Opinion: Access to dental care depends on your zip code

In March, a prominent annual assessment of health showed just how starkly different life can be county to county, state to state.  It demonstrates that your ZIP code can dictate how long and how well you live. But it also shatters the argument that a dental shortage doesn’t exist in Washington.

For the first time ever, the assessment, known as the County Health Rankings and produced annually by the University of Wisconsin and the Robert Wood Johnson Foundation, includes access to dental care as one of the key measures affecting health in a county.  Oral health is critical to overall health yet thousands of Washingtonians can’t get it.  The Rankings show just how dramatic the disparities are when it comes to getting dental care.

In Skamania County, the ratio of Washington residents to dentists is 11,122 to 1.  Across the state, in Whitman County, it is 3,626 to 1.  For the lucky residents of King County, the ratio is 1,063 residents to every dentist.  

Keep in mind that the rankings, which are nationwide, assess the national benchmark at a ratio of 1,500 patients to one dentist.  In other words, if all counties were to strive for a healthy ratio of dentists, this is the goal.  Skamania County has a long way to go.

But even these rankings don’t tell the entire story.  The Rankings assess the number of dentists available in a given area.  They do not look at whether a patient can afford to pay for that dental care or whether the dentists in that county accept Medicaid payment.  Dental coverage doesn’t necessarily translate into access.

Although four in 10 kids have dental coverage through Apple Health for Kids, a majority of dentists do not take this award-winning coverage.  And nearly half of all kids in the state have untreated dental decay – a condition that should be completely preventable.

Across the state, our overburdened dental care system is failing children and working parents in low-income families, elderly people in nursing homes, people with special needs and people who live in rural and Tribal communities.  Lacking access to routine dental care, their oral disease goes untreated, causing them to suffer and miss work or school while their dental problems get worse.

Dental complaints are the No. 1 reason that uninsured Washingtonians seek emergency room care – a situation that’s only gotten worse since dental care for adult Medicaid was almost completely cut in 2011.  Over 18 months, dental problems accounted for 54,000 emergency room visits in Washington, at an expense to taxpayers of more than $35 million.

Out-of-date laws are keeping Washingtonians from getting the oral health care they need.  Long ago, the medical field saw a need to embrace new providers – such as physician assistants — with different levels of skill to provide the appropriate levels of care where needed.

We should do the same for dental care, and modernize our laws to allow a new kind of mid-level dental provider (MLP).  These new mid-levels would help more Washingtonians get the dental care they need, without long waits.  Working as part of a dentist-led team, MLPs would provide preventive care and routine, everyday services, such as non-surgical extractions and fillings.  That way, dentists could see more patients, and MLPs could practice in communities where there aren’t enough dentists.

Such providers are already practicing effectively in Minnesota.  And in Alaska, they have been able to expand care to 35,000 people in remote areas who never had regular access to care before.  Washington is currently pushing to establish midlevel dental providers and at least half a dozen other states have put forward legislation.

Regardless of where they live, Washingtonians should be able to get dental care.  The new County Health Rankings data clearly show where mid-level dental providers could make a difference.

VHARI RUST-CLARK is the President of the Washington State Dental Hygienists’ Association, an active member of the Washington Dental Access Campaign, a coalition of over 30 organizations and tribal governments working to expand access to dental care for children and families across the state. For more information visit: http://wadentalaccess.com/.