The Problem/The Cause

THE PROBLEM

Right now, roughly one in four (5,073,822) Floridians live in areas designated by the federal government as having a shortage of dentists. Sixty-three of 67 counties in Florida (94%) have at least one shortage area.1

Children and adults without dental coverage are much more likely to face overall health problems, and have much less chance for success. Poor oral health is related to other serious medical problems, including diabetes, heart disease, stroke, oral cancer, and respiratory diseases. These illnesses have a significant economic impact through lost productivity for adults, and poorer school performance for children.2

THE CAUSE

In Florida:

Children

  • Nearly one in five children (ages 1-17) had one or more of the following: toothaches, decayed teeth/cavities, broken teeth, and/or bleeding gums (2011)3
  • More than 23% of 3rd graders had untreated tooth decay (2013-14)4

 

Adults

  • 34% of senior citizens (ages 65+) have lost at least 6 teeth due to decay or gum disease (2014)5.
  • 14% of senior citizens (ages 65+) have had all of their teeth extracted (2016)6

 

Medicaid

  • 60% of Medicaid children did not see a dentist in 2016—that’s 1.4 million children7.
  • Only about 18% of licensed Florida dentists participate in Medicaid (2015-16)8
  • In 2014, Florida had the lowest dentist Medicaid participation rate of any state9.

 

Emergency Departments:

In 2016, over one-half billion dollars were billed by Florida’s hospitals for dental conditions (nontraumatic) that otherwise could have been averted by prevention and/or routine dental care.10

Here is the breakdown:

  • 166,997 visits were to hospital emergency departments (EDs)
    • Total charges for these ED visits exceeded $322 million, or more than $882,000 per day
    • Medicaid was the most frequent primary payer for these ED visits, accounting for nearly 40% of visits
    • Repeat visits to hospital EDs for dental care are common.  In 2015, patients with multiple visits accounted for nearly 35% of all visits for dental care as documented as nontraumatic at total charges of more than $83 million.  
1U.S Department of Health and Human Services, Health Resources and Services Administration, Bureau of Clinician Recruitment and Service.  Find Shortage Areas: HPSA by State & County. Accessed September 18, 2017. http://hpsafind.hrsa.gov/HPSASearch.aspx
2 U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General.
Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial
Research, National Institutes of Health, 2000. http://silk.nih.gov/public/hck1ocv.@www.surgeon.fullrpt.pdf
3 https://www.kff.org/other/state-indicator/children-with-oral-health-problems/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
4 Florida Department of Health Public Health Dental Program. (2016). Oral Health Status of Florida’s Third Grade Children 2013-2014. https://www.astdd.org/www/docs/fl-third-grade-2013-2014.pdf
5 CDC oral health data, 2014, https://nccd.cdc.gov/oralhealthdata/rdPage.aspx?rdReport=DOH_DATA.ExploreByLocation&rdProcessAction=&SaveFileGenerated=1&rdCSRFKey=a7be6642-b297-46e3-bb54-232a145463c4&islLocation=12&iclTopic_rdExpandedCollapsedHistory=&iclTopic=ADT%2cCHD&islYear=2014&hidLocation=12&hidTopic=ADT%2cCHD&hidYear=2014&irbShowFootnotes=Show&iclIndicators_rdExpandedCollapsedHistory=&iclIndicators=ADT1_1%2cADT1_3%2cADT1_4%2cCHD1_1%2cCHD1_3&hidPreviouslySelectedIndicators=&DashboardColumnCount=2&rdShowElementHistory=&rdScrollX=0&rdScrollY=0&rdRnd=57503
6 https://www.kff.org/other/state-indicator/percent-who-had-all-teeth-extracted/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
7 Analysis by Pew Dental Campaign of EPSDT 2016 data, posted on CMS website in September, 2017
8 “Florida Medicaid Dental Information,” memo by Beth Kidder, Deputy Secretary for Medicaid, Florida AHCA to Frank Catalanotto. Sent July 25, 2017
9 Tomar, et..al., “Trends in dental-related use of hospital emergency departments in Florida”, (2016) Journal of Public Health Dentistry, ISSN 0022-4006
10 Tomar, S. Hospital Emergency Department and Hospital Inpatient Admissions in Florida for Non-Traumatic Dental Conditions, 2015 and 2016. Unpublished research.