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Tooth or dare: The reality of oral health disparities in Minnesota

Poor oral health is an indicator for many larger and chronic health issues such as heart disease, stroke, rheumatoid arthritis, and more.

Shivani Thakker

Picture yourself at home one evening, relaxing and watching a movie with your family. The dishes are done, the garbage has been taken out, all is well. Suddenly, you feel stabbing pain in your mouth. Well, let’s be honest, you’ve felt it before, but put it off to the side because there are more important things to think about than a little toothache. Next thing you know, you’re in the emergency room finding out that you have extensive tooth and gum decay.

Oral health is more than just a clean mouth and a nice smile, and it is time we treat it as such. The reality is that poor oral health is an indicator for many larger and chronic health issues such as heart disease, stroke, rheumatoid arthritis, and more. Rural Minnesotans tend to have poorer oral health outcomes when compared to urban residents because of a  lack of access to dental providers, lack of dental insurance, and lack of reliable transportation. However, rural health is not a top priority during legislative sessions, and dental care is further on the backburner. The harsher reality is that rural Minnesotans aren’t getting the appropriate care needed, and the Legislature hasn’t developed an effective enough policy to make a dent in the growing disparity in oral health between rural and urban environments in this state.

Rural dentist shortage

We could begin addressing this problem by looking at the sparse counts of dental providers available. With the vast majority of oral health providers concentrated in urban Minnesota, it’s fairly obvious that rural residents are at a great loss when it comes to oral care. 80 percent of dentists in the state of Minnesota practice in an urban setting, and the numbers don’t look much better for any other type of oral health provider. In Minnesota, the dentist to population ratio is 1 dentist per 2,272 small town or small rural city residents. In rural or isolated cities, the ratio becomes 1 dentist per 3,938 residents. In urban Minnesota, the ratio is drastically different at 1 dentist per 1,601 urban residents.

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These numbers are daunting. Has anything been done to address this problem? Yes, and no. Yes, in 2009, Minnesota became the first state government to authorize licensing of dental therapists and required these providers to serve low-income, uninsured, and underserved patients. These dental therapists are a part of the dental team and can be compared to the physician assistants of dental care. They can even perform oral evaluations, treatment plan formulation, routine extractions, and more. However, the reality is that this hasn’t truly addressed the problem of that growing disparity between rural and urban oral health. As of December 2016, there were only 63 licensed dental therapists, half of whom were practicing in the Twin Cities metropolitan area.

Looking for solutions

So how do we get oral health providers to serve the 132 designated “dental health shortage areas” in the state of Minnesota?

One way to increase the number of dental providers in rural Minnesota could be to start a mobile clinic, with dental providers participating on a rotational schedule. Even if this mobile clinic simply aided in preventive oral care with annual cleaning and cavity check-ups, it would make a big difference in the quality of life that people would have. Mobile clinics have been shown to improve health outcomes, so investing in a mobile clinic specific to dental care is not too farfetched of an idea.

Too much time, money, and pain has been spent within this issue. It’s time to face this growing disparity head on by contacting legislators who can make this growing issue a higher priority.

Shivani Thakker, B.A., is an MPH candidate in the School of Public Health, University of Minnesota.


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