Oral health and dental care are seeing a decline in utilization and an increase in accessibility inequities in Colorado, yet the legislature has not taken action, according to Colleen Lampron, owner of AFL Enterprises—a public health planning and management company.
She says 1.3 million Coloradans—or 25.1%—lack access to dental insurance and only 28% of the state’s dentists served Medicaid patients in 2018. This causes 40% of Coloradans to not have reliable dental care.
However, Lampron says teledentistry and community-based dentistry could be the answer to tackle inequities and gaps in insurance coverage.
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In 2020, dental utilization fell by 34.4% in Colorado as a result of the pandemic. Without a model for teledentistry throughout the state, many people did not receive the dental care they needed.
In the last legislative session, lawmakers passed Senate Bill 139 concerning reimbursement for teledentistry, but Lampron says the Department of Health Care Policy and Financing (HCPF) “isn’t paying for the full scope of care that could be delivered via telehealth.”
Lampron says the gap in dental coverage especially affects low-income communities. For example, in low-income schools, students have triple the disease rate compared to schools with smaller proportions of low-income students.
“With oral health in Colorado, we don’t really recognize that as a health concern, and we tend to leave it in the hands of dentists who are actually trained to address dental disease.”
Medicaid members have many barriers in accessing reliable dental care. In 2014, the Colorado Dental Association started the “Take 5” program to encourage dental providers to accept five Medicaid patients per year through “incentive payments to help offset some set up costs associated with enrollment, training staff, and learning billing systems.”
Lampron says though 60% of dentists are participating in the program, not all of them actually see Medicaid patients. She says 29% of dentists fall into this category. Of the 28% of dentists who saw Medicaid patients, 5% served 1-9, 12% served 10-100, and 11% served more than 100 patients.
Lampron says Medicaid patients also have barriers due to their ability to find care. She says dental practices are most often located in “more affluent” communities without bus stops. Therefore, a vehicle would be needed for a low-income individual to access care, which she says presents a major problem for many in Colorado.
She also notes that the hours dentists’ offices are usually open is challenging to meet for many low-income individuals who work multiple jobs or cannot afford to take time off to get their children out of schools for an appointment.
To fix these issues, Lampron says expansion and investment in teledentistry is the answer. In this new model of teledentistry, necessary cleaning equipment—like toothbrush and fluoride—is mailed to the patient with instructions on proper brushing, flossing, and fluoride application techniques. The dentist could then teleconference in and further assist the patient while giving expert opinions and consultation on their care.
Lampron says this is especially “powerful” for parents who can take charge of their child’s dental care and have a better understanding of how to keep their child healthy. This allows a healthy child to see the dentist less in-person, which would then give the seat to someone in more need of in-person dental care and reduce traumatic experiences for children at the dentist’s office, says Lampron.
A teledentistry appointment costs only half of what an in-person cleaning costs, says Lampron. These lower costs can help lead to more opportunities for underserved patients.
Lampron says the state needs stronger advocacy and an oral health coalition to get the message across and help change the dental system.