The Dental Divide
Practitioners help patients overcome lifelong bad habits and restore smiles
In his four years at the Red Bird Clinic, Inc., Collins has treated patients who’ve lost all their teeth to substance use, or who ask him to pull healthy teeth in order to secure prescription painkillers. Others struggle because they’ve developed poor dental health practices. “In 2019, I put dentures on five children 15 years old and younger,” he says.
He’s also worked with recovering meth addicts trying to turn their lives around, “but they couldn’t get jobs because their teeth were so bad, they were still identified as addicts,” Collins says. “Nobody would hire them. Nobody would pay for their dental care. And they’d go back on drugs again.”
He tries to meet the needs of patients facing the greatest struggles, while also performing plenty of general teeth cleanings and cavity-fillings. The clinic is located in the middle of a poverty-stricken area and serves patients from all income levels. Collins is one of about 2,100 practicing dentists in Kentucky and many of them tell similar stories, with the common theme that the oral and dental health issues many patients have result from both individual habits and systemic challenges.
A 2020 analysis by WalletHub ranked Kentucky 43rd in the nation in oral health. According to a report from the American Dental Association and the Health Policy Institute, Kentucky is below the national average (though not dramatically) in categories like these, for example:
• Adults with private dental benefits coverage: U.S.—59%; Kentucky—53%.
• Children with private dental benefits coverage: U.S.—64%; Kentucky—62%.
• Number of dentists per population: U.S.—60.5%; Kentucky—56.6%.
Kentucky’s dentists, hygienists and dental health specialists (such as orthodontists, periodontists and oral and maxillofacial pathologists) are working to improve Kentucky’s numbers, one patient at a time, often with the help of partner organizations, including the Cabinet for Health and Family Services’ Oral Health Program, the Kentucky Oral Health Coalition and the Kentucky Dental Association (KDA), to name a few.
Garth Bobrowski is past president of the KDA and has been a practicing dentist in Greensburg for 40 years. “I have had many patients who are drinking 10-15 soft drinks per day or drinking three 2-liters of soft drink per day,” he says. Patients sometimes arrive at his office carrying a 44-ounce soft drink. “I ask how many of these 44-ounce drinks do you have in a day? The answer: ‘All day and most of the night.’ Folks do not even know how many they are consuming.”
The role of poverty
Bobrowski has found that another barrier to better dental health is poverty. Many Kentuckians lack health insurance or don’t visit the dentist out of fear that the cost of dental care will be too high.
“Rural areas, especially where businesses have closed, (along with) inner cities, tend to have a lack of good-paying jobs or there may be jobs that do not provide dental insurance,” Bobrowski says. He recommends that people “talk to their dentist about planning their oral health needs and how to finance their care. Just be honest and realistic. … Many offices offer in-office savings plans or payment plans. Just ask.”
According to the Cabinet for Health and Family Services, about 1.6 million Kentuckians (more than one-third of the state’s population) receive Medicaid, the combination state-federal health insurance program that covers some dental services. However, the reimbursement rates for dentists are so low that many dentists lose money treating Medicaid patients. As a result, some dentists no longer accept Medicaid, or aren’t scheduling new Medicaid patients. In some cases, changes in how Medicaid is administered have contributed to reducing access to dental care.
Rachel Naylor is an orthodontist in Maysville. She says, “When I started practice 16 years ago, about 25% of our patients had Medicaid, but at that time all children that had a moderate to severe need for braces would qualify.” Changes in eligibility requirements mean that’s not the case anymore, she says: “Most recently, only about 10 (Medicaid) patients a year in our practice met the criteria for orthodontic treatment.”
Broader health issues
The University of Kentucky College of Dentistry (UKCD) and University of Louisville School of Dentistry (ULSD) are among the entities working to help provide greater access to dental care throughout the commonwealth. (See sidebar at right.) Even among those who have access to dental insurance, there are challenges, like the anxiety people feel about going to the dentist, as well as a general tendency to downplay the importance of dental care.
“The mouth is the gateway to the rest of the body. When you treat your mouth poorly you more than likely are treating the rest of your body the same way,” says Pineville dentist Audrey Kinder, a recent UKCD graduate.
