The goal of the dental pain management program is to increase access to emergency dental care, and reduce opioid use.
A La Crosse County Health Department program that reaches people suffering from severe dental pain who struggle to get the help they need, often for weeks or even months, is expanding.
The county’s dental pain management program was launched in 2019 with state funding, in part as an attempt to reduce opioid addiction. Dental pain often sends those who don’t have a regular dentist to the Emergency Room, where they may be prescribed opioid painkillers. This can include people who are in treatment for opioid addiction, meaning a dental emergency could lead to renewed addiction. The goal of the program is to increase access to emergency dental care while lessening the use of ERs for non-traumatic dental pain, and in doing so, to reduce opioid use for dental pain.
The program was awarded $59,783 from the Wisconsin Department of Human Services in 2019 to run through 2020. The grant was recently extended through 2021 and the amount was increased to $113,715. Between Sept. 1, 2019, and August 31, 2020, the program served 304 clients, who otherwise may have been unable to access dental services.
“The additional funding will help us serve more members of our community who are suffering from dental pain, which if left untreated can cause severe problems,” said Jacquie Cutts, the Public Health Nursing Manager at the La Crosse County Health Department.
Clients of the county program rated their dental pain as severe in 60.9% of cases. Before receiving treatment through the program, 24.5% had experienced dental pain for weeks, 22% for months, and 11.5% for one year or more, according to the health department.
“Dental care is one of the least accessible types of health care and is disproportionately inaccessible for People of Color and those who have low incomes,” Cutts (pictured right) notes.
La Crosse County is considered a dental health professional shortage area, according to Cutts, and in 2019 an estimated 34.2% of adults aged 18 and over had not visited a dentist in the past year. The demand for access to low-cost dental care is simply too large given the low number of dentists in La Crosse County who take adult Medicaid, combined with the lack of affordable self-pay options for low-income residents, Cutts said.
Scenic Bluffs Community Health Center, which is supported by federal funding, does have a dental program for low-income residents, but can only see patients at their La Crosse location two days a month and has a two year wait list for routine adult dental care. Scenic Bluffs is one of two Federally Qualified Health Centers in the local region. The second is in Black River Falls.
Meanwhile, there’s only one private sector dentist who accepts adults with Medicaid in La Crosse County. Cutts said part of the reason for that is Medicaid’s poor reimbursement rate for dentists in Wisconsin. The shortage of options locally makes it an uphill battle for many to get the oral health care they need.
“This is why many people continue to struggle with dental pain and untreated dental disease, resulting in longstanding implications for oral health, general health, and mental health,” Cutts said. “There are connections in the literature between poor oral health and everything from cardiovascular disease, cancer, and poor birth outcomes. Addressing oral health is an important part of holistic wellbeing.”
The health department is hoping to fill more of the gap in dental care for residents with dental pain and low access to dental care through the increased funding for its dental pain management program. This will include seeking greater participation by local dentists in the program. Cutts said data from the program may also help to advocate for more systemic solutions addressing state-level policy, Medicaid reimbursement rates and oral health care access programs generally.
In addition to its dental pain management program, La Crosse County also runs two pediatric oral health programs. The county’s Fluoride Varnish program, primarily funded through Medicaid, applies fluoride varnish to children’s teeth at WIC clinics starting at age 6 months. At the same time, the children receive oral health screenings to detect dental decay and other oral health concerns, and referral for treatment.
The second program is called Seal-A-Smile and involves public health nurses and dental hygienists providing preventative oral health services in schools. Services provided include oral health education, screenings, cleanings, fluoride varnish applications, and dental sealants.
The school-based programs, even in the abbreviated school year of 2019 – 2020, served 1,371 children (up from 551 the year before) and provided almost $130,000 of services, free of charge to families and schools.