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Dental deserts

11/7/2013

At last count, there were 1,159 dentists practicing in Kansas. As the state's population is 2.88 million people, that's about 2,500 patients per dentist. If every Kansan had an annual checkup, the dentists would have to see basically one patient an hour -- eight per day, five days a week.

Of course, this is a meaningless average.

Because not everybody goes to the dentist. Others frequent the chair more often than once a year. And more than 700 of the state's dentists practice in Kansas City, Lawrence, Topeka and Wichita.

Which leaves at least 57,000 residents living in so-called dental deserts. These are places where no services are offered and the closest dental office is at least a 30-minute drive. No surprise, a lot of those deserts are in western Kansas. Most counties in the western half of the state have only one or two dentists; 12 have none at all. And with less than a quarter of Kansas dentists accepting Medicaid patients, the deserts get more barren.

Everybody concerned with the situation appears to agree something needs to be done -- but that's as far as the consensus goes.

The Kansas Dental Association and a majority of state dentists supports extending Medicaid dental coverage to adults, fluoridating water systems in all communities, designing programs to entice dentists to the deserts, and allowing dental hygienists to perform more tasks. This approach is supported by the American Dental Association.

A smaller number of dentists believe establishing mid-level dental practitioners is the answer. They are joined by the Kansas Health Foundation, Oral Health Kansas, the Kansas Dental Project, Kansas Action for Children and other groups. Such a specialist would have more training than a hygienist but less than a dentist. Fort Hays State University has offered to establish a four-year degree program to provide the credentials necessary for a registered dental practitioner.

Both camps presented bills to the Kansas Legislature last year, with neither side supporting the other. Understandably, lawmakers punted. They recommended mediation instead, which is precisely what happened.

Three meetings with a professional mediator resulted in no agreement. Both sides will be hard-pressed even to get a subcommittee hearing at the Capitol, let alone have any legislation passed. If there is one thing legislators take particular exception to, it's not finding compromise when they've called for it.

Inadequate access to oral health care, in the meantime, continues. The Pew Research Center reported that in 2010 at least 17,500 emergency room visits in Kansas were caused by toothaches and other dental problems. In 2011, almost 55 percent of Kansas children who are covered by Medicaid received no dental care. With each passing year, western Kansas dentists who retire are not replaced immediately -- if at all -- and the dental deserts grow larger.

Something, or someone, has to give.

Given the nature of the Brownback administration and the current Legislature, we would offer it is the Kansas Dental Association that has little supporting its stance. State leaders had zero appetite for expanding Medicaid coverage in conjunction with the Affordable Care Act's rollout, even though the federal government was going to pay for most of it. Analysis from the Kaiser Commission on Medicaid and the Uninsured shows that expansion would have provided insurance coverage to an additional 144,000 Kansans, and brought $5.3 billion in Medicaid funding over the next 10 years.

If elected leaders are willing to turn their backs on that many Kansans' general health care, we can't imagine dental care will sway them differently. Even if by some fluke it did, the vast majority of Kansas dentists don't accept Medicaid patients.

The Legislature needs to approve the creation of registered dental practitioners. It is a market-based solution to a very real problem that won't go away on its own.

Editorial by Patrick Lowry

plowry@dailynews.net

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