Although oral health in America has improved greatly over the past few decades, it is far from equitable. For many, access to oral health is out of reach. This is particularly true in Florida where almost 6 million residents live in dental deserts. Among the most impacted by lack of access to dental care are low-income, uninsured and minority families and children who bear the burden of poor oral health at disproportionate rates.
Oral health in early childhood lays the foundation for a healthy life throughout the lifespan. Yet, tooth decay remains the most common chronic disease among children in America. In fact, it is five times more common than asthma. Recent data demonstrates that oral health in Florida’s children is just about the worst in the nation.
One in five children in Florida suffer from treatable dental problems. Among Florida’s Head Start children aged 3-6, the prevalence of untreated decay and dental caries has increased by 15.4% and 6.9% respectively. Florida ranks 6th in the nation for the highest percentage of third-grade children with unfilled cavities.
Florida has the highest percentage of children without preventive dental visits. In 2019, only 41% of Medicaid-eligible children received any dental care, meaning that approximately 1,400,000 didn’t receive any dental care at all.
In a recent report, Florida Institute of Health Innovation conducted focus groups among families of Medicaid enrolled children in Florida to offer insight into Medicaid dental consumer experiences. According to the participants the most common barriers include:
Access to dental care for Florida’s special health care needs population is even worse regardless of socioeconomic status. According to 2020-21 National Survey of Children’s Health, Florida ranks 3rd in the nation for the highest percentage of children (26.7%) with special health care needs without any preventive dental visits in the last 12 months.
A recent report from Florida Voices for Health captured the oral health care access experiences of Floridians with special health care needs. Some of the most common barriers include lack of oral health providers, out of pocket cost, denial and appeal of benefits, unreliable and poor-quality care, and lack of adaptation and accommodation from dental providers. While these barriers are similar to the barriers experienced by other neglected populations in Florida, the difference is that the individuals with special health care needs are especially vulnerable to the effects of poor oral health. Due to their health conditions, it is difficult to maintain optimal oral health. For example, children with developmental or physical disabilities may lack the ability to verbally express dental pain resulting in the condition going unnoticed for a long time.
Individuals with special health care need have unique challenges with varying level of complexity which makes accommodation and treatment difficult. Those with intellectual and developmental disabilities are among the most impacted. Mary oral health professionals in Florida lack adequate educational preparation and clinical experience to successfully treat and manage this population.
The reality is that dental care is one of Florida’s greatest unmet health needs. We lag behind the rest of the country in ensuring that every child has access to quality and affordable dental care. Lack of access leaves our families and children with few options other than seeking care at the Emergency Room (ER).
In 2020, Florida had the highest rate of ER visits for non-traumatic dental conditions (NTDC) for those aged 14 and below (26.7 per 10,000 people) compared to all other states. These visits were highest among Black males and black females. Medicaid was found to be the most likely payer for these visits.
Not only are hospitals not able to treat the root cause of non-traumatic dental issues, but they are typically 6-7 times more costly than an average visit to a dental office. Florida has the highest average charge for ER NTDC visits for children aged 0 years ($1.9K), 5 years ($2.1K), 10 years ($2.6K), and 15 years ($2.6K). Better access will improve oral health outcomes and save money.
These untreated dental problems directly contribute to significant healthcare cost and what’s more, contribute to many indirect costs including overall development, inability to intake proper nutrition and loss of learning hours impacting success later in life.
Poor oral health has been linked to a number of systemic health outcomes: heart disease and heart attack, diabetes, stroke, respiratory health, pneumonia, pregnancy outcomes, HPV, blood pressure and kidney disease. For example, people with moderate to severe gum disease were found to have a significantly increased risk of suffering their first heart attack. Research shows that people with gum disease are twice as likely to have a stroke caused by hardening of large arteries. Furthermore, strong evidence was found of a bidirectional association between diabetes and gum disease where diabetes can increase the risk and severity of gum disease and vice versa.
Florida must stop simple cavities from becoming grave health problems that alter the health and livelihood of our youth throughout their lifespan.