Lately the media has dedicated a lot of attention to dental care and achieving the perfect smile. Advertisements advise viewers of the best tooth whitening products and procedures for bleaching and straightening your once pearly whites. But the key to maintaining dental health is regular visits to the dentist, which are often overlooked and not treated with the same importance as other health care.

Since improving oral health was named as a Healthy People objective, there have been significant improvements in oral health.  According to data from the National Center for Health Statistics, the percentage of adults and children with oral health problems such as dental caries (also known as “cavities”), dental decay and periodontal disease has decreased in recent years.(1)   But while overall dental health has improved, dental insurance coverage has not increased. “Only 44 percent of persons in the United States have some form of private dental insurance (most with limited coverage and with high co-payments), 9 percent have public dental insurance (Medicaid and Children’s Health Insurance Program), 2 percent have other dental insurance, and 45 percent have no dental insurance”.(2)

The cost of dental care is certainly one of the main barriers to maintaining oral health, but as the following article suggests, a lack of dental coverage and cost may not be the only barriers to dental health care.  Using data from the 2002 Community Health Data Base’s Southeastern Pennsylvania Household Health Survey, this article discusses the dental health practices of adults and children and the barriers to dental health care.

Dental Health in Adults in SEPA

One of the most important things that adults can do to maintain their dental health is to visit the dentist regularly, however, many adults in the region have not been to the dentist in the past year.

• One out of three adults in Southeastern Pennsylvania have not been to the dentist in the past year (32.6%), this represents approximately 937,600 adults in the region who have not seen a dentist in the past year.
• In Philadelphia, the percentage of adults who did not receive dental care in the past year is greater than that of adults in suburban counties (42.4% vs. 26.5%). 
• Poor adults are more likely to have gone without dental care in the past year than non-poor adults (57.7% vs. 29.6%).
• Minority adults are also more likely to go without dental care.  Compared to 28.2% of white adults, 40.6% of Asian, 42.1% of Hispanic and 44.5% of African American adults have not been to the doctor in the past year.   (See Figure 1)

Barriers to Dental Health Care

A lack of insurance and cost are two barriers that prevent many SEPA residents from receiving adequate dental care.  

• In SEPA, there are approximately 211,500 uninsured adults who do not have any health or dental coverage.  Additionally, 27.8% of insured adults in the region, or approximately 743,350 people have health insurance but no dental coverage. 
• In total, one out of three adults in SEPA do not have dental coverage (33.1%), which projects to nearly one million adults.  And among those who do have dental coverage, many others may have inadequate coverage with high co-pays and limited benefits, which may limit their access to dental care.
• In SEPA, 44.4% of adults without dental coverage have not been to the dentist in the past year, as compared to 26.2% of adults with coverage for dental care.  
• Among adults without dental coverage, 39.3% cited cost as the main reason why they did not visit the dentist in the past year.

But cost and a lack of insurance are not the only reasons why people do not visit the dentist regularly.  In many cases, one of the most difficult barriers is getting adults to understand the need to prioritize dental health. 

Of the nearly two million adults in the region who do have dental health coverage, 26.2% did not visit the dentist in the past year; this projects to approximately 497,600 adults who have dental coverage but chose not to visit the dentist in the past year.  Although high co-pays and limited dental coverage could prevent many adults with dental coverage from seeking care, only 12% of adults with dental coverage cited cost as the main reason they did not go to the dentist.  

• Among adults who have dental coverage but did not go to the dentist in the past year, 25% said that they “don’t need [dental care]”, 13.6% said that they did not have enough time, and another 10% said that they just weren’t motivated to go.  Other reasons ranged from not having a dentist, just not thinking about it, or a fear of the procedure. (See Figure 2)
• The majority of adults without dental coverage also gave other reasons as to why they had not been to the dentist rather than citing cost as the main reason (60.7%).  Specifically, one out of four said that they “didn’t need [dental care]” (24.7%).

As can be seen from the number of adults with dental coverage who are choosing not to visit the dentist regularly as well as the high percentage of adults without coverage who are not going to the dentist for reasons other than the cost, it is clear that oral health is not as much of a priority as other health care.  In some cases, this may be due to a lack of health literacy due to language, cultural or financial barriers that separate individuals from the health community.  In other cases, it may be merely that the health community has not fully educated people as to the importance of dental health.  But whichever the case, doctors and other health professionals must teach adults to prioritize dental health, and if not for themselves, for their children.

Children and Dental Health

Given that many adults do not understand the need to prioritize their own dental health and visit the dentist regularly, it is not surprising that many children in the region do not receive adequate dental care.

• In Southeastern Pennsylvania, approximately fourteen percent of children between the ages of 4-17 have not been to the dentist in the past year (13.9%) – this represents 105,800 children in the region who have not visited a dentist in the recommended time.
• One out of four African American children ages 4-18yrs have not been to the dentist in the past year (24.6%), compared to 19.1% of Asian children, 18.0% of Hispanic children, and 8.4% of White children.
• Parents of children who had not been to the dentist in the past year cited lack of perceived need (29.0%), cost (19.6%) and lack of motivation (11.7%) as the major reasons for failure to receive appropriate dental care.

To improve oral health for both adults and children in Southeastern Pennsylvania, it is necessary to better understand the reasons why adults are not visiting the dentist regularly, and why they are not taking their children.  In addition to improving dental coverage and making dental care more affordable, “to promote oral health and prevent oral diseases, oral health literacy among all groups is necessary”.(3)  Health providers must explain to their patients the importance of visiting the dentist and help them make it a priority so that today’s children can continue to have healthy smiles.

For information regarding PHMC’s Community Health Data Base 2002 Household Health Survey, or to learn more about the dental health conditions of residents of Southeastern Pennsylvania, contact Diana Levengood, at (215) 731-2039 or dianal@phmc.org.

Notes:
1. Centers for Disease Control and Prevention, National Center for Health Statistics, Healthy People 2000 Review, 1998–99.
2. Centers for Disease Control and Prevention, National Center for Health Statistics, Healthy People 2000 Review, 1998–99.
3. Healthy People 2010 (http://healthypeople.gov)