Gap in Routine Dental Care for the Poor

Residents of publicly supported housing—public housing developments and rental assistance units—were less likely to have had routine preventive dental care and more likely to have experienced serious oral health issues resulting in tooth loss compared to other residents, a new study by the Partners in Health and Housing Prevention Research Center (PHH-PRC) at the BU School of Public Health shows.

The study, which appears in The Journal of Urban Health, discloses a serious gap in oral health care for an already vulnerable population, especially seniors living in public housing.

PHH-PRC researchers investigated whether living in Boston’s publicly supported housing (PSH) was associated with four oral health-related indicators: having had a dental visit in the last year, having had a dental cleaning in the last year, having had six or more teeth extracted, and having dental insurance.

The researchers found that, despite being as likely to have had a dental visit in the last year, both public housing and rental assistance residents were significantly less likely than others to have had a cleaning in the last year. Additionally, residents of rental assistance units were more than twice as likely to have had six or more teeth removed than nonpublic housing residents. The findings were even more significant for the elderly: Compared to younger residents, seniors 65–75 years old in PSH were 30 times as likely to have had six or more teeth removed—jumping to 43 times after age 75.

According to the researchers, one reason for such a high incidence of extractions is the current Medicaid dental benefit structure. As of January 2014, Dental Medicaid does not cover simple restorative procedures, including fillings, though it does cover tooth extractions. For families with limited financial resources, especially the elderly, the only feasible option may be to have teeth removed.

Deborah J. Bowen, the study’s principal investigator and director of the PRC, said oral health affects “all parts of our overall health, including mental health, self-confidence and self-esteem. It even affects the way others perceive us.”

Bowen, professor of community health sciences at BUSPH, said, “This work isn’t just about telling people they need to floss. It’s about preventing a wide range of chronic diseases and improving self-confidence and mental health. Rehabilitative dental treatment for welfare recipients has been linked to greater success in finding employment. The positive effects of good oral health are incredibly far-reaching.”

The findings were based on results from the Boston Behavioral Risk Factor Surveillance System (BRFSS) survey, an annual household telephone survey of health-related behaviors and conditions among adults living in Boston. The Boston BRFSS is unique, as the PRC partnered with the Public Health Commission to add a simple question to the survey regarding housing status—making the survey an important tool for public housing research.

The PRC has stepped in to address the findings that public housing residents, particularly seniors, are suffering a disproportionate burden of oral health problems while lacking coverage for simple procedures.

The center has received funding from the Sunshine Lady Foundation to pilot the Boston Senior Oral Health Project, which provides free oral health screenings to seniors living in public housing. Those identified as needing treatment (deep cleaning, fillings, dentures, etc.) are referred to local clinics, where they can receive care free of charge.

PRC leaders say they hope to see an improvement in oral health status among seniors in the next round of BRFSS surveys.

Funding for the study was provided by the U.S. Centers for Disease Control and Prevention.