Access to Oral Healthcare for Pennsylvanians with Disabilities - A Rising Public-Health Issue

In Pennsylvania, as in other states, access to oral health care for people with developmental disabilities (among other Medicaid-eligible populations) has become a serious and persistent public-health problem. Although the link between oral health and overall good health is increasingly well understood and documented by the health professions, oral health is often strikingly absent from discussions of public health and health care.

The awkward fit between the dental profession’s predominant business model and today’s public-health infrastructure is creating a troubling trend toward a double standard of oral health care in America. If current trends continue, access issues in Pennsylvania for people with developmental disabilities will worsen. Should that happen, poor oral health will ultimately take an even greater toll on the overall health of hundreds of thousands of Pennsylvanians, with commensurately higher – and often preventable – costs to the Commonwealth’s Medicaid system.

The Unmet Needs
Difficulties accessing oral care are faced by people with developmental disabilities across the country.

  • Dental care represents the number one health care issue among people with neurodevelopmental disorders
  • Dental care is the number one unmet health care need for children with special health care needs
  • Compared to the United States population, people with developmental disabilities have significantly higher rates of poor oral hygiene
  • Research increasingly links chronic oral infections to systemic conditions (e.g. diabetes, cardiovascular disease and strokes). This means that people with developmental disabilities are at a higher risk for serious health problems that lead to even higher costs in loss of function, human suffering and health-care expense.

National Trends
People with developmental disabilities may represent the proverbial “canary in the coal mine.” A review of their problems accessing care raises questions about the dental community’s future capacity to serve all Americans.

  1. The United States is not training as many dentists per year as it did 20 years ago, due in part to falling federal and state investments in dental schools and increasingly non-competitive compensation for dentists on faculty.
  2. Nationally, 35 percent of the nation’s dentists are over age 55. Over one-third of the existing workforce is poised to cut back on practice hours or retire outright in the next decade.
  3. The ratio of dentists to total population is projected to keep declining through 2020; in 15 years there will be 10 percent fewer dentists per 100,000 Americans than there were in 1994.
  4. The clustering of dental professionals in urban areas creates additional disparities in access to care. More than 40 million Americans live in federally designated health professional shortage areas – many of them in rural parts of the country.
  5. Federal funded community health centers are obligated to offer dental care to low-income groups; however, there “safety-net” providers encounter the same severe challenges as dental schools in recruiting and retaining dentists, especially in rural areas.

The Problems
There is a fast growing body of evidence which links poor oral health with increased risks for systemic conditions such as heart disease, diabetes and aspiration associated with chronic obstructive pulmonary disorder (COPD).  Furthermore, people with disabilities are at a greater risk for health issues related to the lack of dental care.

In Pennsylvania:

  • 75 percent of dentists do not accept Medicaid
  • There are approximately 2,000 dentists available to treat approximately 2 million people on Medicaid (1,000 patients to 1 dentist)
  • Dentists cite low reimbursement rates and lack of training as to why they can’t treat people with disabilities
  • 43 percent of the dentists in Pennsylvania are between the ages of 50 and 64
  • 57 percent of pediatric dentists, those who traditionally have treated people with disabilities, are age 50 and older
  • 75 percent of people with disabilities can be treated in a typical dentist office
  • Practices that provide intravenous (IV) sedation and other specialized care are difficult to find

The Solutions
We recommend directing the Legislative Budget and Finance Committee to study and issue a report on the disparities in dental care for Pennsylvanians with disabilities. Issues that would be helpful to review can be found under Policy Recommendations in the full report (below).

  1. Preserve what we already have. Maintain Pennsylvania’s commitment to Medicaid funding for dental services for adults. Proper dental care saves money, while dental problems result in costly medical care.
  2. Provide more incentives in the Medicaid rates for dental services provided to people with disabilities. This would be an incentive for dentists to treat people with disabilities.
  3. Institute a more flexible dental loan repayment program using existing funds to treat people with disabilities, especially in Pennsylvania’s underserved areas.
  4. Ensure that private insurance companies are mandated to provide dental insurance payment for anesthesia for children under the age of five and people with disabilities who need it.
  5. Support workforce initiatives that expand the duties for dental assistance. This will allow dentists to provide more services to all patients.
  6. Ensure that flouride is added to our public drinking water.

With the continued support of the FISA Foundation, in 2007, the Disability Healthcare Initiative published Access to Oral Health Care for Pennsylvanians with Disabilities: A Rising Public Health Issue which identified the issues that contributed to oral health care for people with disabilities being a serious public health problem. As a result, the issue of disparities in access to dental care for people with disabilities received the attention of dental professionals, insurers and Pennsylvania legislators.  In 2009, the Disability Healthcare Initiative published Access to Dental Care for People with Disabilities: Challenges and Solutions – A Report to Pennsylvania’s Legislators.

Access to Oral Health Care for Pennsylvanians with Disabilities: A Rising Public-Health Issue

Access to Dental Care for People With Disabilities: Challenges and Solutions– A Report to Pennsylvania’s Legislators

Achieva's Comments on the Pennsylvania State Board of Dentistry’s Draft 16A-4628 – General Revisions, Proposed Annex dated January 23, 2020 (2020)