Are there dental access issues in Alabama?

Do we have any issues to be concerned about regarding access to dental care in Alabama? Everyone has a dentist who can see them on short notice if they need, right? Wrong.

If you live in Birmingham or in one of the larger cities in Alabama, you might not have a problem being seen on short notice – particularly if you have dental insurance or out of pocket cash for treatment, but if you live in smaller towns or rural areas in our state, you might not be so lucky.

Alabama currently has only one county without a dentist: Greene County. However, about 80% of all the dentists practicing in Alabama practice in the 13 most urban counties. The other 20% practice in the 54 non-urban counties of Alabama; many of these smaller counties only have between one and three dentists. This translates to about one dentist for every 1,800 people in the urban areas, versus one dentist for every 4,100 people in the non-urban areas – a big difference.

This is the subject of a paper Dr. Stuart Lockwood and I are developing and hope to publish with the Lister Hill Center for Health Policy in the next few months. Dr. Lockwood and I are both former State Dental Directors with the Alabama Department of Public Health. We both have examined the teeth of thousands of children in Alabama to assess the state of dental decay and to make referrals to local dentists. We have seen many with excellent dental care and many without any need for treatment. However, we have also seen evidence of neglected dental needs in many children. An even larger concern we have seen is the lack of access afforded to low-income adults with no dental insurance and no public dental coverage in Alabama. We will cover that connected subject perhaps in another post.

Dr. Lockwood and I have been engaged in studying the underlying issues for our widening gap between urban and non-urban areas concerning dental care access for many years. We developed a partnership between the UAB School of Dentistry and the Alabama Dental Association to develop a strategy to correct the disparities we found in the more rural areas of the state.

Through this partnership, we wrote and were awarded a grant to do several things in this area. One was to take the available data on dental practices in Alabama and with the help of the UAB School of Public Health develop a GIS map detailing where all dentists’ practices are located in Alabama. The grant also allowed for rotation experiences in rural areas for dental students as a way to allow them to see dental practice life in these areas. We also provided significant financial awards to a few graduating dentists who agreed to practice in a rural area and also agreed to see a certain percentage of Medicaid patients for a specified number of years. Graduating dental students can have very significant school debt, and this was designed to assist them with that debt and help them establish a practice. The grants were planned to help “plant” dental offices in nine rural areas needing a dentist. Nine such practices came about through this grant program and they have successfully continued in those areas to this day.

I’ve worked with Dr. Lockwood and the state dental association on language presented to the state legislature and the Governor’s office for consideration of a similar state-based financial incentive program for new dentists willing to locate in a rural area. We hoped this would also encourage young dentists to choose a smaller town or rural area in which to practice. While all our legislators were favorable to the concept, funding has not been significant just yet. We continue pursuing this possibility.

Another issue regarding distribution of dentists involves the current ages of dentists in rural areas. We will discuss these findings in some detail in our upcoming paper.

So – to answer the question, “Is it easy to find a dentist to see you on short notice anywhere in Alabama?” – no. However, many of us are engaged in this concern and working towards positive solutions for all Alabamians. We hope to be able to answer my question in the affirmative in the near future!

Dr. Conan Davis recently retired from his position as Assistant Dean for Community Collaborations and Public Health at the UAB School of Dentistry. He continues to research the inequities in access to dental care across Alabama.