizations that operate mobile clinics throughout west central Minnesota. Thousands of children have been served by these outreach clinics who likely would not have otherwise had access to dental care.

Thanks to a generous grant from the Otto Bremer Foundation, the ECDN is now operating in 47 counties in Greater Minnesota. To learn more about the ECDN, visit ecdn.wcif.org.

Mobile Health/Dental Clinics

Not sure if this was in MN or a different state, but I remember reading about mobile health/dental clinics that had a "route" and rural communities would be able to have this service on a regular basis. Not sure if health and dental were combined in one "house" (RV/van/etc) or the services were separate.

Since there have been many articles about the lack of health/dental care in rural areas perhaps this could be looked into as part of the solution to the problem.

Dentist Clinics don't have to accept MA/MNCARE

When the state first rolled out MNCARE decades ago the majority of dentists did NOT enroll in the program as providers. For some reason, unlike medical providers, they had this option. At that time our family was transitioned from Medical Assistance to MNCARE and we were directly told by our then current dentist that we would no longer be seen in that clinic. We were fortunate and did find another dentist who would take state insurance. Many families were not so lucky.

In the Duluth area there is one dental clinic that specifically accepts patient's who are uninsured or on a state program - Lake Superior Community Health Center. I have heard it can take two years to get an appointment there unless you have a dental emergency. They will then do their best to work you in for an assessment as soon as possible.

Many families travel two hours to Deer River (Smile Clinic) if their children need orthodontic care as there is few/no options for care in Duluth if you have state insurance.

Until the state addresses the fact that dentist/dental clinics can opt out of serving those clients on state insurance this crisis will remain.

Community Dental Health Coordinators Can Help

As a dental assistant living and working in Moorhead, MN, I had the opportunity to be apart of the MN Mission of Mercy (MOM) event last July. While this was not my first MOM (currently #5 on my list!), this mission seemed a little more special to me - as I was able to give back to my community. The MOM is a fantastic event that helps thousands get free dental services, and while many individuals were able to benefit from the free event, the big question is: how do we keep the momentum of access to quality dental care going? A solution is through the Community Dental Health Coordinator (often referred to as a CDHC). A CDHC is trained to interact, with cultural competence, in the dentally underserved communities in which they work. They understand the people, language, and barriers to oral health in those communities; in many cases they already know the people with whom they will work. The CDHC training focuses on community outreach, coordination of care, educational and social interventions in the community, and prevention.

Working under a dentist's supervision, and within the confines of state dental practice acts, in clinics, schools, and other public health settings with people of similar ethnic and cultural, the CHDC can:
•-Collect information to assist dentists in triaging patients
•-Address social, environmental, and health literacy issues
•-Provide dental health education and help people develop goals to enhance their oral health
•-Coordinate care in accordance with a dentist's instructions
•-Help patients navigate the complexities of the health care system.
•-Provide screenings, fluoride treatments, placement of sealants, polishing teeth, and taking x-rays.

I am currently three months away from graduation from a CDHC program in Rio Salado College, AZ. Being a dental assistant for the past 10 years, this new program has provided me with a new way to look at the changing dental healthcare environment in which we are in and focuses on getting high-risk low-income patients connected to dental homes.

The take away: By focusing on oral health education and disease prevention, the CDHC can empower people in underserved communities to manage their own oral health. When disease requires treatment, the CDHC can link patients with dentists who can provide that treatment, and can help obtain other services—such as child care or transportation—that patients may need in order to receive care.

I invite readers to learn more about the role of CDHC by visiting:
http://www.ada.org/en/public-programs/action-for-dental-health/community...