Dental care is unmet need for too many

By Marcia Wharton, MD

Affordable and timely dental care for adults is important for their health and it also saves money, but there is a huge unmet need in Snohomish County and across the state.

The most recent Needs Assessment released by the Snohomish County Department of Emergency Services identified affordable and timely dental care for adults as the most common unmet concern in the county. The annual study, designed to help public and private agencies plan for service delivery, is based on a survey of people representing about 1,500 lowincome households.

The need is acute. When several dental offices in Everett opened their doors recently to provide a day of complimentary dental care to people in need, they saw lines of people wrapping around the buildings. Unfortunately, many in desperate need of care had to be turned away when time ran out.

At Providence Everett Heathcare Clinic, we provide care to all, regardless of their financial situation. We treat patients covered by Medicaid as well as uninsured patients. I see patients every day who are suffering from untreated dental disease. It is tragic and unnecessary because dental disease is preventable.

Health professionals and other interested people and organizations gathered in Everett Dec. 14 for Laying the Foundation: Improving Access to Dental Care by Uninsured or Under-Insured Adults in Snohomish County, sponsored by the Snohomish Health District. One potential solution discussed was restoration of dental benefits for Medicaid-eligible adults by the Washington state Legislature.

The Legislature eliminated oral health coverage through Medicaid for most low-income adults in 2011, leaving about 450,000 people without insurance, and also eliminated funding support for local programs that provide dental care through community health centers that serve the uninsured.

The lack of dental care affects people’s health, quality of life and even their ability to get a job. Still, in tough economic times, people with low incomes and no dental insurance often postpone care until their dental disease is so acute that they can no longer stand the pain. With few options these people often end in an emergency room hoping for some relief. But ERs can only provide temporary relief from the pain and perhaps provide an antibiotic for an infection. The patient is likely to return when the underlying dental problem flares up again.

ER care is also much more expensive, and the result is often a huge amount of uncompensated care, the costs of which are passed on to government, taxpayers and people with insurance. Over one 18-month period, 54,000 dental-related visits to ERs in Washington cost more than $36 million.

The Snohomish Health District Dental Resource line receives over 400 phone calls a month, mostly adults, looking for affordable dental care. In 2011, the Providence Hospital Emergency Room had over 2,500 visits for dental emergencies, mostly adults who received temporary relief of dental pain and infection.

Poor oral health has been linked to heart disease, stroke and diabetes. In fact, one-third of people with diabetes nationally suffer from severe oral disease. Untreated gum disease can make it hard for diabetics to control blood sugar and can lead to costly complications including blindness, amputation, heart disease, kidney disease and hypertension. About 60,000 Medicaid-insured adults in our state have diabetes, but most have no dental coverage because of the 2011 state budget cuts. When diabetics receive regular dental care, overall medical costs are cut, on average, by $3,200 a year per patient.

Restoring dental coverage for Medicaid-eligible adults would help reduce the strain on ERs and reduce costs by promoting early intervention and preventive care. Providing dental care at the right time in the right setting is a good investment. It is cost-effective to treat dental problems before patients end up seeking care in emergency rooms and hospitals.

Dr. Marcia Wharton is a family practice physician at Providence Everett Healthcare Clinic.