The ADA Health Policy Institute (HPI) has published “The Oral Health Care System: A State-by-State Analysis,” which examines data from all 50 states and the District of Columbia. It not only reveals many key trends for patients and practitioners alike concerned about oral health, but it also breaks down specifically how these trends are happening in each state and in DC.
For example, the report notes that the percentage of Medicaid-enrolled children who visited a dentist within the past year nationally increased from 29% in 2000 to 48% in 2013. As a result, the gap in dental care use between Medicaid enrolled children and children with private dental benefits narrowed significantly over this same period in the vast majority of states.
The trends for adults differ dramatically, though. Dental visits by adults with private dental benefits are declining in most states. Also, a separate HPI analysis shows that the gap in dental care use between Medicaid and privately insured adults is much wider than it is for children.
Additionally, 95% of adults say they value oral health and 93% agree that regular visits to the dentist help keep them healthy, as routine dental care is seen as a key part of overall wellness. However, only 50% of adults responded correctly to a set of general-knowledge questions about oral health.
Also troubling, more than one out of 3 low-income adults say they avoid smiling, and 17% report difficulty in normal activities because of the condition of their mouth and teeth. Nearly one out of 4 low-income adults and 14% of all adults report their oral health issues have led them to reduce participation in social activities.
Fortunately, more dentists are available to treat these patients. The supply of dentists per capita increased from 57.3 dentists per 100,000 people in 2001 to 60.5 per 100,000 in 2013. Other HPI research suggests this growth will continue through 2033. Yet challenges in oral healthcare remain, prompting the ADA to make recommendations.
First, the ADA urges policymakers to continue implementing evidence-based reforms in Medicaid, noting that the states with the largest gains in access to dental care among Medicaid children such as Connecticut, Maryland, and Texas are those that implemented comprehensive, multipronged reforms that work.
Second, the ADA says, policymakers and the oral health community both need to consider reinventing how oral health is defined and measured. Many current efforts measure dental disease and the services people use without connecting oral health to physical, social, and emotional well-being. HPI has developed new measures to help shift focus to outcomes-based delivery and reimbursement models.
Third, policymakers should rethink how states and the federal government handle adult dental care. Adults, particularly low-income adults, say cost is the primary reason why they don’t see the dentist. The Affordable Care Act does not consider dental care “essential,” Medicaid makes adult dental benefits optional, and most states only provide basic coverage, which all increase costs for many patients.
For a clickable snapshot of your state’s results in the survey, visit ada.org/hpi.