Oral Care Health Promotion – Oklahoma’s racially, economically, and geographically diverse population faces unique oral health challenges. These problems include poor oral health, inadequate oral health coverage, significant physical barriers to health care, and oral health problems. This includes the lack of medical personnel. Just as the barriers to oral health are varied, so are the potential solutions. Potential solutions include efforts at all levels of government, innovation in health care delivery, and awareness of the unique needs of Oklahoma’s American Indian population. Potential strategies address each of these opportunities and recognize the short- and long-term oral health needs of Oklahoma.
Despite its association with chronic diseases such as diabetes, metabolic syndrome, and cardiovascular disease, oral health contributes significantly to overall health and well-being [1], but oral health Cavity care is an often overlooked and underserved service. Oklahoma’s oral health statistics reflect high rates of tooth decay in children, high rates of tooth loss in adults, and a population that does not receive regular oral care primarily due to cost. The main reasons for this include economic and material barriers and a widespread shortage of oral health professionals. Only 72% of Oklahoma children have had one or more dental checkups compared to 80% nationally, and 66% of third graders have had tooth decay compared to 52% of the national population [2]. For adults, the statistics aren’t much better: In 2019, 60 percent of Oklahoma adults visited the dentist, compared to 68 percent nationally; only 35 percent of pregnant women brushed their teeth during pregnancy, compared to the national rate of 46 percent [2] . Additionally, 42 percent of Oklahomans age 65 and older have lost at least 6 teeth due to tooth or gum disease. Disparities in oral health access and outcomes among Oklahomans suggest that some populations experience greater barriers than others. Cost has been identified as a major reason for avoiding dental care [4, 5], low-income adults and children in Oklahoma are less likely to visit the dentist, and low-income older adults are also more likely to lose teeth (Table 1). . [6, 7]. Most of the oral diseases experienced by Oklahomans are preventable [8]; however, the necessary oral care can be expensive and difficult.
Oral Care Health Promotion
About 23% of American Indians or Alaska Natives (AI/AN) live in poverty, equal to 10.5% of the total US population, and in Oklahoma, poverty affects 19.3% of AI/AN people [9]. Currently, 29 percent of Oklahomans receive Medicaid benefits. AI/AN individuals living in Oklahoma represent 11% of the state’s total Medicaid enrollment [10]. In 2020, before the recent Medicaid expansion, 533,000 Oklahomans were uninsured, the second highest percentage in the nation, leaving many Oklahomans without real options for dental care[11]. Among insured patients, 14.6% of adults avoided oral care due to unreimbursed costs [12]. Among the uninsured, 30% of adults do not get the dental care they need because of cost [4]. In a recent report on oral health challenges and potential solutions, 68% of respondents identified cost as the biggest barrier to improving oral health in Oklahoma communities. emphasized [13].
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Because Oklahoma is a rural state with 70,000 square miles and 4 million residents, 45 percent of whom live in rural areas, physical access to oral health care is also a burden. According to data published in 2017, 66% of the AI/AN population lived in rural Oklahoma [14]. In addition, many rural areas of Oklahoma have insufficient oral health care providers. According to the Health Resources and Services Administration (HRSA), 1.3 million Oklahomans live in areas with a shortage of dental hygienists, which hinders access to health care [15]. A lack of oral health care providers in these areas limits the population’s options other than traveling long distances to seek care [16]. Those with unreliable transportation are more likely to get it wrong or neglected.
Oklahoma does not have the number of oral health care providers needed to support the population, with 55.3 dental care providers per 100,000 people compared to 61.2 nationally [ 12]. Additionally, less than half of dentists in Oklahoma receive Medicaid [17]. Those who face barriers to health care costs face even greater challenges when providers are far away or inaccessible.
