Population considerations

  • Cost of dental care. Many individuals with lower incomes do not qualify for Medicaid and do not have insurance that covers dental costs (Zittel-Palamara, 2005).
  • Access to dental care. Individuals from lower income families may receive Medicaid, but there are only a few dentists that accept Medicaid as a payment option. Few dentists accept Medicaid, and those who do are not always located in lower income communities (Mouradian, 2000). Most dentists practice in suburban communities, not inner-city or rural areas where lower income families tend to live (Nash, 2003).
  • Lack of transportation. Many lower income families, especially those living in rural communities, may not have access to personal transportation (Strickland, 1996). Public transportation may not be available, convenient or affordable (Kelly, 2005).
  • Perceived discrimination. Research shows that low-income families sometimes experience discrimination as a result of using Medicaid and perceive their quality of care to be lower than families who do not use Medicaid (Kelly, 2005).

  Strategies to address these considerations

  • Identify alternative payment options. Work with providers, insurance carriers, community groups and local community leaders to identify free or low-cost oral health services. For example, dental schools often provide low- or no-cost services to allow students to gain experience.
  • Address provider shortages. In some states dental hygienists who have specific training are allowed to provide advanced services (Mouradian, 2000).
  • Increase access. It may be useful to provide oral health screening and treatment in locations where lower income families already receive services, such as WIC or Head start facilities, food pantries and free health clinics. 
  • Increase transportation options. It may be useful to work with local providers and government and community leaders to identify alternative transportation options, such as adding public transportation routes or providing mobile oral health facilities.
  • Improve provider awareness. It is important to educate oral health providers to help them understand the financial challenges that lower income families face when seeking oral care.
  • Increase knowledge. Education strategies for lower income populations should stress the importance of preventive care and good oral health for maintaining overall health.

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