HJAR Jan/Feb 2025

44 JAN / FEB 2025 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH articles/want-a-lucrative-practice-with-great- work-life-balance-go-rural 8 Luo, H.; Wu, Q.; Bell, R.A.; et al. Rural-Urban Dif- ferences in Dental Service Utilization and Dental Service Procedures Received Among US Adults: Results From the 2016 Medical Expenditure Panel Survey.” The Journal of Rural Health 37, no. 3 (June 2021): 655-666. DOI: 10.1111/jrh.12500 9 Hannan, C.J.; Ricks, T.L.; Espinoza, L.; Weintraub, J.A. “Addressing Oral Health Inequities, Access to Care, Knowledge, and Behaviors.” Preventing Chronic Disease 18, March 25, 2021. DOI: http:// dx.doi.org/10.5888/pcd18.210060 10 Henderson-Frost, Jo; Deutchman, M. “Eight Ways to Mitigate US Rural Health Inequity.” AMA Journal of Ethics 24, no. 1 (January 2022): E73-79. DOI: 10.1001/amajethics.2022.73 11 Rural Health Information Hub. “Oral Health in Rural Communities.” Last Updated Aug. 2, 2024. https://www.ruralhealthinfo.org/topics/oral- health 12 Ju X, Mejia GC, Wu Q, Luo H, Jamieson LM. Use of oral health care services in the United States: unequal, inequitable-a cross-sectional study. BMC Oral Health. 2021 Jul 23;21(1):370. doi: 10.1186/ s12903-021-01708-8 13 Roberts, M.E.; Teferra, A.A.; Keller-Hamilton, B.; et al. “Shared and unique risk factors for tobacco use among rural versus urban adolescents.” Pre- ventive Medicine, November 2020:106239. doi: 10.1016/j.ypmed.2020.106239 14 Conway, D.I.; Petticrew, M.; Marlborough, H.; et al. “Socioeconomic inequalities and oral cancer risk: A systematic review and meta-analysis of case-con- trol studies.” International Journal of Cancer 122, no. 12 (June 2008):2811-9. DOI: 10.1002/ijc.23430 15 Vargas, C.; Dye, B.A.; Hayes, K.L. “Oral health status of adults in the United States.” The Jour- nal of the American Dental Association 133, no. 12 (January 2003):1672-81. DOI: 10.14219/jada. archive.2002.0120 16 National Institute of Dental and Craniofacial Re- search (US). “Oral Health in America: Advances and Challenges.” December 2021. https://www. ncbi.nlm.nih.gov/books/NBK578297/ 17 United for ALICE. “ALICE and the Dental Divide: Oral Health in Arkansas.” Arkansas research brief, October 2024. https://www.unitedforalice.org/ National-Reports 18 Rowley, W.R.; Bezold, C.; Arikan, Y.; et al. “Diabe- tes 2030: Insights from Yesterday, Today, and Fu- ture Trends.” Population Health Management 20, no. 1 (Feb. 1, 2017): 6-12. DOI: 10.1089/pop.2015.0181 19 Centers for Disease Control and Prevention. “$413 Billion in Diabetes Costs.” Graphic 2023. https://www.cdc.gov/diabetes/communication- resources/413-billion-diabetes-costs.html #:~:text=Graphic%20text%3A%20In%202022 %2C%20diabetes,wages%20in%20the%20United %20States. 20 Cheuk, R.; Adeniyi, A.; Farmer, J.; et al. “Tele- dentistry use during the COVID-19 pandemic: per- ceptions and practices of Ontario dentists.” BMC Oral Health 23, art. 72 (Feb. 4, 2023). DOI: 10.1186/ s12903-023-02772-y 21 Hung, M.; Lipsky, M.S.; Phuatrakoon, T.N.; et al. “Teledentistry Implementation During the CO- VID-19 Pandemic: Scoping Review.” Interactive Journal of Medical Research 11, no. 2 (July 2022): e39955. DOI: 10.2196/39955 22 National Assembly on School-Based Health Care. “Call for Proposals: Expnading Preventive Oral Health Services in School-Based Health Cen- ters.” April 2012. https://multnomah.granicus.com/ MetaViewer.php?view_id=3&clip_id=371&meta_ id=23175 23 Arkansas Department of Health. “Dental Hygiene Collaborative Care.” Accessed November 2024. https://healthy.arkansas.gov/programs-services/ prevention-healthy-living/office-of-oral-health/ dental-hygiene-collaborative-care/ through a phone call to screen whether the patient should go directly to the ED or con- tact their dentist for an appointment. Integrating oral healthcare into primary care is advantageous since the facility may be the only healthcare office in a rural area. Providing fluoride varnishes to children who live in counties with primary care facilities but no dental offices is an avenue to address children’s oral health needs and refer them to a dental office. Expanding dental coverage in accountable care organizations (ACOs), or patient-centered medical homes (PCMHs) since they do not cover oral healthcare his- torically could be explored. School-based health centers serve an important public health and disease pre- vention service. These centers are uniquely positioned to offer oral health prevention services to children of lower-income families in rural areas. 