Employers face the challenge of filling dentist positions in both private and tribal health systems. It is estimated that the national workforce will require more than 10,000 additional dental professionals to meet the needs of the current population [18]. Consequently, more than 80% of dental practices experienced recruitment difficulties [19]. A recent search of the Indian Health Service (IHS) vacancies database shows a continuing trend of dentist, hygienist and assistant vacancies, with several vacancies in some clinics. jobs are available. This suggests that there is indeed an unacceptable shortfall in the ability to provide adequate care to the American population [20]. Oklahoma’s Indian health system includes federally operated clinics, urban Indian organizations and tribally operated health systems, or I/T/Us for short. Rural Oklahoma has 45 I/T/U systems serving more than 380,000 patients statewide [ 21 ]. As noted above, understaffing within I/T/U leads to delays in care and underfunding often limits services, leading to high rates of underfunded referrals to outside providers [ 22 ]. As mentioned above, the shortage of healthcare providers is not unique to the I/T/U system and exists throughout the service delivery model. Specific root causes include a lack of sustainable funding to recruit and retain providers and the heavy administrative burden currently placed on health care providers, which ultimately reduces the effectiveness of patient care.
After the Medicaid expansion on July 1, 2021, an additional 250,000 Oklahomans, mostly adults, were enrolled in Medicaid [10]. As previously mentioned, approximately 11% of Oklahoma’s Medicaid population is American Indian [10]. Also, in 2021, Medicaid oral health insurance benefits, previously limited to children, were expanded to adults [23, 24]. The combined effect of expanding Medicaid and increasing adult oral care should lead to new and stronger services for the adult population, partially addressing previous oral care challenges. can do. However, the expected increase in utilization and demand for preventive services may put further pressure on the system.
Pdf] Oral Health Promotion: Evidences And Strategies
Fortunately, with recent Medicaid budget changes, the I/T/U system can expect a significant increase in revenue for the senior services it already provides. This change will directly improve services available to Medicaid recipients. It can also indirectly improve oral health services by increasing clinical capacity through increased I/T/U. Oral health insurance options and equity policies should continue to be explored, as the I/T/O system may still struggle to provide needed services and meet optimal staffing levels.
In the absence of an increase in the number of oral health care providers in Oklahoma, opportunities for innovative care should be explored. The COVID-19 pandemic has forced healthcare providers to shift some services to telemedicine. This trend has greatly improved access to health care, including for those with transportation issues and physical limitations. To support the benefits of telemedicine, the Oklahoma legislature defined telehealth models and coverage mechanisms [ 25 ] as well as basic telestomatology [ 26 ]; The American Dental Association has released a position statement supporting telestomatology for patients. Legislation and regulations are needed to consolidate insurance coverage and reimbursement requirements to further increase teledentistry in Oklahoma.
Addressing service utilization and provider availability gaps, especially on loaded I/T/O systems, requires manpower inspection and maintenance. By expanding the services that dental assistants and hygienists can perform and empowering a new type of provider, the dental hygienist (DHAT) can provide critical care to more rural and tribal populations. DHAT is a licensed mid-level facility that provides the most common dental procedures such as check-ups and fillings. DHAT works under the supervision of dentists [28] and is able to provide direct care to people in schools and nursing homes, tribal communities and rural areas [28]. DHAT has been in use since 2005 and is currently licensed for use in various capacities in 12 states [28]. Although DHAT has been practiced around the world for a century, the profession of dental therapy was brought to the United States by tribal leaders in Alaska who sought to improve the oral health of their communities. With a mandate from the federal government, these leaders developed a plan to train Alaska Natives to provide the care their communities most need. By focusing DHAT’s scope on a subset of commonly required programs, they have created an educational program that is accessible and affordable. The result is a sustainable, culturally appropriate dental treatment program that creates high-paying jobs in underserved communities while increasing access to dental care and improving oral health outcomes [ 29]. In 2015, the Standards of Dental Practice [30] were published by the American Council on Dental Accreditation (CODA), which is responsible for accrediting educational programs for dentists and dental hygienists. Having a CODA-accredited dental treatment education program ensures that providers receive the same high educational standards as other dentists and reduces the burden on states to set educational requirements for dentists [30]. Dental therapists under the direct supervision of licensed dentists have been shown to improve access to care and overall oral health in underserved communities.
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