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For Lower-Income Residents, Oral Health Care Is Often Out Of Reach: One-Third Say They Haven’t Seen a Dentist in Two Years

ALEXANDRIA, VA – The first-ever survey of  Northern Virginia’s oral health reveals that lower-income families are at a distinct disadvantage when it comes to getting the oral health care services they need. The survey report, released today by the Northern Virginia Health Foundation, calls on the community  to address the region’s oral health needs by taking steps to improve oral health care access, especially for lower-income families.

Based on a poll of 1,300 North Virginian adults, the survey found that while nearly all (91%) higher-income adults reported seeing a dentist in the last two years, fewer than two-thirds (63%) of lower-income adults said they saw a dentist within the past two years. Cost was the main barrier to getting dental care. Seventy-three percent of lower-income households (defined as those with an annual income below $40,000) did not have dental insurance and two-thirds of this population said they could not afford dental insurance. Sixty-six percent of lower-income adults said they could not afford to see a dentist.

“For people with limited means and no insurance, routine dental care is often out of reach,” said Northern Virginia Health Foundation President, Patricia Mathews. “Because of costs, they are more likely to suffer severe pain from untreated dental problems, miss time from work or school or wind up in a hospital emergency room, which increases health care costs for everyone.”

The report focuses primarily on the oral health status of lower-income adults because there are so few programs to assist them. Medicaid covers very little in the way of dental care for adults in Virginia, and only a patchwork of programs and services exists to meet the oral health needs of low-income adults.

The survey assessed numerous factors affecting the oral health of Northern Virginians, gauging their perceptions of oral health as well as documenting obstacles to oral health care. The results demonstrate that far higher percentages of lower-income residents suffer from dental problems, impacting both their health and their jobs, than do residents with higher incomes.

Among the key findings:

• Adult dental care. Sixteen percent of lower-income adults have not seen a dentist in more than five years, compared to only 3% of higher-income adults. Lower-income residents were also more likely than higher-income earners to put off needed dental care treatment due to cost.
• Dental insurance.  Among those who do have health insurance, only a quarter (24%) have coverage that includes dental care. For higher-income adults, the percentage with dental coverage is 64%.
• Need. Lower-income adults were five times more likely than higher-income adults (26% versus 6%) to say they needed to have a tooth pulled. Poorer residents were more likely to lose their teeth and five times more likely to report needing or wearing dentures. Twenty percent of low-income people had dentures, compared to 4% of higher-income people.
• Emergency care. Lower-income residents who have received care in the last two years sought care for acute dental problems in a hospital emergency room.
• Barriers beyond cost and insurance. In addition to cost and lack of dental coverage, lower-income adults cited several reasons that kept them from getting dental care. For example, 15% said they lacked transportation to get to a dentist, a rate nearly four times greater than that of higher-income residents. And 10% of lower-income earners said they needed child care in order to see a dentist, compared to 5% of higher-income earners.
• Children. Forty-five percent of lower-income parents whose children haven’t received recent care said they couldn’t afford dentist visits for their children. Lower-income parents were more likely to report that only some of their children had seen a dentist in the last two years (16% versus 7% of higher-income parents). Among those parents surveyed whose children have not received care recently, 52% of lower-income parents said they only seek dental care for their children in an emergency, compared to 21% of higher-income parents.

“Too many Northern Virginians are not getting the oral health care they need,” said Mathews. “We hope that an array of Northern Virginia stakeholders – dentists, policymakers, safety net clinics and other nonprofit organizations – will make improving oral health care access a priority so that more residents, especially those with lower-incomes, can get oral health care when they need it.”

To ensure good oral health for all Northern Virginians, the Foundation recommends local and regional efforts that:

• Reinforce the link between oral and overall health among health professionals and the general public. Increased understanding of this link is important for the oral and overall health of all populations, and in particular for pregnant women.
• Foster integration of oral and primary care. Several safety net clinics in Northern Virginia provide integrated primary, oral and behavioral health care; new models of integration should be explored.
• Increase the number of providers who offer a dental home.

At the state level, policymakers should:

• Include comprehensive dental services for all who are Medicaid-eligible. Currently, Medicaid only covers emergency extractions for adults.
• Work to ensure that reimbursement for dental services through Medicaid is at least at the 65th percentile of the American Dental Association rate survey. Reimbursing dental services for Medicaid-eligible patients at a higher rate could increase the number of providers willing to see patients.

