Image of male nurse pushing senior woman in a wheelchair in nursing facility

If there’s a visit to a healthcare provider that fills me with anxiety, it’s the dentist.

Keep in mind my dentist has a wide-screen television I can watch while getting my teeth cleaned, state-of-the art equipment and a lovely staff, and I’ve had maybe two cavities in the past 10 years. I still find myself grinding my teeth in anticipation of an appointment. (The irony is not lost). So I’m incredibly sympathetic to Medicaid beneficiaries struggling to find someone to work on their teeth, and long-term care facilities struggling to provide dental services to residents.

As Kaiser Health News reports, many states don’t offer any dental care to Medicaid beneficiaries, and in Pennsylvania, Gov. Tom Corbett recently reduced the two million adults on Medicaid to being allowed only basic dental care. That means cleanings, fillings and extractions, but not a root canal and limited access to dentures.

In nursing homes, of course, getting residents to a dentist can be problematic. Many dental offices can’t accommodate wheelchairs, and many dentists don’t accept Medicaid. But since federal law requires a nursing facility to be able to provide dental services, and since an oral hygiene plan is part of the MDS, it’s refreshing to see some states moving forward in an original way.

In Minnesota, there’s a new wave of dental therapists who are halfway between a dental hygienist and a dentist. These DTs can do fillings, give local anesthesia and do some extractions under the supervision of a dentist. While the American Dental Association opposes hiring dental therapists, as you might imagine, there are an estimated 82 million Americans who are struggling to find oral health access. These DTs may be a good option in the future for long-term care residents.

There are also business opportunities for those in the long-term care field. Senior Dental Services, profiled last year by the Lynchburg, VA News and Advance, serves 25 facilities by visiting with portable dental equipment, thus making residents more comfortable and easing staff headaches.

Still, only 20% of practicing dentists in the United States provided care to those on Medicaid in 2009, and there were more than 830,000 visits to U.S. emergency rooms for preventable dental conditions that year, according to a bill proposed by Sen. Bernie Saunders (I-VT) and Rep. Elijah Cummings (D-MD) last month. While the bill has a slim chance of moving forward, it proposes dental coverage expansion for Medicare and Medicaid beneficiaries, along with veterans. It also proposes educating more dental healthcare providers.

With all the clinical challenges long-term residents often face, oral care is easy to push aside. But for those of you working to preserve teeth, I salute you, and invite you to comment below on what has worked at your facility.