On a national level, by the year 2060, the number of adults aged 65 or older will reach an estimated 98 million which will account for 24% of the US population (US Census Bureau). Roughly 68% (about 2 in 3) of the adult population over 65 years of age have gum disease. A study by Griffin et al. (2012) indicates that while dental disease is highly preventable, many older adults experience poor oral health and suggest increasing access to preventative dental hygiene treatment and better integration of oral health into medical care be a priority among public health agencies, specifically to those who are home bound, live in nursing homes or who are economically disadvantaged.
Tooth decay among children is one of the most common, chronic conditions. According to Dye et al. (2012), untreated tooth decay can be found in 20% of children ages 5-11 and the occurrence of untreated tooth decay doubles among children ages 5-19 who come from low-income families (25%) compared to those in higher-income homes (11%). School-based sealant programs are highly effective in providing preventative care to children from lower-income homes who are less likely to have dental insurance or to receive regular cleanings. These programs target schools with a high percentage of students receiving free or reduced-cost lunch.
As outlined in HB 154, Dental Hygienists to Perform Certain Functions Under General Supervision, of the 159 counties in Georgia, 118 do not have enough licensed dentists to meet the population demand resulting in emergency dental care versus preventative care. As indicated in HB 154, in 2016 alone 4,106 Georgians sought emergency dental care at Grady costing $1.7 million. According to Fingar et al. (2015), while many gained access to dental care under the Affordable Care Act, some states elect not to cover dental services under Medicaid. However, with so many counties in Georgia being under served from a licensed dentist perspective, geographic barriers would remain an issue even if Medicaid allotments allowed for increased preventative care for the elderly.
According to the CDC, racial and ethnic groups with the poorest oral health in the United States are Non-Hispanic blacks, Hispanics, American Indians and Native Alaskans (CDC, Disparities in Oral Health). In Georgia, the population of residents who fall into one of those groups is a combined 32.1% (US Census Bureau).
Among children, the CDC indicates the biggest disparities in children ages 2-4 and 6-8 years old exist in the Mexican American and black, non-Hispanic populations on a national level (CDC, Disparities in Oral Health). Additionally, the groups most affected by the problem according to the language of HB 154 are children from low-income homes, those residing in rural areas of Georgia where access to dental hygiene services are limited and those who live in group nursing homes, especially those who are on Medicaid.
According to Scott Lofranco, General Counsel and Director of Government Affairs for the Georgia Dental Association, Medicaid typically only covers extractions for an elderly patient and does not cover preventative dental care such as cleanings and fluoride treatments leaving older adults at greater risk for oral health complications.
The lack of preventative oral health services to under served, or in many cases, un-served Georgians is multifaceted. For the individuals, not receiving proper cleanings, fluoride treatments and sealants can lead to severe gum disease and infections that spread to other areas of the body. From a public health perspective, oral health issues result in emergency room visits and, in the case of uninsured or Medicaid patients, many of these ER services are provided without reimbursement.
Lack of access is most prevalent in rural areas of Georgia from a geographic standpoint, and in lower-income areas from a socioeconomic standpoint.
According to Bersell (The Journal of Dental Hygiene, 2017, pages 6-14), the nation is in an oral health care crisis and those who need access to oral health care the most are often the ones who do not receive it due to a multitude of barriers. Many other states have designed programs to expand access to under served populations as well as scope of services for dental hygienists.
Colorado is viewed as the pioneer having given dental hygienists the opportunity to work independently since 1987. At the onset of the 2017 legislative session, Georgia was one of only 3 states in the country that has not expanded services allowable for dental hygienists to provide under general supervision of a dentist.