Lawrence F. Hill
COVID-19 has put up a mirror to our society and our communities, and what is reflected back doesn’t look pretty.
We have seen how where you live, your race, or your income can make you more susceptible to major health problems. We have seen how quickly our health systems can be overloaded and the impact of the lack of access to basic health care services – and that includes dental care.
Many folks postponed dental visits for fear of COVID-19. Dental offices closed for months. But, dental care is more than just about semiannual teeth cleanings. Undetected and untreated oral infections have been associated with adverse pregnancy outcomes, cardiovascular disease, diabetes and other systemic maladies. When precancerous and early cancers of the mouth go undetected, people die.
Surprising to many is that postponed treatment of cavities can also result in serious illness and even death. Such was the case for Kyle Willis, a 24 year-old from Clermont County. Kyle had recently been laid off from his job and could not afford dental treatment. He visited area emergency rooms which had no ability to provide dental care. The infection spread and Kyle died.
Dental offices have been practicing infection control measures, including the use of PPE, for many years. Statistically, in dental offices in which all recommended protocols are practiced, the risk of COVID is extremely low. Do not be afraid to ask your dental professional and observe if they are practicing these safety measures.
Most dental offices have reopened over the past several months. It is evident that some people are continuing to wait to schedule appointments until they feel safer. Yet, it is important to remember that the risk of getting COVID in a dental office is extremely low while postponing care can present considerable risk to one’s overall health. That is a personal choice.
However, there are hundreds of thousands of Ohioans who do not get to choose. Why? Because if they are poor, if they have no dental insurance or are under-insured, if they live in a county with no dentist, if they are Black or brown, if they are enrolled in Medicaid but do not have a dentist nearby who will accept Medicaid patients, if they lack transportation or live in a nursing home, there often is no dental care available to them. COVID has clearly demonstrated that those who are most vulnerable to disease are also the least likely to have equitable access to care.
Dental infections cause millions of hours of missed school and work. Children with toothaches or who go to bed at night in pain cannot learn like their healthier counterparts. Decayed, fractured or missing teeth affect employability. Untreated dental infections among seniors result in tooth loss, soft diets and compromised health.
But there is a high quality, cost effective and successful response to this problem: dental therapists. Dental therapists are midlevel dental practitioners who work in much the same way as nurse practitioners, extending the reach of dental care to areas and populations that have historically lacked access. They receive extensive education and training to provide the most basic dental services such as disease prevention, education, fillings and limited extractions. They are trained by dentists, sometimes alongside dental students, and then supervised by dentists. Their educational programs are accredited by the same organization that develops and monitors the education of dentists and dental hygienists.
While this model is about 17 years old in the U.S., it has been successfully utilized around the globe in the most advanced countries, in some for as long as 100 years. All the studies that have been done report that the quality of care for the services dental therapists are licensed to provide are equal to that provided by dentists.
Twelve states in the U.S. have passed legislation that add dental therapists to the dental care team and the number continues to grow. Just since January, dental therapy legislation has been proposed in several more states. Yet, dental therapists have not been authorized in Ohio.
While some in the dental community have opposed this model of care, there is no evidence to support their opposition. Research has shown that state-licensed dental therapists are well trained to provide high quality, cost effective care under the direct or remote supervision of a licensed dentist.
If we are serious about ensuring that there is equitable access to health care for all Ohioans, dental therapists can be one giant step in that direction.
Lawrence F Hill is a dental consultant for the Ohio Public Health Association, the chair of the National Coalition of Dentists for Health Equity, and the former dental director for the Cincinnati Health Department. If you are interested in more information, or in being a part of Ohioans for Dental Equity’s efforts, please visit: www.ohioansfordentalequity.org.