Oral Health Disparities and Medicaid Coverage in North Carolina

Over a quarter of adults in the United States (US) have untreated tooth decay. Dental caries are one of the most prominent chronic diseases in the US. While many health outcomes in the United States continue to improve, the disparities associated with oral health among adults in the United States have only grown.1 This in part stems from the fact that oral health is often viewed as “optional” by health professionals and public health practitioners. Oral health is often a secondary concern compared to other medical conditions such as high blood pressure, diabetes, etc.2 The current US healthcare system fails to value how intertwined oral health is in one’s general well-being and the overall increase in positive health outcomes that would occur across the US if more emphasis was placed on oral care.3 Another crucial part to oral health disparities are social factors, or determinants, such as food security, diet, education level, socioeconomic status, and race/ethnicity. These disparities ultimately lead to obstacles of both affordability and availability of oral care and are particularly worse for low-income adults, racial/ethnic minorities, and uninsured or publicly insured individuals.4

Affordability refers to the cost of oral care, which is cited as one of the primary reasons that many adults do not seek oral care in the US.5 In fact, adult dental coverage by Medicaid is optional, and many states opt to provide either no care or incredibly limited care known as “bare bones coverage”. Availability of coverage refers to the number of dental care providers in an area. There are many regions across the US with dental provider shortages because many quality dentists are unwilling to move to more remote and rural areas. Fortunately, North Carolina (NC) offers the most extensive and comprehensive coverage to publicly insured patients, yet access to care continues to be an issue.6 This can be attributed to various reasons including the limited availability of dental providers across the state. More specifically, all 100 counties in NC are designated Dental Health Professional Shortage Areas (DHPSAs), such that all of the counties lack a sufficient number of dental providers compared to the population or geographic region to which they serve.7,8 On top of the already apparent shortage of providers, there are an insufficient number of dental providers that accept Medicaid patients. In addition, publicly insured patients may experience other barriers to care including limited access to transportation, an inability to take time off of work to receive care, and a lack of education about the need for oral health care. These factors culminate to widen the divide between the oral health status of adults based on income levels and insurance status.8

Even with the extensive dental Medicaid coverage available to publicly insured patients in NC, there still remains significant barriers to dental care.6 The reasons listed above contribute to these disparities but there are still reasons we do not yet understand and gaps that need to be closed in order to reduce these disparities in oral health care. While there is not one perfect solution to this issue, as dental students, we have the power to advocate on behalf of our patients. We can each play a role to advance the reduction in dental disparities by providing our patients with oral hygiene instruction, oral health education, and comprehensive, preventive oral care.

References

  1. Centers for Disease Control and Prevention, Division of Oral Health. Adult Oral Health: Facts About Adult Oral Health. Published 2020. Accessed April 2, 2024. https://www.cdc.gov/oralhealth/basics/adult-oral-health/index.html
  2. Vujicic M, Fosse C. Time for Dental Care to Be Considered Essential in US Health Care Policy. AMA Journal of Ethics. 2022;24(1):57-63. doi:10.1001/amajethics.2022.57
  3. Northridge ME, Kumar A, Kaur R. Disparities in Access to Oral Health Care. Annu Rev Public Health. 2020;41:513-535. doi:10.1146/annurev-publhealth-040119-094318
  4. Gupta N, Vujicic M, Yarbrough C, Harrison B. Disparities in untreated caries among children and adults in the U.S., 2011-2014. BMC Oral Health. 2018;18:30. doi:10.1186/s12903-018-0493-7
  5. Gupta N, Vujicic M. Main Barriers to Getting Needed Dental Care All Relate to Affordability. American Dental Association; 2019.
  6. Medicaid Adult Dental Benefits Coverage by State. Center for Health Care Strategies; 2019. https://www.chcs.org/media/Medicaid-Adult-Dental-Benefits-Overview-Appendix_091519.pdf
  7. NC Department of Health and Human Services. North Carolina Health Professional Shortage Area: 2022 Profile. Published online 2023.
  8. Hutchinson L. The State of North Carolina Oral Health in 2023. North Carolina Oral Health Collaborative. Published July 2023. Accessed April 2, 2024. https://oralhealthnc.org/the-state-of-north-carolina-oral-health-in-2023/

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