Elisabeth Warder, DDS: Local and state partners need to band together to transform oral health

By Elisabeth Warder, DDS

This is an exciting time for oral health. Too often, oral health is treated separately from our overall health – in how we talk about it, how we insure it, how we treat it. But the truth is oral health is essential for overall health. Oral disease is linked to diabetes, heart disease, stroke, pregnancy complications, pneumonia, and other serious illnesses.

I am a dentist at CHAS Health. When I first moved to Spokane 15 years ago, I was completely astonished by the rampant decay I saw in patients. Our region faces significant oral health challenges. Not only do we not fluoridate our water, we have a severe shortage of dentists in Spokane who are able to accept Medicaid patients.

A third of Spokane County adults have lost one or more teeth to decay. A kindergarten student in Spokane is more likely to have rampant tooth decay than the average child in Washington. These statistics are unacceptable.

As a community, we need to do better. We must continue to identify gaps, champion local and state solutions, fund sound public health policy, and invest in access to oral health care. For several years, I have been a member of Smile Spokane, a network of health care, public health, social services, and community-based organizations. Together, we strive to transform oral health in our region.

We invest in strategies to ensure everyone in our community can enjoy better oral health, overall health and well-being. Following are some of the ways our partners have worked to close gaps for the most vulnerable in our community:

• Access strategy – Providence and CHAS run dental clinics for low-income patients.

• Sealant strategy – Communities in Schools and Toothsavers of Washington provide preventative sealants to children in schools. In 2019, 89 percent of Spokane County elementary schools with at least 50 percent Free & Reduced Lunch received school-based oral health services.

• Care Linkages Strategy – Frontier Behavioral Health and DentistLink connected over 400 individuals living with mental illness to dentists who take Apple Health Medicaid.

Last year, Smile Spokane asked the Spokane City Council to begin fluoridating Spokane’s water supply. In September 2020, the City Council approved a contract to begin water fluoridation, which is a huge win to improve health equity in our community. Currently, Spokane is the largest city in Washington state without water fluoridation.

Not only have we seen exciting developments in the Spokane region, but we are heartened by the work of the Legislature in implementing several important wins for oral health equity:

• Increased funding for the Apple Health (Medicaid) Adult Dental Program. The final operating budget includes a significant increase in our state’s investment in the Apple Health adult dental program, to be used to increase provider reimbursement rates. Washington’s Medicaid dental rates were among the lowest in the country. This change will hopefully increase access to care for the more than one million Washington adults currently covered by Apple Health.

• Expansion of the Access to Baby & Child Dentistry (ABCD) Program, which connects young children to dental homes. This expansion will cover children with disabilities through age 12. The ABCD program, a collaboration between ABCD providers, local organizations, state agencies and Arcora Foundation, has more than doubled dental utilization for young children over the last 20 years, and there is more work to do to continue to close gaps and ensure very young children (under age 2) are getting into care.

• Support for DentistLink. The operating budget also includes funding to support the development of a public/private partnership for DentistLink, a program that connects users across the state with dental providers through their website, phone calls, or texts. This service makes it easier for providers to accept Apple Health patients into their practice.

Despite these successes at the regional and state level, there’s still more to do. We need to continue to invest in prevention: support fluoridation, cover hygiene therapy services to keep mouths healthy, improve access to dental care, and continue to invest in the Medicaid dental program, ensuring the system works for both patients and providers.

We need to continue to band together to identify, champion and fund solutions. This work to improve oral health takes many partners – at the local and state level. It requires a diverse coalition of public, private and nonprofit partners, advocating for systemic change to allow for good oral health, particularly for historically under-resourced communities.

Elisabeth Warder, DDS, is a dentist with CHAS Health and a member of Smile Spokane, a network that strives to transform oral health in our region.