PennWell Dental Community
Dental care in America divides people into two camps: those who can afford regular preventive care and cleanings, and those who can’t.
In 2011, 33.3 million people in the U.S. lived in health professional shortage areas, [PDF] which means that they have no access to dental care. As of May 30, 2012 that number rose to more than 49 million Americans, according to the Department of Health and Human Services.
These so-called dental deserts contribute to a deep disparity in overall health. People who live in these places are more likely to get tooth decay and develop severe health problems. They also spend more money on care, and more time seeking health assistance in an emergency.
Why Do We Have Dental Deserts?
It’s not for a lack of dentists, said Dr. Bill Calnon, president of the American Dental Association, who told FRONTLINE that the number of dentists in America is actually expected to increase over the next few years.
But dentists often graduate with heavy debt, so they tend to set up practices in populated areas where they can attract more patients who pay. That means rural areas are out: There are too few people coming in to make a profit. And areas with high poverty means that would-be patients are often on Medicaid, which means low profit-margin payouts for dentists.
Medicaid covers children and some procedures for adults, but the rate of coverage is left to states — and varies widely. For example, Medicaid pays $150 for a comprehensive oral exam in Maine, and $29.37 in Idaho, but nothing in Arkansas. For a child’s cleaning, Alaska pays $62.40, Kansas an even $30. Florida offers $14. (The Kaiser Family Foundation provided us with a full list of Medicaid payments for various procedures by state — see it here.)
Even those benefits are under threat: 13 states have said they cut dental benefits in 2011 amid the economic crunch, or plan to this year, according to research [PDF] from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.
To compound the problem, dental care is most effective — and least costly — when it’s routine. Preventive care is relatively cheap, and can catch small problems before they become serious. Studies show that children who see a dentist in their first year of life spend about 40 percent less in their lifetimes on dental care, according to Calnon.
“Health disparities are costing this country millions and millions of dollars, because low-income people are being diagnosed much later,” said Henrietta Logan, a professor at the University of Florida College of Dentistry who directs a health disparity center funded by the National Institute of Health.
The state-by-state map below shows the percentage of people without access to dental care using data from the Kaiser Commission on Medicaid and the Uninsured. You can check your county too, in this regularly updated database run by the Department of Health and Human Services that identifies Health Professional Shortage Areas (HPSA), which lack primary medical or dental care providers.