Dental therapist Sarah Chagnon treats a patient at the Swinomish Dental Clinic in La Conner, Wash., as part of a school-based “sealant week” program. More states are considering authorizing licensures of dental health aide therapists, also known as dental therapists. Experts say the midlevel practitioners can help fill gaps in access to dental health care. (Courtesy of Swinomish Dental Clinic)
Alabamians face substantial challenges in oral health and accessing dental care, according to a new report released by the Alabama Department of Public Health (ADPH).
According to the report , nearly half of Alabama’s kindergarten and third-grade students suffer from tooth decay while rural residents face significant barriers to accessing dental care, with fewer practicing dentists and higher rates of disability, poverty and lower educational levels.
Tommy Johnson, the ADPH’s State Dental Director, described parts of the state as a dentistry desert after a meeting of the ADPH’s governing board on Thursday morning.
“The demographics have so much to do with it,” he said. “It’s just that we’ve got such a huge number of rural areas where people live and people can’t drive 50 miles to get to a dentist.”
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The report found that 41% of kindergarteners have experienced tooth decay, and 22% have untreated cavities. By third grade, 50% showed signs of tooth decay and 23% had untreated dental issues.
These figures are significantly higher than national averages. Nationwide, 22% of kindergarteners and 20% of third graders show signs of tooth decay.
The burden of oral disease is not limited to children. 96% of seniors 65 and older in Alabama are disproportionately affected by tooth loss, with 42.5% of seniors are completely edentulous due to teeth decay or gum disease, meaning they have lost all their natural teeth, compared to 17% across the nation.
Like Johnson, Jennifer Harris, health policy advocate at Arise Alabama, also described the state as a dentistry desert, with over half of dental graduates leaving Alabama, leading to a chronic shortage of dental practitioners, especially in rural areas.
“We’re only retaining about four out of every ten dental students,” she said, adding that this shortage severely limits access to timely and preventive care.
Dental care is also expensive, even when a person has dental insurance, Harris said, which leads to people skipping treatment and opting for an extraction instead.
“The cost is prohibitive for a lot of people that are not able to afford treatment if there is something that’s discovered, and this is very unfortunate because when it comes to going to our overall health, our prevention starts in our mouth,” Harris said.
Environmental factors also play a role in worsening oral health in Alabama. Harris said there are ongoing concerns about inadequate fluoride levels in some areas, potentially contributing to higher decay rates among children.
“We really need to get back to doing a better part of the education component, of making sure that people don’t look at oral health as being optional, and then supporting them and being able to find what works for them,” Harris said.
Even when someone can secure transportation, the first appointment is often just a consult, Johnson said, meaning they have to find a way to come back for treatment, which contributes to a lack of access.
“What if we could do something like from a telehealth standpoint or a teledentistry standpoint?” he suggested.
He suggested expanding the scope of practice of other dental providers , such as dental therapists , to increase access to care, as well as utilizing community health workers — people without a health background who promote access to health in underserved communities.
“It’s kind of like being a social worker for dentistry. They are very much attuned to access to care issues, how to find better ways to get transportation for people to get to and from a certain area,” Johnson said.
General recommendations included in the report suggest expanding access to preventive dental services, increasing the number of practicing dentists in underserved areas and enhancing public health initiatives on oral health education.
“It’s tough. We have all these really good ideas, and it’s like, ‘Well, it’d be great if we could do it,’ so we’re trying,” Johnson said.
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