What measures would really boost access to dental care? 3 dentists weigh in

Several state legislatures have recently introduced measures to increase access to dental care for residents as the need for accessible options increases for underserved populations.

While some have passed smaller laws, such as teledentistry authorizations in North Carolina and mandated dental exams for school enrollment in New Mexico, many states have opted for larger expansions in Medicaid coverage to prevent dental emergencies with higher price tags.

A recent research paper by the American Dental Association examines how increased dental coverage can improve access and utilization of dental care, reduce racial disparities, improve health equity and lower medical care costs.

Jeremy Burgin, DDS, is the owner of Burgin Dentistry in Clovis, N.M. He said while expanding Medicaid dental coverage is beneficial for patients, the next battle is getting more dentists to accept Medicaid. One solution, he said, is to increase reimbursements for dental services.

"It's [also] hard for a dentist to accept Medicaid when there's no guarantee the patient's going to show up," Dr. Burgin said. "I know a few offices in town that triple, quadruple booked the same hour and if they get one of the four that are scheduled, then it's good. But the problem is the reimbursement rates are really low and it's hard to make that work. A lot of the reason why a lot of private dentists don't take Medicaid is because of those two things."

The ADA penned a letter to CMS earlier this month asking for changes to be made to Medicaid that would increase dentist participation, including updates to the credentialing and auditing processes.

One concern of these Medicaid enhancements is that it will lead to more fraud, which is already prevalent within the dental industry.

New York City-based dentist Robert Trager, DDS, suggested dental coverage be privatized by DSOs that may be better able to manage it.

"Anytime the government does it you get all these pop-up practices; sometimes they don't even have licenses," Dr. Trager said. "It's a good program, but it should not be run by the government. It should be privatized out to [companies] that know how to run a dental practice honestly and ethically."

Dr. Trager added that the recent push for increased accessibility is mostly politically motivated. However, San Francisco-based dentist Julia Hallisy, DDS, said it can also be attributed to more knowledge about oral health's connection to overall well-being and people voicing the need for more accessible care.

"The public has the power where they vote and where they spend their money," Dr. Hallisy said. "Dentistry is expensive, there's limited dollars. People are starting to realize we're not spending those dollars wisely to wait until you're in a dire situation. It's like everybody waiting until they're extremely ill. You're showing up at the hospital emergency room. We know that's not a good model, but that's what we do in dentistry a lot. People are saying, 'Why is that?'"

While expanding services and insurance coverage can improve accessibility, an additional factor that can benefit patients is improving dental staff shortage areas. Dr. Burgin said his practice is in a shortage area and often provides services such as root canals that other practices are not able to because of reduced staff. He suggested incentives such as tax breaks and tuition support that can bring in more providers.

"It seems to me that most dentists are just fighting tooth and nail in cities, where in smaller towns, you've got as much business as you could possibly ever handle," Dr. Burgin said. "If you could get them to these smaller type communities or underserved areas, I think it would help tremendously."

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