Improving Oral Health Literacy and Access in Kentucky

By John Gregory | 5/21/16 9:00 AM

The commonwealth’s alarmingly high rates of cancer, heart disease, diabetes, and obesity are well known. But another medical problem that doesn’t get as much publicity is just as critical to the well-being of Kentuckians: oral health.

Two representatives from the Kentucky Oral Health Coalition appeared on KET’s Connections to discuss the importance of having good teeth and efforts to address the oral health challenges in the state. Dr. Laura Hancock Jones is a dentist with the University of Kentucky College of Dentistry’s Western Kentucky Dental Outreach Program, and Lacey McNary is a health policy consultant in Louisville.

Loading video player...

The Roots of Poor Oral Health
Consider a few facts: 40 percent of Kentucky children have never been to a dentist. One in four older Kentuckians don’t have their original teeth. In 2011 alone, some 16,000 uninsured or underinsured citizens went to their local emergency room for dental care. Poor oral health can contribute to other physical problems like diabetes, cardiovascular disease, and possibly even Alzheimer’s. It can impact how students learn.

“There’s thousands of children on a daily basis attending school with pain that is totally preventable,” McNary says. “It is really hurting them with their success rates in school and otherwise overall well-being.”

McNary and Jones attribute Kentucky’s poor oral health to a variety of factors. First, there’s a lack of access to dentists. Jones says 42 percent of all the dentists licensed in the state work in either Fayette or Jefferson Counties. As a result, people who live in poorer neighborhoods and rural counties may have to travel significant distances for basic dental services, if they can get transportation to those practices. Another issue is that not all dentists accept Medicaid patients, which can limit access for impoverished Kentuckians.

Other factors include tobacco use and diet. Jones says individuals who smoke are six times more likely to develop periodontal disease. And she says foods rich in carbohydrates and beverages that are high in sugar create the perfect breeding ground for bacteria that feed tooth-eating acids.

“The key point about oral health is you need to maintain that balance, so when things swing out of kilter in our mouth, it affects the environment in which the bacteria live,” Jones explains. “With the shift of acid in the mouth, it can really cause a lot of tooth decay to advance very rapidly.”

Finally, Jones says there’s poor dental hygiene. She says studies show that almost a third of the population never flosses, and brushing and flossing twice a day is recommended. She adds that fear also contributes to bad oral health outcomes.

“Dental and mental go together,” Jones says. “The fear and anxiety of dental treatment is real and it keeps people away until they are in that disaster-care mode.”

Improving Oral Health in the Commonwealth
The Kentucky Oral Health Coalition was originally formed in 1990 as a collaborative of the dentistry programs at the Universities of Kentucky and Louisville. The coalition has advocated for dental health policies, conducted an extensive oral health survey, and developed the Smile Kentucky! educational curriculum and dental health program for schools.

The coalition fell dormant in 2006 but was revived in 2010 under the auspices of Kentucky Youth Advocates. Now, the coalition is completing a statewide dental health survey – the first for the commonwealth in 15 years. Jones says the results of that survey will be released in the fall and will help inform new initiatives the group hopes to pursue. McNary says their top priorities include getting oral health coverage added as a benefit to Medicare and increasing the number of dentists who accept Medicaid.

“We are really interested in trying to create a better environment for dentists who want to serve and can serve low-income patients, whether it’s increasing the reimbursement rate for them or making it easier for them to sign up into the Medicaid system,” McNary says.

Expanding Access to Rural Areas and Children
The Kentucky Oral Health Coalition also advocates for more financial assistance to dental students. Jones says UK and U of L have state-sponsored dental school loan repayment programs, and she says some graduates are receiving incentives to locate in Appalachian communities. Jones says she’d like to see that program expand to cover other rural areas, including western Kentucky where she works.

Jones also wants to see more oral health programs in primary and secondary schools in Kentucky. She says 72 percent of districts have some sort of oral health initiative, but most of those are screenings performed on kindergarten children. Jones says 20 percent of school-based programs provide on-site screenings and only 16 percent of schools offer comprehensive dental care services.

The coalition also seeks to expand an initiative in which students have a protective sealant applied to their permanent molars. Jones says 40 percent of schools offer the program, which has shown to be highly effective in preventing tooth decay.

“Our safety net is growing, but the sustainability of those programs is always in jeopardy,” Jones says.

“Prevention really is a very low-cost solution to a lot of these problems,” adds McNary.

Read a comprehensive spring 2016 report on Kentucky’s oral health from researchers at SUNY-Albany.

foundation_logo2013This KET production is part of the Inside Oral Health Care initiative, funded in part by the Foundation for a Healthy Kentucky.