The dental industry is a complex one that is currently undergoing some changes, but despite certain roadblocks, dental advocates are heading to the Capitol again when the legislature convenes in January to push for better access to care.
For the last three years, Kevin Earle, Executive Director for the Arizona Dental Association, and others have been pushing state lawmakers to include pregnant women in dental coverage under the state’s Arizona Health Care Cost Containment System, commonly referred to as AHCCCS (pronounced like access).
Last session’s bill, which had 54 bipartisan co-sponsors, got derailed as the #RedforEd movement took center stage. Earle and others, including Rep. Heather Carter (R-Cave Creek), are looking to bring the issue back in the upcoming session.
Right now, only children have full dental coverage under AHCCCS, so many adults are going to the ER for dental issues, which becomes a “revolving door,” Earle said.
This can be even more of an issue for women who are pregnant.
Studies have theorized that certain diseases of the teeth and gums can have an adverse impact on the development of children in the womb, Katherine Glaser M.D., Arizona section chair for the American College of Obstetricians and Gynecologists said.
But the biggest hurdle for women who want to keep healthy teeth during pregnancy is access to care, Glaser said.
Third time’s the charm
Getting better access to dental care has been a big issue for Earle, who also successfully persuaded lawmakers in 2017 to expand AHCCCS coverage to include disabled individuals over the age of 21.
But when it’s come to adding pregnant women to dental coverage under AHCCCS, Earle hasn’t been so lucky.
“Maybe third time’s the charm,” he said.
Although dental work may seem routine, for pregnant women, not having proper dental care can have more adverse side effects.
Bacteria and toxins from diseases of the teeth or gums can often spread to other parts of the body through the bloodstream. For pregnant women, that means the bacteria and toxins can spread into the placenta, and thus to a child developing in the womb, Glaser said.
This could in turn create an inflammatory response in the body which could cause a woman to go into labor earlier than expected, according to Glaser.
Early delivery can lead to a host of maladies for a child, among them respiratory problems, gastrointestinal issues or even brain damage.
Those premature births can also have a major financial impact on taxpayers.
The average cost for AHCCCS to care for a premature baby is between $22,000 to $67,000, according to Ann Hammi Blue, a periodontist in Phoenix who has been trying to help push for increased access to dental care for pregnant women.
“That’s going to be a huge cost savings to our system,” she said.
Additionally, 1 out of every 2 adults has some form of periodontal disease, which Blue calls the “silent disease.”
“You often don’t know you have it until it starts to hurt,” she said.
A study in 2015 by Cigna Health found that 43 percent of pregnant women do not go for a dental check-up, despite 76 percent of those women admitting to having problems such as toothaches or bleeding gums.
This could be because of a lack of coverage or due to another issue: fear of the dentist.
“The most important message is that all of this is safe during pregnancy,” Glaser said, adding that many women fear that dental work could harm their unborn child. Even xrays are safe if the womb is properly shielded, Glaser said.
As of Nov. 1, there were 1.8 million people on AHCCCS throughout Arizona, 19,000 of which were pregnant, according to the most recent AHCCCS data.
Women also make up 54 percent of the entire AHCCCS population.
But pregnant women are not the only population of patients people like Earle are interested in helping out, and not the only issue they hope to take to the Capitol.
“We want to shine a light on this issue”
Earle is also pushing to require insurance companies to include dental coverage.
Another problem area is that rural communities often don’t have a dentist or a variety of dental options. Earle and others are trying to find more creative ways to get those underserved groups dental care.
“It’s about taking care of the whole person,” Earle said, adding that unhealthy teeth can often complicate or worsen other health issues such as diabetes, immune deficiency disorders and more. “We want to shine the light on this issue.”
In Arizona, 47 percent of children who had Medicaid did not go to a dentist, despite having coverage.
“That’s unacceptable,” Earle said, adding that getting pregnant mothers coverage and encouraging them to use it could help set healthy standards that can be passed onto their children.
The Arizona Department of Health Services in 2015 found that 52 percent of Arizona kindergartners have tooth decay, higher than the national average of 36 percent.
The American Dental Association also found that one in four low-income Arizonans admitted to having oral health problems they were not able to address.
Blue agrees with Earle and is hoping that the next battle will be to add dental coverage for all adults currently under AHCCCS.
Before the Great Recession, AHCCCS covered dentistry. But when the state faced billions of dollars in budget deficits, dental coverage among the many government services cut and never restored.
Blue would love to see even just $1,000 of coverage for all AHCCCS patients to cover preventative treatments like regular cleanings, which are often far cheaper than treatments that come from advanced diseases of the mouth such as gingivitis and periodontal disease.
Most the pushback for efforts like the one Blue is suggesting has come from those worried about the cost to taxpayers. However, many without coverage are letting their teeth get so bad that it results in excessive infections that land them in the hospital, which results in hefty bills paid for by AHCCCS, Blue said.