Introduction
Chronic dental diseases are among the most prevalent chronic conditions in the U.S.,
despite being largely preventable. Individuals with mental illness experience multiple
risk factors for poor oral health and need targeted intervention. This study investigated
experiences of Kansas Medicaid enrollees with serious mental illness in accessing
dental services, examined their oral health risk factors, and identified oral health
needs and outcomes.
Methods
Survey data were collected from October 2016 through February 2017 from 186 individuals
in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively
(descriptive and bivariate statistics) and qualitatively (for major themes).
Results
Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a
dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived
need, uncertainty about coverage, difficulty accessing providers, fear of the dentist,
and transportation issues. High rates of comorbid physical health conditions, including
diabetes and cardiovascular disease, and current or former tobacco use were also observed.
Conclusions
Medicaid dental benefits that cover only dental cleanings and low levels of oral health
knowledge create barriers to utilizing needed preventive dental care. Lack of perceived
need for preventive dental services and lack of contact with dentists necessitates
the development of targeted oral health promotion efforts that speak to the specific
needs of this group and are disseminated in locations of frequent contact. The Medicaid
population with serious mental illness would be an ideal group to target for the integration
of chronic oral, physical, and mental health prevention services and control.
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REFERENCES
- Oral health: the silent epidemic.Public Health Rep. 2010; 125: 158-159
- The effect of functional dentition on Healthy Eating Index scores and nutrient intakes in a nationally representative sample of older adults.J Public Health Dent. 2009; 69: 207-216
- Oral health, general health and quality of life.Bull World Health Org. 2005; 83: 644
- Oral health disparities and psychosocial correlates of self-rated oral health in the National Survey of American Life.Am J Public Health. 2010; 100: S246-S255
- Evaluating the impact of dental care on housing intervention program outcomes among homeless veterans.Am J Public Health. 2013; 103: S368-S373
- Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities.J Public Health Dent. 2013; 73: 79-82
- Impact of dental visiting trajectory patterns on clinical oral health and oral health-related quality of life.J Public Health Dent. 2010; 72: 36-44
- Inequality in utilization of dental services: a systematic review and meta-analysis.Am J Public Health. 2018; 108: e1-e7
- Oral Health in America: A Report of the Surgeon General – Executive Summary .National Institution of Dental and Craniofacial Research, Rockville, MD2000
- Medicaid's Role in Financing Behavioral Health Services for Low-Income Individuals.Kaiser Family Foundation, Menlo Park, CA2017
- A decade in dental care utilization among adults and children (2001–2010).Health Serv Res. 2014; 49: 460-480
- Children's Use of Dental Care in Medicaid: Federal Fiscal Years 2000–2012.George Washington University Milken Institute School of Public Health, Washington, DC2014 (Accessed February 13, 2016)
- Medicaid adult dental benefits: an overview.CHCS Fact Sheet. 2018; (Accessed January 9, 2018)
- Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs.Health Aff (Millwood). 2015; 34: 749-756
- Dental-related emergency department visits and community dental care resources for emergency room patients.Kans J Med. 2015; 8: 61-72
- Effects of cuts in Medicaid on dental-related visits and costs at a safety-net hospital.Am J Public Health. 2014; 104: e13-e16
- Doctor, my tooth hurts: the costs of incomplete dental care in the emergency room.J Public Health Dent. 2010; 70: 205-210
- A systematic review and meta-analysis of the association between poor oral health and severe mental illness.Psychosom Med. 2015; 77: 83-92
- Oral health impacts of medications used to treat mental illness.J Affect Disord. 2017; 223: 184-193
- The impact of lifestyle factors on the physical health of people with a mental illness: a brief review.Int J Behav Med. 2014; 21: 275-281
- Sublingual atropine in the treatment of clozapine-induced sialorrhea.Schizophr Res. 2017; 182: 144-145
- Oral health of adults with serious mental illness: a review.Community Ment Health J. 2010; 46: 553-562
- The high prevalence of poor physical health and unhealthy lifestyle behaviors in individuals with severe mental illness.Issues Ment Health Nurs. 2011; 32: 589-597
- Morbidity and Mortality in People With Serious Mental Illness.National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, Alexandria, VA2006
- The dental health of people with schizophrenia.Acta Psychiatr Scand. 2004; 110: 306-310
- Advanced dental disease in people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2011; 199: 187-193
- Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases.J Clin Periodontol. 2013; 40: S24-S29
- The individual and program impacts of eliminating Medicaid dental benefits in the Oregon Health Plan.Am J Public Health. 2011; 101: 2144-2150
- Tooth loss and heart disease: findings from the Behavioral Risk Factor Surveillance System.Am J Prev Med. 2005; 29(5): 50-56
- Clinicians’ recognition of the metabolic adverse effects of antipsychotic medications.Schizophr Res. 2005; 79: 281-288
- (KanCare Benefits and Services. Topeka, KS.) (Accessed February 13, 2018 )
- Predictive Modeling for Kansas Medicaid Health Homes: Identification of Target Subpopulations .University of Kansas School of Medicine, Kansas City2014
- Behind the Term: Mental Illness .SAMSHA National Registry of Evidence-based Programs and Practices, Rockville, MD2016 (Accessed March 29, 2018)
- (Kansas Medicaid: evaluating program satisfaction, access to care and unmet needs of adults with serious mental illness. Health Care Foundation of Greater Kansas City Project Final Report.) (Published 2017. Accessed March 29, 2018 )
- Understanding Nursing Research .3rd ed. Lippincott Williams & Wilkins, London2011
- The global burden of periodontal disease: towards integration with chronic disease prevention and control.Periodontol 2000. 2012; 60: 15-39
- (Behavioral Risk Factor Surveillance System (BRFSS). Topeka, KS.) (Published 2015. Accessed March 29, 2018)
- Differences among older adults in the types of dental services used in the United States.Inquiry. 2016; 53: 1-11
- Insurance-related barriers to accessing dental care among African American adults with oral health symptoms in Harlem, New York City.Am J Public Health. 2011; 101: 1420-1428
- Improving the oral health of older people: the approach of the WHO Global Oral Health Programme.Community Dent Oral Epidemiol. 2005; 33: 81-92
- Determinants for preventive oral health care need among community‐dwelling older people: a population-based study.Spec Care Dentist. 2014; 34: 19-26
- Oral health in adults with serious mental illness: needs for and perspectives on care.Community Ment Health J. 2015; 51: 222-228
- Health literacy: a pathway to better oral health.Am J Public Health. 2014; 104: e85-e91
- Oral health-promoting school environments and dental caries in Quebec children.Am J Prev Med. 2017; 53: 697-704
- Dental fear in adults: a meta-analysis of behavioral interventions.Community Dent Oral Epidemiol. 2014; 32: 250-264
- Oral health-related quality of life and nutritional status.J Public Health Dent. 2008; 68: 88-93
- World Health Organization global policy for improvement of oral health-World Health Assembly 2007.Int Dent J. 2008; 58: 115-121
- From victim blaming to upstream action: tackling the social determinants of oral health inequalities.Community Dent Oral Epidemiol. 2007; 35: 1-11
- Community based oral health prevention issues and opportunities.Am J Prev Med. 2002; 23: 8-12
- Dental homes for children with autism: a longitudinal analysis of Iowa Medicaid's I-smile program.Am J Prev Med. 2016; 50: 609-615
- Oral hygiene in patients with severe mental illness: a pilot study on the collaboration between oral hygienists and mental health nurses.Perspect Psychiatr Care. 2016; 52: 194-200
Article Info
Publication History
Published online: August 17, 2018
Identification
Copyright
© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
