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Other obstacles But the biggest explanation for denying public insurance is Medicaid payments, which are determined by the state, are too low. At minimum, reimbursement must cover overhead costs, an estimated 60% to 65% of the dentist’s income, or else he’ll lose money. The American Dental Association advocates reimbursement rates equal to 75% of customary fees, but some states pay dentists as little as 33%. Because low Medicaid reimbursement hinders access to care, it’s great to work with dentists to advocate better payment, Brock Martin said. Still, it’s not the most important battle to win to close the oral health gap among children. “You’ve got to make sure mom and dad are educated and that (oral care) should be a priority to overall health and readiness to learn in school,” she said. Rural woes worse The oral care disparity between rural and urban children, particularly among minorities, constitutes a public health concern, according to Dental Health and Access to Care among Rural Children, another SCRHRC report released in 2008. Rural Hispanic children were most likely to report having gone at least one year without dental care—32%, compared with 22% of white children. Although blacks have the greatest risk of living in poverty nationwide, black children are actually most likely to have dental insurance, either private or public. Of the rural children studied, 77% of blacks, 75% of whites, and 65% of Hispanics receive dental benefits. Brock Martin, co-author of the study, said Medicaid insures a disproportionate number of black children, compared with white children. Brock Martin explained that in South Carolina, children enrolled in Medicaid have a higher risk of caries but a lower rate of untreated caries than children not enrolled in Medicaid. “In spite of their disease burden, they are getting better access to care,” she said. “Medicaid not only levels the playing field but gives them an advantage.”
In Race, Poverty, and Domestic Policy, scholars analyze the long, complex structural and environmental causes of discrimination and their effects on African-Americans. The authors examine the impact of poverty and demonstrate how multiple causes reinforce each other and lead people to poverty. Visit amazon.com. Your role Hygienists and dentists can work collaboratively and rely on tele-dentistry to help underserved areas. A hygienist can take a radiograph and e-mail it to the dentist for review and diagnosis. This portable technology makes it easier to provide services in rural regions, or other areas where severe shortages exist, said Diann Bomkamp, President of the American Dental Hygienist Association. “Because of our strong roles in prevention we (hygienists) will be key in helping with patient care,” she said. “We know prevention will keep people healthier, save costs and help total health.” The ADHA has also developed a competency program to create a mid-level provider between the hygienist and the dentist, called the advanced dental hygiene practitioner. The position, which would require a master’s degree, would allow the ADHP to perform preventive and restorative services and draft treatment plans. But ultimately, the ADHP would have to refer to the dentist. Race and poverty, two strongly interlaced factors, hinder access to oral care in every state from Maine to Hawaii, but the barriers are especially prevalent in rural areas. Understanding these socioeconomic impacts will help narrow the oral health gap. Angela Dee Kwan is pursuing a master’s degree of journalism at Northwestern University. Her work has appeared in Chicago Journal, experience.com and Asian Pacific American News & Review.
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