Oral health indicators for Kentucky have improved over the past 15 years, but many people in the state are still affected by a patchwork system of dental insurance coverage and/or government benefits that have not kept pace with the rising costs of dental care.
This lack of financial resources puts a large number of Kentuckians at risk for developing chronic oral health problems that can be incapacitating if not treated. A particularly vulnerable group are medically compromised patients. These people often require expensive dental work to reduce the risk of infection before undergoing treatment for a systemic health problem, such as heart disease or some forms of cancer.
For most of these patients, the cost of oral surgery or other complex treatment far outpaces the modest maximum limits on their dental insurance, if they have any – and for elderly patients in Kentucky, Medicaid offers only limited adult dental benefits, while Medicare offers none. They are often caught in a situation where they must undergo dental surgery they can’t afford before they are cleared to receive other treatment that is covered by insurance or government benefits.
These elderly, disabled, or otherwise medically compromised patients often turn to nonprofit or charitable organizations for assistance. Since 1985, the Dental Lifeline Network has helped over 110,000 people across the nation get much-needed dental care through its Donated Dental Services (DDS) volunteer program.
In Kentucky, the Dental Lifeline Network began its DDS program in 2015, and provided services to 14 patients during its first year, donating more than $60,000 in free care. Thirty-nine dentists and 24 dental laboratories participated in the state program, which is one of 44 nationwide that generated over $24.5 million in free dental care in the last fiscal year.
Success Leads to Statewide Expansion, but More Help Needed
The Kentucky Dental Lifeline Network’s DDS program enlists dentists to volunteer their time, office, equipment, and staff in the service of one or two patients a year. The volunteer dentist selects the patient from the waiting list after an interview and examination. This enables the dentist to apply his or her expertise in the best manner possible to treat the patient’s unique dental problems, which are often very complex and severe.
“This charitable program started initially for persons with disabilities to receive dental care,” says Dr. Darren Greenwell, who practices in Jefferson, Bullitt, and Hardin counties and is the leadership council chair for Kentucky’s DDS program. “And it’s kind of expanded into mostly medically compromised patients, who need to have some medical care done but need to get their teeth taken care of first.”
“Our dentists treat a lot of organ transplant patients, cardiac, and cancer patients,” he explains. “Their medical care is usually covered, but a lot of times they have no dental coverage, so this program was developed to fill in that space.”
The treatment provided is wide-ranging and can involve removing part or all of a patient’s permanent teeth, putting in partial or full dentures, or restoring teeth via dental implants, Greenwell says.
“Dentistry is kind of funny, the way dental insurance is separate from medical insurance, and it’s been a big issue for a long time,” he adds. “People just don’t think about their teeth as part of their mouth, and the politicians and insurance companies kind of look at it separately as well, which, you know, it’s all part of the same system…. We truly care about our patients and we’re trying to take care of the population that’s missed.”
Kentucky’s Dental Lifeline Network expanded its DDS program throughout the commonwealth last year, when the Kentucky Dental Association endorsed the program and Delta Dental of Kentucky supplied a start-up grant. Despite these positive early steps, the program needs more dentists in Kentucky to volunteer now in order to meet the needs of a waiting list that currently numbers 190.
A Crucial Addition to Kentucky’s Dental Safety Net
Dr. Greenwell says that dental caries (tooth decay) and periodontal disease – the two main oral health problems nationwide and in Kentucky – are usually very advanced in the individuals he treats via the Dental Lifeline Network. “Neglect is a big issue,” he says. “I don’t know if dentistry has done a good job at trying to educate our population, because most of dentistry is preventable.”
Greenwell’s most recent patient was a textbook example of the type of medically compromised individual the DDS program is designed to help. He needed extensive dental work done before more complicated medical procedures could be ordered by his primary care physician. The patient had multiple teeth fractured at the gumline, accompanied by decay and periodontal disease.
“With him, he was in such bad shape that we ended up extracting all of his remaining teeth, and then fitting upper and lower dentures,” Greenwell says. “I actually just saw him, we finally delivered his dentures, and he was quite happy. Hopefully, he can go on and get his medical treatment that he’s going to need.
“These patients are great people, they really appreciate what you’re doing for them,” he adds. “You know, they need the dental care to survive, quite honestly.”