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

The 2017 Legislature has an opportunity to address the silent epidemic of oral disease that especially affects low-income and rural citizens.

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.

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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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