This past year has certainly emphasized how inequities in access to dental care impact overall health. “Oral health impacts more than the mouth,” says Diane Lowry Oakes, chief mission officer of Delta Dental of Washington. “Pain from untreated cavities disrupts learning and work, gum disease can exacerbate chronic health conditions like diabetes, many people hide their smiles due to embarrassment or discomfort.”
The inequities in this arena range across all ages. Oakes explains that, for children, untreated oral disease and painful cavities can affect speech development, nutrition and school readiness. Teachers and school nurses share stories of withdrawn children who they assumed were exhibiting behavioral problems, yet were actually plagued by untreated cavities. On top of that, many children of color experience higher tooth decay rates than the state average. According to Oakes, Alaska Native and American Indian, Native Hawaiian and other Pacific Islander, and Hispanic 2nd- and 3rd-graders are much more likely to have rampant tooth decay (seven or more decayed or filled teeth).
For adults, visible tooth loss or decay impacts can be a hindrance to finding employment. (More than one in four low-income Washington adults say that the condition of their teeth has negatively impacted their ability to interview for a job.) Thanks to the work of oral health advocates and the commitment of the Washington legislature, the state’s Medicaid program does include a comprehensive adult dental benefit. “Although good news,” says Vanetta Abdellatif, Arcora Foundation’s president and CEO, “the program has long been underfunded. Low reimbursement rates have made it difficult for many providers to participate in the program resulting in fewer than 25% of Medicaid-insured adults in Washington receiving essential dental care each year.” In order to help address these challenges and with the goal of improved access to dental care for lower-income adults, earlier this year Washington legislators included a funding increase for Medicaid adult dental in the state budget; increased provider reimbursement rates went into effect on July 1.
“When folks don’t have access to the routine care that many of us take for granted, earlier problems that would have been small fixes balloon into abscesses and lost teeth,” says Andrew Loften, who served as the executive director of The Seattle Housing Authority for nearly nine years. “It changes how people look, how they socialize (or don’t) and the kinds of jobs that are open to them.”
Loften adds that the burden of oral disease is not felt equally in our society. Lower-income adults and Black, Alaska Native and American Indian and Latino adults are disproportionately likely to have had teeth extracted. “This one data point underscores pervasive inequities in opportunity, resources and outcomes,” he says.
According to Abdellatif, a growing body of research points to the link between poor oral health and conditions like diabetes, heart disease, stroke and pregnancy complications. She points out the striking example of the two-way connection between gum disease and diabetes. “This is a powerful example of the compounding impact of racial inequities,” she said, “Systemic racism is a root cause of Black, Indigenous and People of Color populations bearing a disproportionate risk for diabetes, which is in itself a risk factor for severe disease from COVID-19.”
Oakes assesses many factors that impact these racial and ethnic disparities. “We all saw structural racism and poverty drive the stark disparities in COVID infections and death rates. These same factors influence which communities are able to access routine dental care and prevent oral disease. Increasing BIPOC representation within the dental profession is one important way to reach patients that are currently underserved.”
Delta Dental is actively working in this area, while seeking partnerships with others aligned with their cause. They are the corporate funder of Arcora Foundation — the nonprofit led by Abdellatif committed to improving health equity in Washington.
Over the past five years, Arcora Foundation has provided $5.7 million in capital grant funds to support the development, expansion or modernization of 22 dental projects at community health centers, tribal clinics, nonprofit clinics and rural health centers. When fully implemented, these grant-funded projects will result in approximately 142,000 new dental patient visits annually.
Other initiatives range from expanding access to community water fluoridation, a proven public health tool to prevent tooth decay for all, to DentistLink, which is operated by Arcora Foundation and connects users (with a focus on Apple Health enrollees) across the state to dental providers. Arcora Foundation also meets more immediate needs with the SmileMobile, a mobile dental van. Staffed in part by volunteer dental professionals, the SmileMobile has traveled across the state since July 1995, providing services to more than 44,000 patients.
Yet while there are signs of progress, the road ahead remains long. In referencing the state legislature approval of increased dental care payments for adults with Medicaid coverage, Oakes says, “This is a great start to expanding access to dental care for Medicaid-insured individuals, and there is much more work to do to ensure everyone has equitable access to dental care.”
As the state’s leading dental benefits provider, Delta Dental is committed to improving oral and overall health with no one left behind, including funding for Arcora Foundation in its efforts to improve health equity and extending access to underserved communities.