22 These could be increased in rural areas to offer dental care. Dental therapists are authorized to prac- tice in 14 states. They can provide basic dental services in underserved or rural areas that lack dental offices. InArkansas, there is a col- laborative care act, which is an agreement between a dentist and dental hygienist, who are both licensed by theArkansas State Board of Dental Examiners. The collaborative care act involves a permit and allows a dental hy- gienist to provide care in specific settings to children, senior citizens, and people with de- velopmental disabilities without the presence or supervision of a dentist and without hav- ing a prior examination by a dentist. 23 Basic dental care is provided by the dental hygien- ist, and complex or specialized services are referred to the dentist. Laws governing these dental therapists are different depending on each state legislation. Mobile dental units bring dental care di- rectly to a site to provide necessary care. They serve businesses, schools, nursing homes, or community health centers. Some dental schools and dental residencies actually incor- porate them into the curriculum in the form of educational rotations, in which the stu- dent or dental resident performs the needed dental care. Dental camps, such asArkansas Mission of Mercy (ARMOM), host dental care by volun- teer dentists. These usually serve those who have no insurance and are in urgent need of care. Volunteer dentists give their time and talents freely, and many of the supplies are donated by businesses or non-profit entities. Loan repayment programs by the National Health Service Corps allows dentists to pay back loans by working in underserved or ru- ral areas for a period of time. Intentionally, the program is designed to attract dentists to remain in rural areas. Some healthcare pro- viders find they like this lifestyle and choose to permanently practice in these areas. There are other loan forgiveness programs offered via governmental jobs, including the federal and state levels. Leveling the playing field in reducing oral health inequities in rural areas is not only a public health concern, but also essential to overall general health. These social determi- nants of health affect us all and are a major player in health outcomes. Addressing these inequities is in the best interest of the public, our state, and our healthcare system. n REFERENCES 1 Arkansas House of Representatives. “Rural Devel- opment in Arkansas.” News release, May 17, 2019. https://www.arkansashouse.org/news/post/7481/ rural-development-in-arkansas 2 America’s Health Rankings. “Rural Population in Arkansas.” AccessedNovember 2024. https://www. americashealthrankings.org/explore/measures/ pct_rural_b/AR 3 Arkansas Department of Health. “Medical & Dental Professionals.” Accessed November 2024. https://healthy.arkansas.gov/programs-services/ prevention-healthy-living/office-of-oral-health/ medical-dental-professionals/ 4 Stewart School of Industrial & Systems En- gineering, Georgia Tech. “Dental Care Supply: Arkansas, 2021.” Health Analytics, Accessed De- cember 2024. https://www2.isye.gatech.edu/ dentalcare/dentalcare/State_Reports_Supply/ StateReportFinal_Arkansas.pdf 5 America’s Health Rankings, United Health Rankings. “Dental Care Providers in United States.” Accessed November 2024. https://www. americashealthrankings.org/explore/measures/ dental_provider 6 American Dental Association. “The Dentist Workforce.” Accessed November 2024. https:// www.ada.org/resources/research/health-policy- institute/dentist-workforce#:~:text=Dentist%20 workforce%20FAQs,dentists%20per%20 100%2C000%20U.S.%20population. 7 Ebert, S. “Want a Lucrative Practice With Great Work-Life Balance? Go Rural!” American Dental As- sociation, accessed November 2024. https://www. ada.org/resources/careers/career-transitions/