Further, dental health and overall health overlap. Dentists sometimes find evidence of serious health issues like gingivitis, diabetes, heart conditions and worse while inspecting teeth and gums. Kinder recently diagnosed a young patient with oral cancer. “As I looked at this child’s panoramic radiograph, I just cried and had to gather myself before returning to the room he and his mother were sitting in and waiting on me,” she says.
Compassion and empathy are essential to doing this job the right way. That’s the approach many dentists take, particularly Red Bird Clinic’s Collins. One of his patients, Roger Smith, a Jackson Energy Cooperative consumer-member, says he appreciates the way Collins, his assistants and students put patients at ease. “I like the staff,” he says, “They treat you like a person instead of like a number.”
Collins says putting people at ease is part of the mission, one that comes naturally to him. “I was a holler kid,” he says of his own childhood in rural Pike County. “We were dirt poor.”
When he sees patients suffering, particularly if they’ve neglected their own health, “I try to talk to them about the choices they’re making,” he says, “That’s what you’ve got to do to try to change people. You can’t be above them. You’ve got to be with them.”
Dental Health FAQs
In gathering the material for this story package, Kentucky Living assembled a list of key questions and answers related to basic dental health. Sources include a variety of Kentucky dentists as well as online information from the American Dental Association (ADA) Mayo Clinic, WebMD, Healthline and others.
How often should I brush my teeth?
Twice a day for two minutes each time with a soft-bristled toothbrush and an ADA approved fluoride toothpaste. Soft bristles actually clean your teeth better than hard bristles.
How hard should I brush my teeth?
Plaque is soft, so scrubbing isn’t necessary. Instead, it’s best to use small circular strokes on each tooth and on every side of each tooth.
When should I brush my teeth?
In the morning and before bed are best. If you’ve eaten an acidic food, don’t brush your teeth immediately. The acids weaken your tooth enamel and brushing too soon can remove enamel. If possible, wait about 30 minutes before brushing.
What kind of toothbrush should I use?
Soft bristled, and it should fit so that you can reach all areas of your mouth. Electric toothbrushes appear to remove plaque better than manual toothbrushes and electric toothbrushes can be especially helpful if you have arthritis or trouble holding a toothbrush.
How often should I replace my toothbrush?
Every three to four months or sooner if the brush is frayed.
What happens to my teeth when I have a soft drink?
The combination of sugar and acid in soft drinks like Mountain Dew, or even juices and juice-based products, for example, are particularly damaging when consumed throughout the day because they eat away at tooth enamel and create openings for cavities and decay.
If you’re going to consume acidic juices and sugary soft drinks, dentists recommend doing so no more than once a day, ideally using a straw to limit the exposure of your teeth to acids. Bonus points if you rinse your mouth with water afterward.
What happens if I put sugary drinks in my child’s bottle or sippy cup?
This is a terrible idea for your child. When a baby or toddler’s teeth have frequent and prolonged exposure to sugary and acidic drinks, as well as milk and formula, the acid attacks the teeth and gums. Over time, this can cause tooth decay.
Children also should not keep bottles or sippy cups with sugary drinks overnight or for any extended time because prolonged exposure to sugars and acids will damage their teeth.
How important is flossing?
Flossing’s primary benefit is to remove food from the gaps between teeth that can attract bacteria, which can form plaque and cause cavities and gum inflammation. Toothbrushes can’t reach the narrow spaces between teeth so flossing or another device (such as an interdental toothbrush or water flosser) are the only ways to remove food particles. The ADA recommends consumers look for its seal on any dental products, indicating the ADA has reviewed the product and determined it’s effective and safe. Bottom line: flossing (or other activity to remove food from between teeth) is important.
UK and UofL reaching out to provide dental services
One barrier to better oral health for Kentuckians is that parts of the state, particularly the counties farthest east and west, don’t have enough dentists and dental health professionals.
That’s why the University of Kentucky College of Dentistry (UKCD) and University of Louisville School of Dentistry (ULSD) are both involved in efforts to increase dental care access for Kentuckians who live far from the schools’ campuses.
For example, four years ago, the UKCD opened the University of Kentucky Dentistry West Regional Clinic in Benton in partnership with the Marshall County Health Department. It’s one of several clinics and other outreach programs the school provides in Kentucky communities, including Madisonville, Hazard and Lexington.
