Dental Care in Rural Communities
Poor dental health is a serious health issue in rural communities. "People living in rural areas face a multitude of structural barriers when seeking dental care. These barriers, which include dentist availability, ability to pay, and transportation issues, contribute to minimal expectations for receiving dental care and cause people to undervalue dental care," states Lisa Davis, director of the Pennsylvania Office of Rural Health.
Davis continues, "It is important to recognize that there is a complex interrelationship of both the supply of dentists and the population's demand for services. Not only do we need to increase the supply of dentists in rural areas, but we must work to eliminate the barriers that discourage care-seeking behavior and change people's expectations and attitudes about dental care."
A research team recently examined access to dental care in rural areas of the state and the effectiveness of mandatory dental screenings in selected Pennsylvania's schools. The team studied both the demand and supply sides of dental services for indigent populations living in rural areas across the Commonwealth. The demand analysis was based on an evaluation of data describing mandated screenings from the Pennsylvania Department of Health, dental screening data from the Head Start program, in-school dental records from select districts, surveys of both parents and school nurses in select districts, and Medical Assistance claims.
In examining the effectiveness of mandatory screening for school-aged children the researchers found both encouraging and discouraging results. "The screening program is tremendously important. As part of our recommendations, we strongly encourage the Pennsylvania Department of Health, the Pennsylvania Department of Education, and local school districts to make every effort to keep the screening program at its current level and to potentially increase its scope," states Davis.
"However, despite the importance of these screening programs, their effectiveness is limited by lack of continuity of care and low compliance with referrals. One possible solution is to integrate school-based programs and Medical Assistance. That integration might help students to find a dental home and facilitate continuity of care throughout their formative years," Davis adds.
To better understand the supply side, researchers examined the dentist-to-population ratio for 10 rural counties in Pennsylvania. They also explored other factors influencing supply. The data sources included state licensing data for dental providers and data from the Medical Assistance program about providers and utilization.
The supply analysis confirmed that the problem is multi-faceted and that there are no easy solutions. "Not only are there fewer dentists per capita in rural communities, but many dentists serving these communities have an abundance of patients and can restrict their practices to private insurance and private pay patients," states Davis. As a result, patients who seek dental care through the Medical Assistance program may not be able to find a participating provider in their immediate service area.
Compounding problems caused by dentists choosing not to participate in Medical Assistance, there is tremendous variance in the supply of dentists by county and even greater variance across local areas. The researchers found that dentists are in shorter supply in rural counties, counties with a high manufacturing base, counties with above average non-professional employment, counties that have lower than average incomes, and counties with high poverty rates.
Based on their findings, researchers recommend that the Commonwealth offer support to increase enrollment in Pennsylvania's three dental schools, foster the recruitment of underrepresented populations into dentistry, continue or expand the Pennsylvania Loan Repayment program to encourage more dentists to practice in Pennsylvania and serve the poor in areas of low dentist supply, utilize Community Health Centers as a venue to offer oral health care, and formalize the expanded function dental assistant as a licensed provider.
"Many steps need to be taken to improve oral health care for citizens in rural Pennsylvania. There is no doubt that one step is to improve the number of providers in low-income areas. However, without addressing the population's aversion to preventive dental care, we are only going half-way. We need to understand the multitude of barriers that keep rural residents from accessing appropriate dental services. Once we clearly define those barriers, we can work to solve them and decrease the disparity between rural and urban communities," concludes Davis.
The project was funded through a grant from the Center for Rural Pennsylvania, a legislative agency of the Pennsylvania General Assembly. The research was conducted by Myron Schwartz, former research associate with the Pennsylvania Office of Rural Health and Alberto Cardelle and Kristina Whitmire at East Stroudsburg University.