More work needed to expand #oralhealth care to underserved N.H. communities (via @caseymcdermott & @ConMonitorNews)

24 Jun


While New Hampshire has broadened access to oral health care in recent years, geography, disparities in dental insurance coverage and other socioeconomic factors still prevent many from getting important preventative and restorative treatment, according to a new report.

The report, produced by the NH Kids Count and the University of New Hampshire Carsey School of Public Policy, notes that missing out on routine dental care doesn’t just mean missing out on clean teeth – oral health is linked to overall health, and those without regular access to dental care can be left to resort to seeking treatment through hospital emergency departments, which carry significant financial costs.

“We have somehow kind of separated oral health care from the rest of our health care system, and it maybe leads to people sort of not realizing that there are people who are challenged in oral health care,” said Erika Argersinger, NH Kids Count policy director. “Not getting that care has very real impact on other parts of their health.”

Inequities in oral health care affect residents of all ages, the report notes, and residents who live in more rural parts of the state tend to experience significant barriers, but they’re not alone. More than half, or 56 percent, of third-graders in Coos County showed signs of tooth decay in 2014, according to the report. Among the same age group, 14.2 percent of third-graders in Strafford County experienced untreated tooth decay last year – the highest in the state – followed by Coos County at 14 percent.

The report further points out: “Approximately 8 percent of third graders statewide were found in need of treatment prior to their next regularly scheduled dental appointment, and 1 percent were found in need of urgent treatment, a condition characterized by ‘infection, pain, or swelling requiring dental care within the next several days.’ ”

Insurance coverage and the ability to seek out Medicaid-covered oral health care are identified as two significant barriers that could be keeping residents from getting the treatment they need. In New Hampshire in 2007, they note, “charges for emergency department services for dental conditions totaled $5.9 million . . . up from $1.8 million in 2001.”

Medicaid coverage for dental care for adults older than 21 “is limited to treatment of acute pain or infection,” according to the report, but coverage for children covers a broader scope of preventative and treatment services. The report suggests, however, that there may be a need for more dentists who will accept new patients covered by Medicaid.

To improve oral health among children and adults alike, the authors of the report suggest changing how traditional oral health care is delivered – pointing to the creation of a “mid-level oral health care provider” in states like Minnesota and Maine and the use of school-based sealant programs in some parts of New Hampshire. The report also points to three examples of mobile dentistry units already making the rounds in New Hampshire, providing care directly to patients who live in more rural areas or otherwise might not have regular access to a dentist: There’s the Ronald McDonald Care Mobile Unit, which covers mainly the Concord region; the Molar Express in the North Country; and the Families First Mobile Health Care Unit in the Seacoast region.

Last year, the Legislature set up a commission to study barriers to oral health care and to assess the viability of expanding the supply of mid-level dental professionals. The initial findings of the NH Kids Count and Carsey School report were presented at the group’s May meeting.

Looking ahead, Argersinger said it will be important for the state to consider multiple approaches – and to be mindful of multiple barriers, economic, geographic and otherwise – as it works to expand oral health care.

“We need to look at solutions that bring services out to communities that are underserved,” Argersinger said. Still, she added, “there is no one silver bullet here.”



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