Last year, rural Utahns went to the hospital for preventable oral health issues 40% more often than their urban counterparts. Moab was no exception to this trend, according to the Moab Regional Hospital’s CEO, who was quoted in a state report on oral health released last month.
The report, co-authored by Michelle Martin and Michelle Silver of the Utah Department of Health, compiles statewide data on non-traumatic dental visits to emergency departments, visits that almost always address preventable dental issues such as cavities, gum inflammation and tooth infections rather than sudden injuries like chipped or broken teeth.
Besides a rural-urban divide in healthcare offerings, the report also shows that, from 2007 to 2017, most hospital visits to address oral health problems took place outside of regular business hours, when a visit to the dentist was not an option in many cases.
The findings suggest that rural Utah is afflicted by a dearth of oral healthcare offerings — something that may not come as a surprise to residents of a town with only two dental offices — which yields a cycle in which patients go to emergency rooms to receive temporary fixes to chronic health problems.
Treating the symptoms
Patients who go to the hospital for a non-traumatic dental condition — like a cavity or infection that, after weeks, months or even years of neglect, has suddenly become unbearable — typically do not get optimal care for their problems and “would be better served in a dental office,” according to the report, because of the “availability of quality care and the likelihood of continuity of care.”
Emergency departments “cannot adequately treat for dental issues,” according to the report, because they “are not generally equipped to provide comprehensive dental services,” as dental offices do. As such, most patients who visit emergency departments for acute dental issues are “simply treated for pain and or infection, not the source of the actual dental complaint.”
The problem of visiting the hospital rather than a dentist is, in part, a problem of timing. The report, published last month, shows that at least 48% of the visits took place after 6 p.m. or before 7 a.m., when most dental offices are closed, but that estimate is likely on the low end. The American Dental Association estimates that closer to 75% of hospital visits for dental problems occur outside regular business hours.
Besides the cycle of treating symptoms without addressing root causes, rural Utah’s elevated visitation to emergency departments for oral health issues suggests the existence of additional problems with the system.
Inequities in oral health
Data in the report show that black Utahns were nearly three times as likely to be treated in a hospital for oral health issues compared to white Utahns during the study period. Hispanic and American Indian residents also visited emergency departments at a disproportionately higher rate than white residents — 40% and 60% more, respectively.
In 2017, the average hospital visit for preventable oral health problems in rural Utah cost over $1,100. Only 24% of patients statewide had the help of private insurance in covering the cost; 49% had public insurance through Medicaid, Medicare or other programs.
One of the largest groups were uninsured patients. More than one in three patients were either forgiven of their oral health service charges by the hospital, typically because of financial distress, or paid out of pocket due to a lack of insurance.
Moab Regional Hospital CEO Jen Sadoff, who is quoted in the report, talked about the direct cost to the hospital when care goes uncompensated in the emergency department. However, Sadoff said, the patient also faces costs.
“Dental issues can lead to days lost at work or school, the impact of which directly contributes to the cycle of intergenerational poverty,” Sadoff said. “If we want to find a way to deliver more value in healthcare, we need to move upstream in our delivery.”
What’s the fix?
As Sadoff alluded, one means of addressing Utah’s oral health problems, which are amplified in Moab by a lack of dental services, is by delivering oral healthcare at younger ages for children and more consistently for adults who are at risk of developing dental problems.
One way of making dental care more regularly available is through sheer availability. The Moab valley has only two dental offices, leading the state’s Office of Primary Care and Rural Health to designate the area as a Low-Income Population Health Professional Shortage Area.
The designation equates to official recognition that Grand County, including Moab, is limited in its healthcare offerings and that residents with low wages in particular are overburdened when seeking healthcare. One factor considered for the designation is community water fluoridation, which as The Times-Independent has reported previously, Moab lacks.
Besides the lack of dentists, challenges to oral health in rural areas also include a lack of fast and reliable transportation to dentists, dental care being excluded from Medicaid coverage (although emergency room visits are included), a lack of community water fluoridation, higher levels of poverty, a lack of childcare and the lack of after-hour dental clinics.
For each of these challenges, however, the report offers potential policy changes as solutions. Although municipalities can’t do much to expand Medicaid to cover dental costs, they can implement water fluoridation, integrate oral health into primary care settings, attract after-hour dental clinics, increase cooperation in remote tele-dentistry programs and more.