Are Uninsured Patients Receiving the Dental Care They Need?

A recently published study indicates the need for oral health care services at free clinics.

 

What does being “healthy” mean to you? The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” In terms of being physically healthy, we tend to think of characteristics that have to do with heartbeat, blood pressure, and cholesterol levels. However, we may overlook one important aspect of our physical health – our oral health.

Oral health is a significant public health issue in the United States. Approximately one-third of adults between the ages of 20 and 64 have untreated tooth decay. Although water fluoridation programs have improved oral health since the 1960s, there are still many unmet needs for dental health care. This is especially true among low-income individuals and families, as high dental costs make it difficult for those without insurance coverage to find the dental care they need.

Free Clinics for Underserved Populations

In the United States, safety-net facilities like free clinics allow underserved populations to receive health care. Underserved populations are those whose life circumstances cause them to experience greater challenges in terms of health, and whose needs are often overlooked unintentionally. This may be due to income and employment conditions, education and literacy, or insufficient insurance coverage, among other factors.

Although Canada is widely known for its free health care, most dental services still require extended health care coverage. Apart from those who just cannot afford to receive dental services regularly, it may also affect new immigrants, refugees, and people without documentation such as the homeless and mentally ill.

Oral Health Tied to General Health

What many fail to realize is that dental health and overall health are tied together – good oral health allows for our physical, mental, and social well-being. Oral healthcare is also especially important for those with chronic diseases who require dental treatment. Diseases like rheumatoid arthritis, diabetes, or liver conditions all affect oral health. Many studies have also found associations between periodontal disease and systemic diseases like heart disease.

In an article published in the Journal of Primary Care & Community Health, the authors address the need for collaboration among dental care and health care practitioners to provide care to underserved populations. However, they note the lack of research on underserved populations who use safety net facilities like free clinics in the United States: do these individuals acknowledge their need for dental treatment? How are their health beliefs associated with their attitude towards their oral health and general health?

Surveying Uninsured Patients

To answer these questions, researchers surveyed a total of 585 primary care patients utilizing a free clinic in the United States. The participants included those who are not eligible for public or private health insurance coverage, and live below 150% of the federal poverty level. Most of the participants were between the ages of 19 and 64.

The study, which took place during the months of May and June 2016, required patients to complete a self-administered paper survey. They answered questions that measured their perceived general health and oral health behaviours. One question asks “In general, would you say your health is…” and the patient answered using a scale in which the number one meant excellent, and five meant poor. The questions about oral health behaviours involved:

  • Whether the individual has a perceived need for dental treatment
  • Frequency of brushing teeth
  • Frequency of flossing teeth
  • Whether a participant has received dental care at the clinic
  • Whether the individual had received preventive dental care in the past six months

dental care

Need for Dental Treatment

The study found that more than 60% of the patients at the free clinic perceived their need for dental treatment. The same patients that realized their need for dental treatment also reported worse perceived general health compared to those who did not report any needs for dental care.

The researchers also found that free clinic patients who brush their teeth more than once a day had a better perceived general health than those who did not. The authors note that “one possible explanation [of this finding] is that individuals who brush their teeth every day may be more health conscious and have a healthier lifestyle in general than those who do not.”

Future Steps: Education and Collaboration

So are uninsured patients getting the dental care they need?

This study highlights that in order to provide uninsured patients with oral health care, underserved populations need to be educated about the importance of oral health through health promotion programs. The authors note that “future research should examine how health education related to oral health care can have an impact on promoting a healthy lifestyle and improve overall physical health.”

They also indicate the need for dental care and health care providers to collaborate to provide care to underserved populations. Unfortunately, they write, “dental care providers are often not considered a part of interdisciplinary health teams.” Perhaps this study will show otherwise.

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