Report outlines ‘pressing crisis’ for dental care access in West Virginia

Nearly a quarter dental practices in West Virginia are not accepting new patients, and people in the state wait on average 70 days for their first dental care appointment, according to a report released earlier this month. 

“Beyond the Waiting Room: the State of Dental Care Access in West Virginia,” outlines what contributors call a “pressing crisis” in dental care in West Virginia, particularly for vulnerable populations.

Authors of the report, published Nov. 8 by the West Virginia Oral Health Coalition and the Harmony Health Foundation, used a “mystery shopper” assessment of what patients go through trying to schedule a dental appointment. The authors sampled 192 dental care sites in West Virginia, representing about 42 percent of the 456 dental care sites.

The study showed a “concerning” increase in wait times compared to previous mystery shoppers done in other states before the pandemic, it says. For example, a 2014 mystery shopper program in Connecticut found that 75% of practices offered appointments in less than two weeks and the majority (59%) provided appointments within a week.

West Virginia, like other parts of the country, faces a shortage in dental care providers. According to the state’s 2021 Oral Health Report Card, the state had 48.3 dentists per 100,000 residents, compared to 61 per 100,000 for the United States. More than 800,000 state residents live in an area of the state with a shortage of dental care professionals, as defined by the federal government. 

The shortage of dental care workers is one factor in the state’s poor oral health outcomes. The state earned an overall D on its 2021 Oral Health Report Card.

According to the report, 24.1% of the state’s dental practices were not accepting new patient appointments. Patients wait on average 70 days for the first appointment. Only 36.7% of the dental care providers could offer appointments within 30 days.

Access to dental care is especially challenging for people with intellectual and developmental disabilities. Of 48 dental care sites called, 15% did not treat patients with intellectual and developmental disabilities. They also face the longest wait time — up to 115 days — for first available appointments, the report found. 

Adults and children who self pay face a wait time of up to 73.2 days, and children on Medicaid wait up to 58 days. Of all the dental care sites surveyed, only 28.5% said they accepted Medicaid patients. 

“These findings demonstrate the urgent need for policy interventions to address the prolonged wait times and limited access to dental care services in WV, particularly impacting those in underserved communities and individuals that are dependent on government-funded health insurance,” the report says. 

Gina Sharps, oral health coordinator for the West Virginia Oral Health Coalition, said the workforce shortage is a major part of the state’s access problem. Often, dentists are doing their best to care for patients, but can’t get to every person, she said. 

“That’s something to be mindful of as well,” said Sharps, who contributed to the report. “You can’t point fingers and say, ‘You need to do X, Y and Z.’ We can give them an ear and hear from them saying, ‘We are providing as much care as we can.’”

The report outlines a set of policy recommendations meant to improve access to care, including incentivizing the use of advanced technology in cooperating with mobile dental practices.

Dr. Meghan Bastin, a pediatric dentist and assistant professor at West Virginia University who contributed to the paper, said addressing the state’s dental care access problem will take thinking innovatively and recognizing that traditional care processes are not solving the problem on their own. 

“The paper notes that we could look towards technology to help us with this,” Bastin said. “For example, perhaps teledentistry or mobile dental clinics would be a good answer to help connect people to dentists virtually, or even maybe they stay in their own home and someone comes to them.”

She added that technology like app-connected toothbrushes to help people learn where they’re missing while brushing their teeth could also be helpful. 

Bastin said one way WVU, the state’s only dentistry school, is addressing the workforce shortage is by adding a pediatric dental residency program so that dentistry students and providers don’t have to leave the state for that added training. 

“Which is super important for the state because as the state’s only dental school, we didn’t have that specialty option for students,” she said. “And they would have to leave West Virginia to gain that training, and then return. So that’ll be really nice to be able to grow our own and to teach those who are interested to be able to do that here at WVU.”

Offering student loan repayment programs to students who take on debt for education is another thing that could help, she said. 

The report also suggests having medical care providers do basic oral health assessments and preventative treatments. 

Children on average see a medical provider more often than a dental provider, Sharps noted. 

“Non dental providers are so much more uniquely positioned that they can provide the early intervention and education to parents and to make that dental referral for the age 1 dental visit and that’s best practice guidelines — age 1 dental visits — but we still hear a lot that children aren’t getting into until [age] 3 or 4.”

The report’s other policy recommendations include increasing training focused on treating individuals with intellectual and developmental disabilities, expanding Medicaid dental coverage and shifting reimbursement structures from fee-for-service to incentivizing outcomes.

While the report brings to light sad statistics, Sharps said, it should be used as a called to action for organized dentistry in the state. 

Adding to the state’s dental care workforce will take not only dental providers, but academia and state government working together, she said.