There is only one endodontist in the entire state of Connecticut providing care to patients on Medicaid: Dr. Demetress Davis. Dr. Davis has been providing root canal treatment to patients on HUSKY for the past six years, helping many save their teeth.
She is known as a kind and skillful dentist, accepting patients and providing high-quality care no matter if they have private or public insurance. To underserved communities and oral health advocates, she is a hero. We need more people like Dr. Davis in Connecticut.
We are fortunate to have many skilled providers, fantastic dental schools, and a comparatively robust Medicaid program. So, why aren’t there more dentists and oral health specialists treating people on HUSKY? The answer is: we have a chronically underfunded safety-net.
Individuals on public insurance and those who lack the resources to pay out of pocket for dental care often resort to tooth extraction when there is an infection for immediate relief and understandably so. The average cost of a root canal without insurance ranges from $700-$1,800, not including the crown that is often required.
Compare this to the lower average cost of a simple extraction of $150-$300, and the choice becomes clear for many low-income community members. For those who have to choose extraction due to this steep financial barrier, there is a clear racial disparity among those who have lost teeth to those who have not.
The Centers for Disease Control and Prevention has data showing that there are much higher rates of Black and Hispanic adults (52% and 44%, respectively) aged 65 and older who have lost six or more teeth due to tooth decay and gum disease compared to white and other races (28%) in the state of Connecticut.
This is why periodic and preventative care is so essential. It reduces unnecessary pain, it’s more cost-effective, and it lets us avoid tough treatment decisions. It is difficult for many low-income residents to obtain routine and comprehensive oral health care, with the average cost of dental care visits increasing by 30%. The increase in cost, lack of adequate dental care financing, and a shortage of dental health professionals contribute to a serious public health threat.
COVID-19 presented the world with many challenges, one of which was how to safely conduct dental procedures and check ups. A national study has shown that since the pandemic, “nearly half of respondents (46.7%) reported delaying going to the dentist or receiving dental care due to the COVID-19 pandemic.”
With the limited number of dentists who accept patients on HUSKY in Connecticut, there is a strong possibility that many are not receiving their necessary dental care. Common concerns among dentists about participating in HUSKY include the administrative burdens and low reimbursement rates associated with the program.
We were gratified to see Gov. Ned Lamont proposed a 25% increase in reimbursement rates for all adult dental services along with an increase in the endodontic (root canal) reimbursement rates to align with the pediatric fee schedule. We are hopeful that an increase in the reimbursement will expand the number of in-network dentists.
An increase in Medicaid reimbursement rates is one solution, but another, possibly more impactful solution, is dental therapy. Dental therapists would be able to provide a limited variety of essential preventative and restorative dental services such as extractions, fillings and cleanings to underserved communities. With 2019 passage of dental therapy legislation, Connecticut acknowledged there are not enough providers, and we have the opportunity to create our own pipeline, but we haven’t realized it yet. When the state does make a concerted effort to develop the dental therapy workforce, it is crucial the programs prioritize affordability and equity, rather than profit.
Dr. Davis’s dedication to provide endodontic care is inspiring, but she cannot do this alone. Public health dentists cannot bear the brunt of these systemic inequities to care. It’s up to state policymakers and legislators to show us what’s possible and Connecticut has a chance to be one of the leading states to work towards dental equity. We have a variety of tools at our disposal, and we must utilize them all at once to save the teeth of our most minoritized communities.
Richard Rodriguez, DDS is a graduate of Texas A&M School of Dentistry and Master of Public Health Candidate at Yale School of Public Health. Anthony Gentile is a senior at Sacred Heart University studying communications.