OPINION: N.D. assessment shows need for dental care
Post Date: Jan 02 2015
By Dr. Shawnda Schroeder − Printed in The Bismarck Tribune
January 2, 2015
Last spring, the North Dakota Center for Rural Health completed an assessment on oral health needs and policy recommendations.
It was conducted at the request of the Legislature’s Interim Committee on Health Services, and the CRH brought together many people with experience in oral health in North Dakota. After comprehensive examination of data, it was found that many in North Dakota are in need of oral health services.
Specifically, the research found oral health status was worse among rural, American Indian, aging and low-income residents in North Dakota. Only 60 percent of adults with a disability reported going to the dentist, compared to 76 percent of nondisabled adults, illustrating another group that did not receive the oral health care they needed.
In addition, the percent of people who had visited a dentist in the last year declined with age. In
2013, 93 percent of Head Start children had seen a dentist in the last calendar year. In that same year, 75 percent of middle-schoolers and 67 percent of adults had been to the dentist. Furthermore, those 65 and older were far more likely than any other age group to have reported an oral health problem (32 percent).
Another variable that predicted worse oral health access, utilization and status among North
Dakota residents was being a Medicaid beneficiary.
From 2000 to 2008, increases in state Medicaid payments for dental services were associated with an increased use of dental care by children and adolescents covered by Medicaid. However, while payments again increased in 2011, 2012 and 2013, the percentage of Medicaid-enrolled children who had had a dental visit declined over that same period.
With the historical growth in Medicaid reimbursement, North Dakota had the second-highest rate in the nation for adult dental services and one of the highest rates of reimbursement for pediatric dental services (62.7 percent) in 2014. Comparatively, the American Dental Association reported that the national average for adults was 40.7 percent, and 48.8 percent of commercial insurance for pediatric dental services.
While the reimbursement rate is high, the data illustrates a concern for access. In 2013, 249 North
Dakota dental practices billed for at least one Medicaid patient, but only 65 (26 percent) of these practices saw more than 100 Medicaid patients. More than 50 percent of Medicaid patients who saw a dentist in 2013 received care from one of only 21 North Dakota dental practices. Further, a 2013 survey indicated that only 25 percent of licensed dentists in North Dakota accepted any and all Medicaid patients.
The number of licensed dentists in North Dakota has slowly increased from 327 in 2007 to 380 in
2013; however, 35 percent of those who responded to a dental workforce survey in 2013 planned to retire in the next 15 years. In addition, despite the increase, 12 counties had no dentist in 2014.

For other counties, nine had one dentist, nine had two dentists and five had not reported. Data from 2013 shows that 67 percent of all licensed North Dakota dentists worked in the four largest counties (Burleigh, Cass, Grand Forks and Ward). Overall, 79 percent of counties in North Dakota had six or fewer working dentists.

To address these issues, the group brought together by CRH developed and discussed 24 possible models for the state, all of which are highlighted in the complete report. However, their priority recommendations included the following:
1. Increase funding and reach of safety-net clinics to include providing services in western North
Dakota; review nonprofit oral health programs that use hub-and-spoke models of care. Specifically, hub-and-spoke refers to an existing safety-net clinic providing additional services by opening and managing satellite clinics in surrounding (rural) communities.
2. Increase funding and reach of the Seal! North Dakota Program to include using dental hygienists to provide care and incorporating case management and identification of a dental home. Includes Medicaid reimbursement for services.
3. Expand scope of work of dental hygienists and use them at the top of their current scope to provide community-based preventive and restorative services and education among high-need populations.
4. Promote dentistry professions among state residents and encourage practice in North Dakota through a consolidated loan repayment program and partnership/student spots at schools of dentistry.
5. Increase Medicaid reimbursement.
These recommendations reflect the position of the oral health experts brought together for this assessment, but are not recommendations of the Center for Rural Health. For more information, read the complete report at http://ruralhealth.und.edu/projects/ndoralhealthassessment/publications.
(The writer is employed with the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences.)

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