The Northern Virginia Health Foundation is dedicated to improving the health of residents of Northern Virginia, with an emphasis on the health and healthcare of low-income uninsured or underinsured persons and health education, prevention of disease and wellness programs.
 

Contact:
Julia Howard: 703-486-5691
Jhoward@novahealthfdn.org

We were created in 2005 and made our first grants five years ago.  We are proud of our accomplishmentsw – but we are aware that the challenge of improving the health and healthcare of Northern Virginians is not ours alone.  That is why we will continue to be engaged in efforts that are "beyond grantmaking", believing that collaborations and partnerships often create far greater positive change than can be accomplished by a sungle grant.  And we will strive to embed the issue of health equity in all of our work, recognizing that health disparities often are the result of policy and environmental factors that can affect health and are preventable.

The current economic climate has had a profound effect on the lives of those in our region, most particularly low-income persons without health insurance.  That reality prompted our Board of Directors to re-examine our grantmaking strategy in light of the reduction of our financial resources.  As a result, our strategic plan focuses our work on:

• Helping sefety net clinics move toward creating medical homes that can provide primary care, behavioral health and oral health care;
• Supporting oral health safety net programs;
• Encouraging and supporting wellness and prevention strategies and programs;
• Providing information on health reform, health data and trends.

This website will give you insights into our work and will provide resources that you can use in yours.  We look forward to continuing our work with current grantees and partners, and to developing new relationships that will help us improve the health and healthcare of residents of Northern Virginia – particularly those who are currently uninsured.

Oral Health Care

Since 2008, the Foundation has been convening the major private and public providers of oral health care to the uninsured and underinsured in Northern Virginia to foster collaboration and provide opportunities for peer learning.  The group adopted a mission statement and by-laws in June 2011 and is now known as the Northern Virginia Oral Health Services Coalition.  To find out more about the Coalition's work, click here.

The Foundation has commissioned a survey to better understand the scope of the oral health needs of low-income Northern Virginia residents.  A copy of the survey results will be posted on this website.  Check back to download it.

The Foundation is also a member of the Virginia Oral Health Services Coalition, whose mission is to work through advocacy, education, and innovative new programs to change perceptions of oral health; remove known barriers between people and oral health services; build an effective oral health infrastructure by ensuring that dental providers and future dental providers are prepared to meet the needs of the underserved in Virginia; and, bring excellent oral health to all Virginians.  To learn more about the Coalition, click here to access their website: http://www.vaoralhealth.org

Obesity

The Foundation is partnering with local community coalitions to help address the conditions that contribute to the growing incidence of obesity in the community. 

Foundation staff co-chair Alexandria’s efforts to reduce the obesity rate among young children in the city.  According to a 2007 study by Inova Health Systems, 43.5 percent of Alexandria children ages 2-5 are overweight or obese.  That alarming statistic galvanized the community to take actions.  Since it was organized two years ago, the Alexandria Childhood Obesity Action network has focused on five key areas:  ensuring that every child in the city has access to a safe and age-appropriate place to play; helping early childhood and family daycare providers integrate healthy eating and active play in their curriculum; piloting a SNAP/Double Dollar program at the Four Mile Run Farmers market to increase food stamp recipients ability to purchase fresh and healthy food; increasing Alexandrian’s ability to grow their own food and prepare it in healthy ways by collaborating with community organizations to start gardens and offer cooking and nutrition classes; and promoting breastfeeding by working with service providers to develop common messages to communicate with new mothers and working with businesses to adopt breastfeeding friendly policies.  For information about Alexandria's childhood obesity prevention efforts, click here.

To download a copy of the National Association of County and City Health Officers article "Building an Obesity Movement through Policy and Environmental Change in Alexandria, Virginia;" click on NACCHO Article.

Arlington recently hosted an "obesity summit" for interested community members and organizations.  For a copy of the "Summit's" proceedings, click here.

Health Equity

In May 2008, the Foundation co-sponsored, with the Washington Regional Association of Grantmakers, a screening and discussion of a portion of "Unnatural Causes: Is Inequity Making Us Sick?"  More than 40 funders and municipal health and human services leaders participated in a robust discussion of the quality of life facts that make us all sick.  For more information on the documentary, go to http://www.unnaturalcauses.org/