Even before coronavirus, almost half of adults in rural areas went without dental care – North Carolina Health News

Rural adults are less likely than their urban peers to see a dentist for preventative treatments, according to the CDC.

Millions of rural residents have not seen a dentist in over a year, a recent CDC report reveals.

In 2019, before the coronavirus pandemic forced dentists to shut down, 42 percent of adults in rural areas did not receive dental care, according to the survey. In urban areas, roughly a third of adults did not see a dentist that year.

In both groups, people of color and low-income residents were less likely to have seen a dentist in 2019. These disparities were wider in rural areas, where issues such as transportation barriers, dentist and dental hygienist shortages and lack of health insurance are more common. The coronavirus pandemic has likely exacerbated the need, especially for low-income patients, the report says.

The things that really went by the wayside [with the pandemic] are the maintenance, the routine exams and the cleanings things that keep people healthy, said Katherine Jowers, who oversees oral health programs at the Asheville-based Mountain Area Health Education Center. Were still dealing with very old treatment plans for patients we havent seen in two years. Nothing was on fire so they didnt come, and now all of their plans are completely disrupted and we have to start from scratch.

Since cavities and other dental problems dont resolve on their own, what might have been small areas of decay that could have been addressed with a filling have likely advanced to more extensive decay that requires a root canal or even extraction.

Lower-income patients are already predisposed to forgoing preventative dental treatment because of cost, especially if they arent in pain, said Anahita Shaya, a dentist at the Brunswick County Health Department.

People are having to choose between the necessities of life, she added. If theyre having to pay for fillings and a cleaning out of their pocket and thats against having to pay their electric bill or mortgage or rent, [preventative dental care] is not always at the top of the list.

Oral health is an important part of overall wellness and if left untreated, tooth decay can lead to a whole host of other complications. Cavities have been linked to heart disease, pneumonia and sepsis, for example. Pregnant women with poor oral health have been found to have a higher risk of premature births and other complications.

Shaya sees some of these complications in her own practice, with patients turning to the emergency department for dental abscesses.

The same is true for communities nationwide. Dental abscesses accounted for 3.5 million visits between 2008 and 2014 and cost a collective $3.4 billion, research shows. Uninsured people and Medicaid beneficiaries accounted for the bulk of these emergency visits.

Though receiving antibiotics at the ER can cost $1,000 or more out of pocket, Blake Gutierrez, a dentist at MAHEC, said patients go there because they dont think there are other options. In most cases, however, emergency departments cant fully address a dental issue. At most, emergency providers can administer antibiotics and painkillers, but without dental treatment, the source of infection remains and can flare up again.

Even after an ER visit, patients may still be hesitant to seek dental care because of cost. Care Credit, a company that provides financing for dental and other health procedures, estimates that an extraction, the cheapest option for advanced tooth decay, can cost anywhere from $130 to $500, depending on the complexity of the extraction. Root canals, another common treatment, can cost $1,000 or more.

Rural North Carolinians have another significant challenge to deal with when seeking care: lack of dentists. Most dental providers congregate in urban areas, according to data from the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. Some rural counties, including Hyde, Tyrrell and Gates, did not have an active dentist in 2019, the data shows.

Greg Chadwick, dean of the East Carolina University School of Dental Medicine, keeps close tabs on that data. By his calculation, the state has roughly 5,600 active dentists, and most of them over 4,500 work in cities. The remaining 1,400 serve North Carolinas 80 or so rural counties.

A study published this year by the American Dental Association notes North Carolina has about 54 dentists per 100,000 residents, behind the national average of about 61 dentists per 100,000. Based on a 2015 analysis generated by the federal Health Resources and Services Administration, North Carolina is likely to remain a state with not enough dentists to meet the demand into the future.

That math alone makes it so patients in rural areas have to travel farther for care, he added, something that many residents struggle with. The only way to address these disparities is to make dental care more accessible, perhaps by coupling it with primary care as many community health centers do across the state.

These health centers arent always enough. MAHECs dental clinic, for instance, has a two-month wait for a cleaning and general exam. Another provider, CommWell Health a community health center with locations in Sampson and surrounding counties has seen a similar trend.

Time, said MAHECs Jowers, isnt on rural patients side, especially since the pandemic delayed care for so many of them.

Youre not addressing needs that were minor needs two years ago, she said. [Dentistry] is the type of health care where if you dont address the problem, it doesnt get better by itself.

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Even before coronavirus, almost half of adults in rural areas went without dental care - North Carolina Health News