COLUMBIA — Three years is a long time to wait to see a dentist if you have a toothache.
That's how long an uninsured adult sometimes has to wait to open his or her mouth and say "ah" at the Family Dental Center of Columbia, part of the Family Health Center of Boone County and the only dental clinic in Columbia for low-income and uninsured people.
Basic oral health regimen
In adults, failure to take care of basic oral health can increase the risk of cardiovascular disease, contribute to their babies' low birth weight and premature, birth and can worsen existing chronic conditions, such as diabetes. By following these simple at-home care tips, risks can be greatly reduced:
- Brush teeth twice a day.
- Replace your toothbrush every three to four months.
- Floss daily to avoid plaque buildup.
- Eat a balanced diet and avoid snacking.
- Have a regular oral exam every six months.
— American Dental Association; Lan-Tu Holem
Oral health care in Columbia schools
Several elementary schools go beyond dental education, providing preventative treatments.
Fluoride rinse program
- New Haven
- Rock Bridge
- Russel Boulevard
- West Boulevard
From 2007-08, 838 students participated in this weekly program
In-school dental screenings
- Blue Ridge
- Early Childhood Special Education Center
- New Haven
- Rock Bridge
- Russel Boulevard
- West Boulevard
From 2007-08, 937 students received free dental screenings.
— Columbia Public School
With a staff of just two dentists and a dental hygienist and funding from a federal grant, the center is able to discount services to patients without insurance as long as they can prove they can't afford to pay a dentist, said Gloria Crull, executive director of the Family Health Center.
And there are many people who fall into that category.
“(Family Dental Center) uses its grants wisely, but it still doesn’t satiate the need,” Crull said.
Fewer than 40 percent of Missouri employees have dental insurance through their employer, according to the Missouri Coalition for Oral Health White Paper published in 2007. That leaves the rest who can't afford to buy dental insurance on their own paying out-of-pocket for dental work or just letting routine work go undone.
The Family Dental Center is not the only location being flooded with more requests for help than it can meet.
The Oral Health Network of Missouri in Jefferson City also receives calls every day from people needing a dentist immediately, saidKaren Dent, the director.
“Most clinics set aside a few slots per day for emergencies, but more calls come in for emergencies than are available,” Dent said.
It doesn't help that mid-Missouri already suffers from a dentist shortage.
Missouri has only one school of dentistry, at the University of Missouri-Kansas City. With more dentists retiring than graduating, it is difficult to fill positions, dental care administrators said.
"Many dental practices are already full, so they don't need to see Medicaid patients," said Joe Pierle, chief executive of the Missouri Primary Care Association and the Oral Health Network of Missouri.
And if they do take on Medicaid patients, dentists have to be willing to accept what comes out to roughly 40 percent reimbursement, according to the Oral Health White Paper.
“You have to keep in mind, private practice dentists are a small business and they have to keep afloat,” Crull said.
Only part of the population is served by Medicaid. In 2005, Medicaid cut dental benefits for adults, bringing the number of adults without dental coverage in Missouri to more than 600,000, according to the Oral Health White Paper.
“It’s pretty dismal if you look at the oral health status of uninsured adults,” Crull said.
When the kids know more
When it comes to knowing the importance of routine dental care, some kids know more than their parents.
The Missouri Oral Health Preventive Services Program is offered at the Delmar Cobble School for the Severely Handicapped, the Easter Seals Child Development Center and the Nora Stewart Community Nursery in Columbia.
Most educational programs take place in public schools, including Columbia Public Schools, and focus on preventative care, such as application of fluoride varnish treatments and providing toothbrushes and toothpaste. While they've proven effective in preventing problems, adults still "fall through the cracks,” Crull said.
Without proper education on regular oral health care, old-fashioned cultural beliefs can take over — like the idea that “no pain equals no problem,” Dent said. Then, dental care becomes a secondary concern “until (the patient is) in pain and then (has) an extensive problem that needs a big fix.”
Misunderstanding how oral health works also keeps adults from getting the proper care. The key to oral health is designing a treatment plan to be carried out over the course of years, not just a single visit.
“With oral care, (dentists) don’t just treat a single tooth, they create a plan to treat the entire mouth,” Crull said.
Regular checkups help prevent more severe dental problems that require expensive operations and reduce overall costs per patient.
But treatment plans aren’t without a downside. They require more time and that translates into longer appointments. That leaves less time for patients who need immediate care.
It's a kind of triage system, where patients are prioritized based on the severity of their condition, and it's not the ideal way to provide oral health care for the uninsured patients that need it. But with few new dentists and limited funding, it will have to do for now, Crull said.
“The big issue is dental care for the adult population because children are already covered," Pierle said. "The argument can be made that (educating) kids and focusing on prevention has the larger impact, but we have adults with jobs or looking for jobs, and, if we want them to be productive and active, they need care, too.”
Filling the Gap
The Family Dental Center of Columbia is in the process of expanding its facilities and staff, Crull said. The center will purchase more equipment and recruit another dentist, but the second task is easier said than done.
Boone County is one of many counties in the state that has had a hard time attracting new dentists. But the hope is that a partnership between the Oral Health Coalition and the UMKC School of Dentistry, which places dental students on rotation in rural clinics, will result in more of them staying after graduation.
Since 2006, the partnership has placed more than 20 dentists in Missouri Federally Qualified Health Centers, which are nonprofit clinics for the uninsured.
At the Family Dental Center, the student dentists work with Lan-Tu Holem, the dental director.
For Holem, working in public health is a passion she said she tries to share with the young dentists.
"(Working in public health) is really rewarding, especially the appreciation I see in patients," Holem said. "I've been in (public health) for a long time and will stay in public health until I retire."
Better staffing of nonprofit clinics is making a difference, but the need for accessible oral health care for uninsured adults is still unmet. Finding a clinic and getting there is still impossible for many who are uninsured.
"There's so much demand for care," Holem said, "and (the uninsured) people deserve that care and need access to it."