Great Health Divide | Bridging the dental care gap

BEVERLY, Ky. (WKYT) - From three decades of practice, Dr. Bill Collins has too many stories that show the need for dentists like himself.

“I had a girl going to her prom three years ago, she came in with no teeth,” Dr. Collins said. “She was 17 years old.”

And, more recently, he added, an even younger patient needed dentures. She was 13.

“Something’s wrong,” he said.

Oral health care is an important part of a person’s overall wellness, experts say.

Yet in regions like eastern Kentucky, it can be difficult for many to get the dental care they need. The American Dental Association estimates that 67 percent - roughly two-thirds - of all dentists in the U.S. do not accept patients on Medicaid.

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That has a big impact in areas like Kentucky’s Appalachian counties, where a significant portion of the population is made up of Medicaid patients.

It is why Red Bird Dental Clinic, where Dr. Collins is dental director, serves folks in the rural parts of Bell, Clay and Leslie counties using a sliding scale based on income to try to close a gap that has been open wide for decades.

“The need for dental care is universal,” said Dr. Lee Mayer, associate professor emeritus at the University of Louisville School of Dentistry. “It’s just a matter of whether it’s attainable or not.”

Nearly half (26) of Kentucky’s 54 Appalachian counties have a shortage of dental care for the low-income population, federal records show. Part of the problem, experts say, is that Medicaid reimbursement fees are lower than those of private insurance.

“It was never meant to be an entire practice,” said Dr. Jerry Caudill, the Kentucky state dental director for Avesis, a Medicaid claims adjudicator and administrator. “It would fill in their empty chair time, and they could give back to society in that way, to help those less fortunate. And that’s a good model. If every dentist in the state did that, that would be wonderful. But many do not. And so it puts more of a burden on those that are willing to.”

It also makes it hard to draw dentists to areas with such sizable Medicaid populations.

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Red Bird has partnered with the U of L School of Dentistry to receive the staffing the clinic needs and to provide dentistry students with different hands-on experiences than they may be used to.

“At Louisville our patients tend to be more older patients, sometimes very medically compromised patients,” said Dean Dr. Gerry Bradley. “Sometimes here they’re seeing really a broad section of patients across all the age spectrums with very different dental needs, and sometimes very acute needs because of the lack of care over time.”

Less than half of adults in 18 Appalachian Kentucky counties visited a dentist in the previous year, CDC data shows. (Those counties include all of those served by Red Bird.) The national average is 60 percent.

Kentucky counties with the lowest percentages of visiting a dentist in the past 12 months:

1. McCreary: 40.8%
2. Clay: 44.9%
3. Jackson: 45.8%
4. Lee: 45.9%
5. Wolfe: 46%

And in those same 18 counties, close to - if not more than - a third of adults 65 and older have lost all of their teeth, the CDC says. The national average is 17 percent.

Kentucky counties with the highest percentage of senior citizens who have lost all of their teeth:

1. McCreary: 36.8%
2. Clay: 36.1%
3. Bell: 35.5%
4. Wolfe: 34.2%
5. Lee: 34.1%
6. Harlan: 33.6%

“Dentures as a practice - it’s labor-intensive, it’s costly - and obviously it’s a part of the community here that’s a big need,” said Patrick Higgins, vice president of marketing and new business development at Whip Mix Corporation, a Louisville-based medical equipment and manufacturing company.

In a remote area like where Red Bird is located, technology is helping the clinic do more with less, providing services to people there that they otherwise would not be able to get so close to home:

• Whip Mix has set them up for digital dentures, allowing them to scan and 3D print them. It makes the process simpler, cheaper and quicker. (They are also discussing what other equipment can help them with their workflow.)
• U of L helped the clinic secure a cone-beam radiographic machine that helps them get a better image of the jaw, which is helpful when placing implants.
• Avesis provided a grant for the clinic to purchase an entire portable dental unit for Red Bird’s mobile dental clinic program.

Those at Red Bird say innovations like these are critical for them to be able to continue filling the gap here, as are their partnerships with companies like Delta Dental of Kentucky, a not-for-profit insurance company that has committed to the clinic $100,000 each of the past three years, leaders said.

But they cannot do it alone. Many across the region still face barriers to care.

Industry experts are trying to figure out how to recruit more dentists to the area - especially when students graduate from dental school with an average of $305,000 in student loan debt - and how to retain them.

Many say Medicaid reimbursement rates will have to be raised.

Still, the non-profit hopes its services and partnerships with private companies can be a model for other underserved areas as they work to help those who need it most, because the need has not gone away.

“It breaks my heart that I can’t find an answer to solve the problem, and I’ve seen it for 30 years,” said Dr. Collins. “And it’s not just me. It’s every dentist out here. If we knew how to solve it, we would.”

But as they deal with lower reimbursement rates, rising costs of care and staffing shortages - among other problems - it makes that mission in these mountains even harder.

On Monday, see how Red Bird is working to break the cycle that makes some of those procedures necessary in the first place.

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