UKCD also is doing education outreach in advance of launching a free oral cancer screening program serving Pike, Letcher and Harlan counties, where rates of oral cancer are as much as 54% higher than in the rest of the state.
UKCD spokesperson Ann Jarvis says the school’s goal is “to take care of the oral health needs of the people of Kentucky.”
Carrie Hopper is dental assisting program coordinator and dean of Allied Health and Personal Services at West Kentucky Community and Technical College (WKCTC) in Paducah. “In our service region area, there are shortages of dental specialists, like periodontists, endodontists, dental laboratory, etc.,” she says.
To help address that need, WKCTC is working with the ULSC, which sends fourth-year dental students to the college every month during the school year to treat underserved children in the service region.
In addition, ULSD and WKCTC plan to open a dental clinic in Paducah in 2021. “The clinic will serve both pediatric and adult patients,” Hopper says. “The focus will be on adult patients in our service area who are underserved and underinsured; the clinic will accept Medicaid, private insurance and self-pay.”
As part of its outreach efforts, ULSD sends dental students to work and learn at the Red Bird Dental Clinic in Clay County. Alex Stewart, a fourth-year ULSD student who grew up in Louisville, had never been closer to Red Bird than Red River Gorge Geological Area before a recent stint at the clinic. He described it as “fast-paced” and has gotten valuable experience performing a variety of procedures: “Extractions, fillings, dentures, partials, cleanings,” he says. “I definitely recommend it.”
The trips also reinforce one of the basic lessons of dentistry work—the common humanity of all patients. People may come from different places, backgrounds and cultures, but once they’re in the dentist’s chair, Stewart says, “Everyone’s mouth is the same.”
Dentists and COVID-19
COVID-19 forced dental offices to close in March and prompted dentists to adapt their practices so they could safely reopen and continue seeing patients. The Kentucky Board of Dentistry has guidelines that include health screenings, mask-wearing and cleaning procedures.
Maysville orthodontist Rachel Naylor says, “The assistants and doctor have to wear a more substantial level 3 mask all day due to our proximity to patients. It’s a little difficult to get used to breathing in it at the beginning of each week.”
One ally for dental practices that need to stock up on personal protective equipment (PPE) has been Delta Dental of Kentucky. The nonprofit dental insurer has distributed personal protective equipment to more than 2,000 Kentucky dentists and made a special donation of $350,000 to free dental clinics throughout the state. “Securing PPE was never part of our daily jobs before,” says Jude Thompson, president and CEO of Delta Dental of Kentucky, “but it was worth it.” Delta Dental also offered millions of dollars in advances to dental practices to help them continue operating.
Thompson says that while dental offices had to close for a few weeks in the spring, he hasn’t heard of any practices closing permanently. Patient visits as of late summer were only about 5% below what they were at the same time a year ago, he adds, meaning many Kentuckians are trusting their dentists to manage the added risks of COVID-19.
That’s good news for dentists and patients. “If you’re a person with underlying health issues, forgoing care has consequences,” Thompson says.
Greensburg dentist Garth Bobrowski says while the adjustment to COVID-19 prevention has been challenging for dentists, it’s a task that’s within the industry’s collective experience and expertise. “We adapted through AIDS, MERSA, flu epidemics, SARS, etc.,” he says. “For decades, dentistry has had a great hand on infection control practices.”
Open wide
From information about dental health programs to videos designed to get your kids to brush their teeth, it’s all covered in this comprehensive listing. And learn more about the people and organizations working to help people have healthier smiles in Kentucky and beyond.
Bite down on these resources
Find out why it’s important to get dental checkups, brush your teeth and watch what you put in your mouth. Get this information and more at these websites:
Kentucky Cabinet for Health and Family Services’ Oral Health Program
Kentucky Oral Health Coalition, a dental health advocacy organization.
Where’s the Sugar? This video explains how drinks and snacks impact dental health.
A video for kids explains why it’s important to brush teeth and the best way to do so.
Dental activities for children
The American Dental Association gives advice about caring for your mouth during different stages of life.
WebMD offers tips for finding a dentist and what to look for in a dentist.
Tips for overcoming dentophobia (fear of going to the dentist).
and
www.webmd.com/oral-health/easing-dental-fear-adults#2
Redbird Mission Dental Clinic:
The Kentucky Board of Dentistry’s published guidelines for dental care during COVID-19.
