HJAR Jan/Feb 2025

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2025 43 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas majority of Arkansas dentists live in these areas. Dentists who choose a small town or rural communities find they can do rather well, as dollars go further; but staff may be difficult to acquire, and other economic fac- tors come into effect. 7 What this means in terms of utilization is that with a shortage of rural dentists, people have an issue with access to care, especially if they have to travel to see a dentist. This means people cannot obtain needed dental care or preventive care timely, resulting in bigger problems later. 8 When patients have moderate or severe periodontitis, a dis- ease linked to chronic diseases — such as diabetes, adverse pregnancy outcomes, atherosclerotic cardiovascular disease, rheumatoid arthritis, Alzheimer’s disease, chronic obstructive pulmonary diseases, nonalcoholic fatty liver disease, and oth- ers — then there is a compounded problem that will only get worse if untreated or not managed. 9 Oral health disparities are exacerbated in rural populations, which produces a marked difference compared to their ur- ban counterparts. Statistically, rural popu- lations are older, lower income, less likely to achieve higher education or have den- tal insurance, and more likely to rely on Medicaid and Medicare. 10 Rural areas have a higher proportion of homes not served by community water systems, and, there- fore, do not receive the preventive benefits of fluoridated water. 11 Studies confirm inequalities exist in ru- ral areas concerning dental care utilization. There is an inverse relationship between dental health service use and need. Dental utilization is greater by those with higher education and income, however those that need dental care the most have lower edu- cation levels and low income. 12 This health- wealth divide in dental health outcomes and access to care not only occurs in Arkansas, but is nationwide. Studies also indicate a higher prevalence of tobacco product use among rural versus urban areas. 13 Tobacco use increases the risk of periodontal disease and oral cancer. Re- search has demonstrated that low income, low educational attainment, low socioeco- nomic position, and social deprivation are all positively associated with oral cancer. 14 Rural residents are challenged with worse oral health outcomes across their lifespan. Statistically, those living in rural areas are less likely to obtain preventive dental servic- es and more likely to seek dental care in the emergency department (ED). Even though people are retaining their teeth longer, rural residents have nearly double the prevalence of edentulism than nonrural populations. 15 Poor oral health is reported to affect both the ability to secure employment and work- place productivity. Regrettably, research in- dicates that the appearance of a person’s teeth influences what others ascribe to them, such as intelligence, honesty, or leadership potential, which also affects employability. 16 Societal factors influence us all, whether we’re aware of it or not. Those who have dental benefits or can afford to straighten or whiten their teeth improve their social and job opportunities. People who are in- secure financially often forego preventive dental care, since these services are con- sidered non-essential. Not receiving rou- tine and preventive dental care can lead to tooth decay, extractions, social insecurities, embarrassment, and decreased quality of life outcomes. 17 It is estimated that diabetes will increase by 54% tomore than 54.9millionAmericans in 2030. 18 The CDC reports diabetes and its related complications accounted for $413 billion inmedical costs in the U.S. for 2022, including lost work hours and wages. 19 Considering that periodontal disease and diabetes have a bi-directional associa- tion, it makes sense that these two con- ditions will wreak havoc if left untreated and unmanaged. From a public health perspective, it’s in the best interest of the healthcare system to prevent unnecessary dental emergen- cies and ED visits by addressing these oral health inequalities. If dental healthcare professionals choose not to practice or travel to these rural areas to deliver care, there are other ways and initiatives that exist to level the field of this inequality be- tween rural and urban healthcare. Teledentistry proved to be a viable option during the COVID-19 pandemic, as it expe- dited oral health consultations, diagnoses, and treatment planning while decreasing transmission risk in dental offices when they were locked down. 20,21 A key benefit of teledentistry is reduction of travel and fi- nancial burdens associated with travel, as it improves access for patients with disabilities or other barriers that accompany in-person visits. 21 Before going straight to the ED, many times a dental emergency can be handled “Dental utilization is greater by those with higher education and income, however those that need dental care the most have lower education levels and low income. 12 This health- wealth divide in dental health outcomes and access to care not only occurs in Arkansas, but is nationwide.”