ST. LOUIS — People in Missouri have some of the worst teeth in the country, but it's not all their fault. One in five residents lives in an area with too few dentists, and more than 1 million people don't have dental insurance.
To help fill those cavities, the first dental school in St. Louis in more than two decades is expected to open by 2015. Third- and fourth-year students at A.T. Still University's Missouri School of Dentistry and Oral Health will practice at a $23 million clinic near Lafayette Square and provide care at community clinics around the state, including Grace Hill Health Centers in St. Louis.
"Missouri has huge oral health disparities and huge access to care challenges," said Chris Halliday, the dental school's dean. "People are having a very tough time either finding the resources to visit a dentist or finding a dentist who is able to treat Medicaid patients."
A.T. Still is a group of health sciences campuses based in Kirksville. The dental school expects 42 students in its inaugural class this fall, with room to expand to 60 students in future years. Pending accreditation approval in August, students will attend classes in Kirksville for their first and second years before moving to St. Louis for clinical practice.
In Missouri and across the country, more dentists are retiring or leaving full-time practices than there are students graduating from dental schools each year. More than 900 prospective students applied for the private school's first class.
"It's a high priority for us to try to place our grads in the state of Missouri, and it's a high priority for us to enroll students who are from Missouri," Halliday said.
The state needs at least an additional 280 dentists to meet the oral health care needs of its residents, according to the Kaiser Family Foundation. A dozen counties in Missouri have one registered dentist and six counties have none. About 64 percent of adults in Missouri visited a dentist in the last year, compared to the national average of 70 percent. One-quarter of the state's kids have untreated tooth decay which can lead to emergency room visits.
The lack of dental insurance in the state is an even bigger problem than the shortage of dentists, said Vicki Wilbers, executive director of the Missouri Dental Association. Medicaid does not cover dental health care for most low-income adults in the state. And even jobs with higher salaries don't always include oral health in benefits packages.
"There are a lot of dentists in the state of Missouri that have open schedules and could see more patients," Wilbers said.
Missouri has not had a dental director in the state health department in 10 years. Dental directors in surrounding states, including Illinois, are charged with promoting oral health to legislators, applying for federal grants and expanding insurance coverage.
The Affordable Care Act is set to offer dental benefits to millions more Americans in 2014, creating a need to educate more dental providers. There are 64 dental schools in the U.S. compared to 150 medical schools. Two-thirds of registered dentists in Missouri are graduates of the state's only dental school at the University of Missouri-Kansas City.
A dental school at Washington University operated for 100 years before graduating its last class of 30 dentists in 1991. The board of trustees voted to close the school because of declining enrollment and competition from state-funded schools. St. Louis University shuttered its dental school in 1971 for similar reasons but still offers post-graduate programs in orthodontics and periodontics. Today the closest dental school is in Alton at Southern Illinois University, which graduates 50 dentists each year.
A.T. Still University opened its first dental school in Arizona in 2003. Annual tuition, fees and equipment for first-year students cost more than $72,000. Halliday said tuition rates have not been set for the Missouri school, but scholarships and financial aid will be available. At the University of Missouri-Kansas City, annual tuition is about $28,000 for residents and $55,000 for nonresidents.
Kirksville is the birthplace of osteopathic medicine, developed in 1874 by Andrew Taylor Still, for whom the university is named. Doctors of osteopathy complete the same amount of training as medical doctors. Osteopathic medicine focuses on the whole body in the treatment of patients' symptoms, meaning dental students will learn how oral health affects patients' overall health, Halliday said.
Halliday estimates that an additional 11,550 patients in Missouri will receive dental treatment each year from the school's students. The Missouri Foundation for Health has contributed $3 million to the school for its efforts in serving low-income communities. Graduates will receive a certificate in public health as well as a doctor of dental medicine degree.
"They will be treating conditions in the mouth which will improve the overall health of the individual and the community," Halliday said.