By Susan Richards
The landmark report issued late last year by the National Institutes of Health (NIH) titled Oral Health in America: Advances and Challenges was recently reviewed by the INCISOR. The NIH and hundreds of professional contributors took a comprehensive look at the impact of oral health on the community and economy, from children to older adults, as well as emerging science and technology in the dental field.
While that report provided an overall look at the improvements and ongoing concerns in the United States, another study was released around the same time that broke things down state by state. National dental provider Express Dentist took a deep dive into what’s working and what’s not, ranking each state and the District of Columbia by using 25 key metrics from sources including the NIH, the American Dental Association (ADA), America’s Health Rankings, and more.
The Factors that Shape Oral Health
According to the Centers for Disease Control (CDC), approximately 37% of adults didn’t visit a dentist in 2020. Although COVID-19 can be blamed for some of that, people may have any number of reasons for neglecting their oral health, including dental anxiety, lack of insurance and money, or an inability to get to the dentist’s office.
Where people live can play a large part in their access to dental care. The CDC refers to the conditions where people live, work, learn and play that can impact a varying range of health risks as social determinants of health, or SDOH. Each state may contain multiple factors that combine to determine its oral health care ranking. Some of these indicators included in the Express Dentist report are:
- Ratio of dentists to people in the state
- Community water fluoridation
- Frequency of dental visits
- Medicaid coverage available for dental care
- Lifestyle habits such as smoking
- Personal attitudes toward oral healthcare
The survey also looked at reasons for the lack of regular dental care which could be a result of a low dentist ratio per capita or people unable to find a dentist. Surprisingly, Alabama has a low number of dentists per 100,000 people but only 5% of people surveyed cited the reason for missing appointments as being unable to find a dentist.
According to the NIH report, 18% of Americans live in rural areas and more than half of those regions have a dental provider shortage. These residents generally have to travel further, lack dental insurance, and are less likely to have fluoridated water. Rural residents have a greater percentage of untreated caries and edentulism, with West Virginia seniors ranking highest for complete tooth loss at 26%. COVID-19 exacerbated these deficits.
Cost and insurance were additional contributing factors to the high and low rankings in each state. Citing cost as the reason for not visiting a dentist in the previous year, Texas scored lowest with 18% and Hawaii at only 8%.
Access to Medicaid dental benefits is limited for low-income populations. With no federal mandate about dental care for adults on Medicaid, states vary on provisions. Most offer emergency dental services, but less than 50% of states provide full dental care for adults as opposed to children on Medicaid, who receive preventative and comprehensive care. According to the NIH report (pg. 77), Tennessee and Alabama offer no Medicaid dental coverage for adults and many of the states with limited benefits coincide with the lower ranking states on the Express Dentist report.
The Best and the Worst
With each of the 25 criteria worth up to four points each, states could achieve a maximum of 100 points. All told, Connecticut was the leading state with 86 total points and Arkansas came in last with 42. The top five and bottom five were rated as follows:
Top Five States for Dental Health
2. District of Columbia
5. New Jersey
Bottom Five States for Dental Health
50. West Virginia
You can find all the states in between and where they ranked as well as the key indicators used to determine the ranking, here.
Making a Difference
So, how do we level the oral health landscape from Connecticut to Arkansas? While disparities in income, insurance, and geographic access contribute to the decline in dental care, researchers with the National Center for Biotechnology Information (NCBI) consider these gaps to be avoidable and require interventions and changes in policy.
In addition to simply adding to the dental workforce, diversity is needed as well to promote inclusion and encourage more demographics to seek better oral healthcare.
One of the key indicators in the study – ‘dissatisfaction with life due to poor oral health’ – is both disheartening and encouraging. As dental professionals, we know the impact we can ultimately have on the quality of life – by the patient, by the community, and by state.
Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.