MARIETTA, Ohio – A dental clinic that takes Medicaid and bills people with no insurance on a sliding scale is a rarity in Appalachia where unmet dental care is rampant.
Some adult patients at the Southeastern Ohio Dental Clinic in Marietta never saw a dentist as children, some children as young as 5 have had all their baby teeth pulled and some patients in their 20s need dentures.
The Columbus Dispatch reports children in Appalachia have a nearly 60 percent higher rate of tooth decay than elsewhere in Ohio while about half of working-age adults don’t have dental insurance.
The staff at Nationwide Children’s Hospital in Columbus sees many patients who can’t find care in Appalachia, said Dr. Paul Casamassimo, the hospital’s chief of dentistry.
“You’re talking about this hot spot of tooth decay in Ohio that is the result of many things – social deprivation, lack of fluoride, lack of access to care, just general poverty,” Casamassimo said.
“Ultimately the solution, whatever the constellation of approaches is, really is going to cost money, and I think that’s something that’s a very, very high hurdle to get over.”
The Marietta clinic is run by the Washington County Health Department, where those with no insurance might pay about $30 an appointment, office manager Karita Miller said.
Dental care in southeastern Ohio is a priority for Ohio State University’s College of Dentistry, said college dean Dr. Patrick Lloyd, who wants to recruit a higher percentage of students from the region. Currently, about 3 percent of Ohio State dental students come from Appalachia, but Lloyd wants that to increase to 6 percent with the next freshmen class.
New dentists who grew up there are more likely to return, he said, and if the state helps more dentists get rid of debt if they practice in the region, they’ll be lured there.
Dentists graduate with an average debt of $195,000, he said.
In Ohio, there is one dentist for every 1,874 people, but in Appalachia it’s one for every 3,138 people, according to the Ohio Department of Health.
Dr. William Gable, of McConnelsville in Morgan County, said the only way he sees more of his colleagues setting down roots in Appalachia is if Medicaid reimbursement increases.
Gable, who accepts Medicaid, chose his practice almost three decades ago because he thought it had a lot of potential. “The practice brought me here, but the people kept me here,” he said.
More than half his patients are on Medicaid, and things can get tight for him financially, Gable said.
The state has had some success luring dentists to poorer areas with its existing loan-repayment program, but most don’t stay in Appalachia for the long term, said Barbara Carnahan, an oral-health information specialist with the Ohio Department of Health.
A task force convened by the department recommended in 2009 that the state explore higher Medicaid reimbursement for the region’s dentists.
Some patients at the Marietta clinic say they can’t afford toothpaste and toothbrushes, while others say they don’t understand why they should worry about their children’s baby teeth.
Adessa Jackson, a clinic dental technician, said she tries to educate as much as she can during appointments, stressing the importance of a low-sugar diet and regular oral hygiene.