Rural America is running out of teeth
West Monroe, Louisiana (InvestigateTV) – Dentist Ronald Stratton drives approximately 50,000 miles in his car each year to fight tooth decay in one of the most disadvantaged areas of the United States
Stratton is the only dentist in the parish of East Carroll, Louisiana, where nearly half of its residents are poor.
At 7:30 a.m. every weekday, Stratton drives his gold GMC Yukon to his dental clinic, an hour and a half from his home.
“If I ever left I think it would be very difficult to have another practicing dentist here,” Stratton said.
Lack of access to dental care plagues many rural parts of America.
Nationally, 229 counties in the United States did not have a single dentist in 2019, according to federal data.
The federal government has designated 476 counties as dental shortage areas, 107 of which are in the Appalachian and Delta regions, including the parish of East Carroll.
This lack of access can lead to tooth loss and potentially other health problems such as heart disease.
“It really is a mirror of overall health,” said Daniel W. McNeil, clinical professor of dental practice and rural health at the University of West Virginia.
In the United States, nearly 14% of seniors have lost all of their teeth. In the Appalachian and Delta regions, almost all counties exceed the national average.
In East Carroll Parish, where Dr. Stratton practices, nearly 40% of seniors have lost all of their teeth, the fourth highest percentage in the country.
Over the past three decades, Stratton has claimed to have extracted over 40,000 teeth and performed more root canals than he can remember. He sees about 8,000 patients a year.
When Stratton started seeing patients in 1990, he never planned to stay in the parish as there were two other dentists in the area.
But then they left, leaving Stratton as their sole supplier. He said he had to stay for the sake of the residents.
In the parish of East Carroll, the need for oral health care is great.
It leads the country with the lowest percentage of adults having seen a dentist in the previous year – 33.9%.
Two of the parish’s four public drinking water sources are non-fluoridated, which helps prevent tooth decay.
And, because such a high percentage of the population lives in poverty, residents have to pay a lot out of their own pockets for oral health care.
Medicaid, insurance for the poor and the disabled, does not cover some procedures or fully cover others.
In Louisiana, for example, it does not cover the cost of root canals after the age of 21. He doesn’t pay for braces. And Medicaid reimbursements to dentists have stagnated for decades, Stratton said.
Many of his Medicaid and uninsured patients cannot afford to see an oral surgeon for tooth extractions, leaving the job to Stratton.
“In many cases, these teeth have to go away,” Stratton said. “I’m just happy that I can sort this out for them. “
Meeting the need for oral health care in the region
Stratton solved Margaret Sheppard’s problem.
After losing his teeth years ago, Sheppard received dentures for his upper teeth thanks to Medicaid.
But they never adapt properly. With these teeth, she was in constant pain and could not chew properly. Her dentist at the time could not help her.
She started looking for a new dentist and found Stratton 35 minutes from her home.
Within weeks, Sheppard, 72, had a new prosthesis and a big smile.
“I kind of gave up,” Sheppard said. Her former dentist, “just couldn’t do it right.”
Now she’s resumed eating her favorite foods: burgers, neck bones, and pig’s trotters.
Sheppard knows her tooth loss could have been prevented if she had received regular oral care. Like millions of Americans, she avoided annual exams.
According to the Centers for Disease Control and Prevention, about 40% of Americans between the ages of 18 and 64 forgo an annual visit to the dentist.
In the Delta region, where Sheppard lives, more than half of adults have not seen a dentist for at least a year.
Sheppard said she was never able to find the time for dental visits. She had six children to raise and a job in a retirement home, where she worked 16-hour shifts.
Everything has changed now. She’s a regular at Dr Stratton’s office.
“We won’t let him go,” she said. “He’s going to stay here.
Oral health prevention starts with children
The key to a life of healthy teeth may be to simply set aside time during the school day for children to brush their teeth.
And, researchers at the University of Pittsburgh-based Center for Oral Health Research, said a pledge could save taxpayers billions of dollars.
“Poor oral health, especially cavities or dental caries, results in many hours of lost time at school, loss of work… and this puts children on a path of having poor oral health. dental all their lives, ”said Mary Marazita, director of the Center for Craniofacial and Dental Genetics at the University of Pittsburgh.
In 2001, Marazita and Daniel McNeil, clinical professor of dental practice and rural health at the University of West Virginia, obtained funding to study the status and socio-economic factors of Appalachian children in their respective states. For the past two decades, they have followed children from the womb until they are around six years old.
Their results showed that early prevention is the main driver of good oral health.
“Dental disease doesn’t require huge programs, but simple things that can easily be provided in a school setting,” Marazita said.
According to a 2017 report from the South Carolina Rural Health Research Center, rural children were less likely to receive preventive dental care than urban children and were also less likely to report having excellent or very good teeth.
Many barriers exist for rural residents, said Marazita and McNeil. Some may lack transportation or time to take off from work. Some live in states such as Arkansas that do not have a dental school, which provides no local pipeline for dentists.
Many residents live in areas where there are too few dentists – let alone who will accept Medicaid due to limited reimbursements that make it difficult to run a business.
According to 2018 data from the American Dental Association, about two-thirds of all dentists in the United States have not served any publicly insured patients.
“We should have a reimbursement system for oral health care providers that allows them to provide the best service for each patient,” McNeil said.
Last year, West Virginia passed a bill expanding dental coverage for adults under Medicaid, adding $ 1,000 in coverage for adults to receive additional dental services.
For many families, this can mean finally tackling serious oral health issues.
In addition to federal government programs, preventive oral health care done at home and at school, fluoridation has contributed to tooth decay.
“Over several decades, having fluoridated water has proven to be a major public health success in terms of preventing cavities,” said Marazita.
But too many people now depend on bottled water, which does not contain fluoride, to quench their thirst. Marazita calls bottled water “one of the triumphs of marketing”.
It is also a victory for cavities.
Lack of fluoridation in water systems
The CDC hailed the addition of fluoride to public drinking water sources as one of the top 10 public health achievements of the 20th century.
Even so, the water that at least 49 million U.S. residents consume – about 14% of the total population – does not contain the important decay-fighting agent, according to CDC data.
“We know that in communities that have fluoride, they can see an average of 25% less cavities than communities that don’t,” said Tracy Boehmer, CDC fluoridation engineer.
The CDC does not require states to report the number of public drinking water systems that are fluoridated. But 32 states are voluntarily sending this information to the CDC, involving more than 33,000 water supply systems in the United States.
Of these, more than 60% of them do not add fluoride to the water.
In Louisiana, 88% of drinking water systems lack fluoridation. In California, it’s 89%. And in Alaska, it’s 95%.
“This can be prohibitive for many small communities,” Boehmer said. “Mainly because regardless of the initial cost, but also for the operation and maintenance of the new equipment. “
To cater for these small communities, the CDC helped develop a fluoridation tablet that can be added to water supply systems that previously couldn’t afford to pay for it.
The system is being tested in White County, Georgia.
KC Industries, which developed the tablet, said that if the new water supply system was used in an area of 5,000 people, it would cost each person $ 1 per year to keep fluoridation in the system.
Combined with the fluoride systems already in place and this new technology, the CDC estimates it has the capacity to reach 90 million people.
Such a move could help many people like those served by Dr. Stratton in northeast Louisiana, where dentists are scarce.
“The people here have been so good,” Stratton said. “But there is a lot of need.”
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