Summit and local groups focus attention on oral health, a big problem for Kentucky and one that can hurt overall health

By Sarah Vos and Al Cross
Kentucky Health News

When it comes to dental health, Kentucky is down in the mouth. It ranks among the worst in the nation, with high numbers of working adults who don’t have all their teeth, and a high percentage of children with untreated tooth decay.

These and other unflattering facts about the state’s dental health, and ways to change them, were part of frank discussions at the Kentucky Oral Health Summit in Lexington on Wednesday, May 11.

Part of the problem is that Kentucky doesn’t have enough dentists to serve its population, especially in rural areas. (New York Times photo by Stephen Crowley: A student awaits treatment at First Kids Dental in Barbourville.)

“We don’t have enough dentists to fight basic disease,” said Julie McKee, dental director for the state Department of Public Health.

For those who rely on Medicaid, including more than 460,000 Kentucky children, dentists are even harder to find. Only 25 percent of dentists in the state regularly take Medicaid patients, McKee said.

Another part of the problem is a basic lack of understanding about oral health and its role in overall health, several participants said.

Research has shown that gum disease and cavities are closely related to other health issues and that a healthy mouth is key to a healthy body. Diabetes, heart disease, and premature birth are all associated with poor oral health. In children, poor oral health can affect school performance.

“Healthy teeth don’t hurt,” McKee said. “Sick teeth hurt. People with sick teeth can’t learn.”

In some parts of Kentucky, local and regional oral health coalitions are working to raise awareness about the problem and encourage people to get dental care. They face many obstacles.

A large number of Kentuckians don’t have dental insurance, and dental bills paid with private funds can be expensive. Inside the dental profession, there are turf battles between dentists, dental assistants and dental hygenists.

The Oral Health Summit attracted dozens of representatives from county and school oral-health programs and public-health clinics, and some dentists. However, no one from the Kentucky Dental Association, which represents practicing dentists, attended the conference.

Mike Porter, the association’s director, said that the group’s leaders could not attend because they were all in Washington at a national leadership conference. Porter said that the KDA was “totally committed” to improving the state’s oral health. “It was just a logistics issue,” he said.

To increase the number of kids getting preventive care, mobile units visit schools to examine and treat children during the school day. But these efforts are sometimes opposed by dentists who worry that the competition will hurt their businesses.

“The dentists are concerned these mobile units are going to come in and take their clientele,” Teresa Morehead, a Lawrence County school nurse, said in an interview. “Right now, they’re not anybody’s clientele.”

School-based programs are also hindered by the fact that many parents don’t understand the importance of baby teeth to long-term oral health. Parents think that because baby teeth fall out, it doesn’t matter if a child gets a cavity, McKee said, but baby teeth hold spaces for the adult teeth, allow children to eat a variety of foods, are used for speech, and affect children’s self-esteem.

“They don’t understand the importance of needing that follow-up,” said Felicia Elliott, a nurse and health specialist for the Audubon Area Head Start in Western Kentucky. “They don’t understand how it will affect their future life.”

But these workers on the front lines of children’s health often have trouble finding a dentist who will take new Medicaid patients, or ones who will see patients who can’t afford to pay.

Stacy Trowbridge, who runs the Barren River District Health Department’s dental services, said she often sees children with severe problems who need more care than she can give in the mobile clinic. One boy, for example, had 17 cavities and was in the nurses’ office every day because of tooth pain. But Trowbridge couldn’t find a dentist who would take him, and his parents couldn’t afford to pay for the care on their own.

“We don’t know where to send them,” Trowbridge said.

Another barrier to improving oral health in Kentucky is that many nurses and doctors have not been taught to look inside patients’ mouths, visually examine their teeth and identify problems.

“If you’re not trained, you’re not comfortable,” McKee said. She that is part of the “headless horseman of health care,” which also includes the limited extent of insurance for dental and mental health services and eye care.

The conference attendees, who were working on the state’s strategic plan for oral health, identified several things Kentucky could do to improve its oral health. These included expanding the services dental hygenists can provide, educating communities and legislators about the importance of oral health, and getting high-profile figures such as athletes to promote good oral health.

The goal, McKee said, is to change attitudes and help Kentucky’s citizens, businesses, and policy makers see the value of oral health and realize that their teeth, baby or adult, are worth keeping healthy.

“Oral health,” she said, “is everybody’s business.”