By Kenneth D. Smith, Ph.D.
Dental and medical care have always been separate systems, despite calls dating back to the 19th century to integrate them to improve access. The mouth is the primary entry point to the digestive and respiratory tracts where bacteria can cause infections and inflammation linked to stroke, heart disease, and clogged arteries. Poor oral health increases the risk for chronic conditions, like cancer, diabetes, and even Alzheimer’s disease, that can be debilitating and costly to treat. Diabetes has long been associated with increased risk of gum disease, which can harm the body’s ability to control blood sugar levels. Despite the serious consequences of going without routine dental care, it is still often seen as optional.
With few exceptions, health insurance does not cover dental care. Most people who have coverage get it through their employer or pay out-of-pocket. Those who don’t have coverage often skip preventative visits altogether due to cost, and care is delayed until the pain is too much to ignore. While there is a sparse network of non-profit clinics and dental schools that offer dental care at a free or reduced price, it is not a comprehensive solution. Wait times can be lengthy, and appointments are prioritized based on severity, meaning only those who are the sickest are able to gain access.
Tennessee is one of only three states that doesn’t provide dental coverage to adult Medicaid enrollees. A 2018 study revealed 52 percent of adult TennCare enrollees had not seen a dentist in at least two years. Twenty-seven percent admitted they hadn’t been to the dentist in more than five years. For every 1,000 adults enrolled in TennCare there were 213 hospital admissions or emergency department visits for non-traumatic dental conditions; a vast majority could have been prevented or treated for a relatively low cost in a single dental visit. But without access, individuals postpone care, leading to worse problems that are more costly to treat. Delayed dental care can lead to an emergency room visit, hospital admission, or sometimes even death. If hospitals can’t recoup the cost of these expensive visits, they are shifted to others as higher hospital bills and premiums.
People of color, low-income families, people with disabilities, and those living in rural communities are disproportionately affected by limited dental care access for various reasons. In some cases, there aren’t enough dentists working in the areas where these people live. In other situations, social barriers prevent upward mobility. Sixty percent of adult Medicaid enrollees say the appearance of their mouth and teeth affects their ability to interview for a job, and 45 percent of Tennesseans who’ve had permanent teeth removed say it led to being stigmatized and blocked valuable opportunities.
A new policy brief from the Tennessee Justice Center recommends strategies to reduce oral health disparities and improve dental access for all. Governor Lee’s budget proposal for the upcoming fiscal year allocates money for some of the recommended strategies that will go a long way towards improvements. If approved, funds would help recruit more dentists to work in rural and underserved communities, give dental benefits to 610,000 adult TennCare enrollees, and increase reimbursement rates to encourage more dentists to accept TennCare.
These policies may lead to better management of chronic conditions and tremendous savings over time that will improve TennCare’s overall value. I applaud Governor Lee for including oral healthcare in his budget and hope lawmakers will give it their seal of approval.
Kenneth D. Smith, Ph.D., is a health economist and Assistant Professor of Public Health at the University of Tennessee Knoxville.