NMDA Journal Fall 2019

nmdental.org 17 continues on page 18  Identified Vulnerable Populations Medicaid, CHIP, & Medicare Populations Many patients, served by the UNM dental clinics, were under the Medicaid, Medicare, or CHIP insurance programs, with others either holding a private insurance or being uninsured. In 2016, there were over “72 million Americans on Medicaid or CHIP programs,” yet only around “39% of US dentists” accepted these forms of insurance. 5,6 New Mexico has a higher percentage of acceptors (51.5%), likely since “half of all New Mexicans” are on either Medicaid (and CHIP) and Medicare. 6,7 At the UNM dental clinics “most major insurance plans” are accepted, including Medicaid, the UNM Delta Dental Insur- ance Plan, Metlife, Aetna Cigna, and United Concordia.⁸ In addition, New Mexico is among the states which offers extensive dental care services to both Medicaid-based and Medicaid-expansion popula- tions (includes CHIP coverage), meaning that these patients may receive comprehensive services including diagnostic, preventa- tive, and restorative procedures that are approved by the American Dental Association, as long as they don’t exceed the per-care annual expenditure of $1,000. 6,9 Medicare, however, “does not cover most dental care services,” which means that older patients must use out- of-pocket pay for most of their services. 10 Rural Populations from Dental Shortage Areas Though most of the interviewed patients did not describe trans- portation as being a huge barrier (Figure 3), there were still a few individuals who had trouble accessing adequate dental services due to their geographical location. New Mexico has a large rural population, making up approximately 22.6% of the state’s popula- tion.⁷ In many of these rural areas, “17% of New Mexicans have no Medicaid-accepting dentists within a 15-minute drive,” which sometimes means that these patient will need to drive for several hours to attain necessary dental services.⁶ Some patients in cities along the state-lines will actually enter other states, including Tex- as, Arizona, and Colorado, to receive dental care as these services are closer to them. They also often accept New Mexican insurances, meaning that state/federal dollars allocated towards New Mexicans are being spent in other states. Frequent Readmissions in Pediatric Populations While patients will “revisit” their dentist for a regular check-up or for follow-up procedures in the Dental Residency Clinic, there are several preventable pediatric cases commonly found in the Ambu- latory Surgical Center, where these children often return every few months. In fact, among the patients interviewed in the ASC, the second largest age category was patients between 0–9 years of age (Figure 2). This places a financial burden on Medicaid and CHIP, even though these cases can be prevented through proper brush- ing and flossing techniques. Children are a high-risk population in New Mexico, as the state is ranked “49th for childhood well-being” since around “one-third of children live at or below the poverty line in this state. 11 Though there are dentists who make the effort of cleaning these children’s teeth, at the cost of state-insurance dol- lars, there is noticeable pessimism among these providers, due to observed negligence and incompetence by the parents/guardians of these children. Other Vulnerable Populations There were some other patient populations which may have poor oral health through barriers they faced, such as not being able to speak English as a first-language, having AIDs/HIV, being a current or former prisoner, being uninsured, and being a non-US citizen, to name a few. In the interviews conducted at UNM, there were only a few patients who fit in these categories, including patients who only spoke Arabic or Vietnamese, patients who openly admitted to having an auto- immune deficiency disorder, and inmates who couldn’t be served by other New Mexican dental facilities. However, due to the small size of the study population pool, and the few interactions with patients in these categories compared to other major ones, they were deter- mined to be beyond the scope of this study. Hopefully, with future research into these patient populations during a longer timeframe, with greater administrative privileges, a more expansive study can be performed to yield accurate and larger data sets and information. Possible Interventions In an impoverished, diverse, and rural state like New Mexico, there are only a select few evidence-based interventions that are effective. When viewing the successful options, there are several interventions which are already in place to reduce adverse oral health conditions. At an individual level, dental sealant programs can prevent up to “80% of tooth decay in treated teeth.” 12 Another intervention that has shown success, despite its controversies, is community water fluoridation. Its approximated that water fluoridation can lead to a “25% reduction of tooth decays”. 13 From an economic stand-point, water fluoridation has also “saved approximately $38 in dental treatment costs for every $1 invested.” 13 Other interventions in place are recommended by the Community Guide through their Community Preventative Services Task Force (CP- STF), which includes school-based health centers. These centers often deliver vaccinations and advertise contraceptive use, but some also incorporate the promotion of oral health care. As public schools don’t charge tuition, lower-income children can access these facilities. Not only does the Community Guide believe that this intervention can im- prove oral health, they also state that it can also “improve the students’ academic performances and better prepare them for college.” 14 Current Smoker Former Smoker Never Smoked Didn’t Respond/ Didn’t Remember Percentage of Patients in Category Ambulatory Surgical Center Dental Residency Clinic (Figure 6) Percentage of UNM Dental Clinic Patients Who Were Tobacco Users, 2019 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 31.4% 11.4% 51.4% 76.9% 5.7% 10.3% 7.7% 5.1% Barriers to Adequate Oral Healthcare in the UNMDental Clinics' Patient Populations