Dental Care (and Lack Thereof) in Rural America

By DON ROLLINS

It’s not the first time I’ve received a call to reschedule my regular checkup. So sorry to move you again, but someone has a dental emergency. Could we look at next week?

My puffed up, middle class entitlement notwithstanding, I’ve learned to roll with these occasional inconveniences. This is small-town Appalachia where dentists are in short supply, and those who accept Medicare are a vanishing commodity. Truthfully, how pissed can I be at a guy who’d rather risk losing full-ride patients than turn his back on the hurting folks at the economic and social margins of my hometown?

Sadly, this dearth of dentists in rural areas extends well beyond the hills and hollows along the Appalachian chain. A Pew study from 2015 predicted shortages of dental professionals in every state within a 10-year window; and estimated only one-third still accept any form of public insurance.

Increasingly left to fend for themselves, low-income rural Americans are much more likely to turn to hospital emergency rooms and urgent care clinics when dental crises arise. Pew estimates the cost at $1.6 billion annually — an astronomical number given that while ER staff can assist with immediate pain relief, those patients (over half, children) remain caught up in a health care system that will treat their symptoms but not the underlying conditions.

Yet even as some states experiment with reforming the current model for delivering dental services to less populated regions, it’s the rare legislator that factors for the impact of rural poverty itself: increasing the number and scope of providers is of little consequence when patients are without reliable transportation, backup childcare, flexible work hours or insurance of any kind.

Clearly, any attempts to alleviate this kind of suffering must be holistic. A sampling of the strategies some states have initiated includes:

• Training “midlevel” dental professionals to be embedded with ERs, walk-ins and mobile medical teams;

• Creating dental “vouchers” similar to those issued for food and other government-sponsored programs;

• Contract with/create area transportation options, such as shuttles, to convey patients to and from services;

• Contract with dentists to make regular rounds to schools, community centers and assisted living facilities;

• Develop the role of technology in prevention education, locating providers, prep and follow up instructions, obtaining records, etc.

Predictably, revenue sources for these rural innovations are few and “soft”: Big Medicine and Big Health Care have little to gain with so few consumers in play. Same with elected officeholders and their more thinly populated districts.

But while supporters of better oral health for rural America can’t go lobbyist-to-lobbyist with the medical and health care monoliths, they can join the majority of Americans fixed on further health care reform, single-payer or public/private. They can get to know progressive candidates’ plans in detail, and get behind the one most aligned with the unique needs of under-resourced ruralites.

Don Rollins is a Unitarian Universalist minister living in Hendersonville, N.C. Email donaldlrollins@gmail.com.

From The Progressive Populist, September 15, 2019

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