Dental leaders discussed efforts to improve oral health for Floridians at the 2024 Florida State of Reform Health Policy Conference last month.
More than six million Floridians live in dental deserts, according to KFF. And there are 295 dental care health professional shortage areas in the state, Health Management Associates Managing Principal Beth Kidder said.
“Dental health has been neglected,” Kidder said. “There’s very little insurance coverage for oral healthcare. Medicare doesn’t cover it. Medicaid sort of covers it, sometimes for adults in some states, on some level. We are still last in the nation on (Medicaid) children accessing dental care. We’re (only) looking at about 33 percent of children on Medicaid getting any kind of dental care.”
Dr. Astha Singhal—associate professor at the University of Florida’s College of Dentistry and an Oral Health Florida board member—said Medicaid offers very limited dental benefits, if any, for adults in the state.
“In my previous work, I looked at several different states that have tried changing policies in terms of what services are covered,” Singhal said. “We’ve seen that, in several states that have changed policies in both directions, Medicaid adult dental coverage is really critical to ensure basic access to dental care for that population. I think Medicaid adult dental benefits have to be a core part of the solution. Dental care is extremely expensive for anybody, but especially for those with limited means.”
Dr. Tamara-Kay Tibby, dental director for Liberty Dental Plan of Florida, said the normalization of oral problems has served as a barrier to healthcare access as well.
“It’s been normalized. People expect to get cavities (and have) issues with their teeth. No one sees this as something we can actually intervene in, so it can be discouraging. There has to be a holistic integration of medical and dental (care). Dental has to have a seat at the table. It has to be included in any treatment plan. The way we’re doing it now is not working. We’re spending more healthcare dollars than most countries, and we’re having worse outcomes.”
— Tibby
Dr. Frank Catalanotto, founder and president of Floridians for Dental Access, said the organization is focused on supplementing the dental workforce, specifically by advocating for the addition of dental therapists to the state’s workforce. Both Senate Bill 1254 and House Bill 1173 would have created a new licensed dental provider position (dental therapists) in Florida, but both bills failed during the legislative session in March.
“Dental therapists are mid-level providers; 14 states have adopted dental therapy,” Catalanotto said. “They’re actually working in six states. It takes a couple years to get the educational programs going. The two states with the longest history (with dental therapy) are Alaska and Minnesota. Dental therapists, with their lower salaries (and) limited scope of practice, can improve access, and have in other states.”
Betty Kabel—past president of the Florida Dental Hygienists Association and the American Dental Hygienists Association—said she worked with other states as they developed dental therapy guidelines, along with the Commission of Dental Accreditation as it developed standards for dental therapy programs.
“It’s very much a vital solution to this big problem. If I had a dental therapist working in our FQHC (federally qualified health center)—we have three dental centers—and if we could have several dental therapists in each one of our centers, it would be a tremendous help. Because we could have another provider actually providing care, rather than [working on] a simple extraction.”
— Kabel
Many Minnesota organizations that initially opposed dental therapy are now benefiting from the position, Kabel said.
“It’s a win-win because they’re seeing the population that really needed the care,” she said. “You also have dental hygienists who are dual-licensed (as dental hygienists and dental therapists), so they’re utilizing that provider to do multiple services. It expanded their ability to see more patients.”
Medical/dental service integration could also help with workforce supplementation, Kabel said.
“If you could have dental hygienists working side by side with providers to work on preventing this disease, that would really help,” she said. “There are dental and medical (providers) in FQHCs. But interestingly, they don’t always talk to each other, even though they’re in the same building.”