As the saying goes, what gets measured, gets changed. While the oral health status of Kentuckians is widely acknowledged as needing improvement, the hard numbers to support this claim have not been aggregated and presented to the public in a comprehensive way – until now.

With funding from the Pew Charitable Trust, the Center for Health Workforce Studies at the University of Albany conducted research to better understand the oral health status of Kentucky’s population and to identify areas for change. Margaret Langelier, project director for Center for Health Workforce Studies, recently provided testimony to the health and welfare committees in both the House and the Senate.

Langelier began her presentation with the good news. Because of Medicaid expansion 430,000 people, mainly adults, gained dental benefits. Consequently, in 2014, 100,000 more Medicaid eligible people in Kentucky received an oral health service than in the previous year. She also lauded regulatory change in supervision requirements for qualified dental hygienists that allows public health departments to expand dental outreach efforts.

According to the report, one of the biggest challenges before the state is to address oral health disparities. Rates of dental caries, periodontal disease, and oral cancer are greatest in the populations in Kentucky who come from lower socioeconomic groups, have lower levels of education, and reside in rural areas.

• In 2014, only 38.1 percent of Medicaid eligible children received a preventive service.
• Only 13.2 percent of children ages 6-9 had a sealant placed on a permanent molar in 2014.
• In 2012, the percentage of adults who had not seen dentist during the previous year was 10^th highest in the US.
• Between 2002 and 2012, the percentage of adults who reported no dental visit in the previous year climbed 7 percent.
• Kentucky is fifth in the nation for adults 65 and older with all natural teeth extracted with a rate of 24.8 percent.
• Kentucky is second in the nation for age-adjusted incidences of oral cancer in 2012.

Langelier pointed out that some of Kentucky’s oral health status disparities are related to access and lack of providers. Although the oral health workforce appears to be adequate on a per population basis, it is not evenly distributed compared to the population.

• In 24 of the 120 counties there were fewer than 1.7 dentists per 10,000 population. The national percentage is 6.0 dentists per 10,000 population.
• Four counties had no dentist at all, 13 counties had only one dentist, and 12 counties had two dentists.
• Nationally 77 percent of the Federally Qualified Health Care Providers provided direct dental services, but only half of the Federally Qualified Health Care Centers in Kentucky provide direct dental services.

The report recommends increasing access and reducing disparities in the following ways:

• Continue to support and fund the dental benefit provided through adult Medicaid.
• Help the Federally Qualified Health Centers to build infrastructure for oral health services, find qualified personnel, and encourage them to seek available state and federal funding.
• Expand and replicate school-based and school-linked oral health delivery services that have been proven effective in meeting demand in areas with health provider shortages.
• Expand scope of practice for dental hygienists and dental assistants.

Sen. Max Wise, R-Campbellsville, whose wife is a pediatric dentist, discussed the need to fight off “brain drain,” which occurs when young people from rural counties attend dental school and never return home. “We need to make sure we are doing something to attract those dentists back into the rural areas,” he said.

He also discussed the impact of cuts to Medicaid reimbursement rates. “Many members may look at me and say, gosh I can’t believe he’s saying that, but we have cut reimbursements to general dentists by 10 percent and all we are doing is hurting children by cutting those reimbursements,” he said.

Sen Ralph Alvarado, R-Winchester, discussed the impact of dental varnishing in Clark County. He said that when a varnish program was implemented, cavity rates plummeted from 50 percent to less than 10 percent at a cost of 60 cents per varnish, making it very cost effective.

To access the Center for Health Workforce Studies report, click here.

This KET production is part of the Inside Oral Health Care initiative, funded in part by the Foundation for a Healthy Kentucky.