“The process was easy because I was already in the DCF system,” Lloyd said. “I just completed forms online and waited for a decision. Mia and Davion were re-approved, but they said I was ineligible for Medicaid based on my income.” In a June report, Kaiser Health News said 82% of Floridians or a quarter-million people in the state have lost coverage. State data shows that most of those people are still eligible but lost coverage for procedural reasons such as having outdated contact info or computer glitches. The report further said that 10% of those who lost coverage were terminated because they were ineligible or hadn’t used Medicaid over the past 12 months. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program that has three parts: Managed Medical Assistance, Long-Term Care, and Dental. All people on Medicaid must enroll in a dental plan. Daniel van Hoogstraten is an Ohio-based consultant and healthcare advocate who has devoted decades of support in the nonprofit space. He works in various states and on Capitol Hill with a focus on groups who are trying to help people. He says Medicaid falls into that bucket very often. “So, there's two big things going on with Medicaid right now in Florida and that's obviously the disenrollment that was paused, but then continued on,” van Hoogstraten said. During Covid-19, the federal Public Growing evidence connects a healthy mouth with a Health Service Act was implemented. It healthy body. Here are some examples showing why thatmore youthan couldn't oral healthstipulated is about much a smile:roll people off Medicaid, but it ended May High Blood Pressure 11 of this year. Florida began rolling Putting off dental during early who adulthood is linked to people offcareMedicaid had been an increased risk of having high blood pressure.1 on it for a long period of time. Now, Patients with gum disease are less likely to keep their blood pressureare underlosing control with medicationbecause than are people Medicaid those with good oral health.2 they are not eligible or because they didn't properly complete the enrollDiabetes ment process.” Untreated gum disease makes it harder for people with diabetesvan to manage their blood glucose levels.3for many Hoogstraten says Diabetes raises the risk of developing gum 86%.4 states, if not all, Medicaid isdisease theirbylargest state expenditure. Obesity It is big money and taxpayer money, so Brushing teeth no more than once per day was linked with the he and offellow development obesity.5advocates are currently talking to Frequent consumption of sugar-sweetened drinks the risk of both government administrations toraises determine if their obesity6 and tooth decay among children7 and adults.8 process is working well and transparent. He thinks states are generally trying to do the right thing. “I also think Medicaid departments are behemoths because of the really Sources large population they serve,” van Hoogstraten said. “The populations are 1. Oreskovic, NM et al. (2017). Oral health status and longitudinal cardiometabolic risk in 4. Baranowski MJ, et al. Diabetes in dental practice-review of literature. Journal of a national sampleoften of young adults. of the American Dental Association, Health and Sport. 2019; 9(2), 264-274 soJournal hard to reach, and148(12), they're Education, constantly shifting and changing. The 930-935. 5. Furuta M, et al. (2020). Longitudinal associations of toothbrushing with obesity and 2. Pietropaoli D, et shortcomings al. Poor Oral Health and Blood Pressure Control among US hyperglycemia. Journal of Epidemiology, JE20190165. or mistakes are usually not nefarious or ill intentioned, but Hypertensive Adults: Results from the National Health and Nutrition Examination 6. Luger M, et al. Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Survey 2009 to 2014. Hypertension. 2018 Dec; 72(6): 1365-1373. Müller F. Oral Hygiene Systematic Review from 2013 to 2015 and a Comparison with Previous Studies. Obesity they're inevitable.” Reduces the Mortality from Aspiration Pneumonia in Frail Elders. Journal of Dental Facts. 2017; 10(6): 674-693. Research. 2015 Mar; 94(3 Suppl.): 14S–16S. Bleich SN, Vercammen KA. The negative impact of sugar-sweetened beverages on Despite the State’s best intent,7. without Medicaid, Floridians like Lloyd 3. Preshaw PM, Bissett SM. Periodontitis and diabetes. British Dental Journal. 2019; children’s health: an update of the literature. BMC Obesity. 2018; 5(6). 227: 577–584; Teeuw WJ, et al. Effect of periodontal treatment on glycemic control of 8. Bernabé E, et al. Sugar-sweetened beverages and dental caries in adults: a 4-year struggle to findDiabetes affordable diabetic patients:will A systematic review and meta-analysis. Care. 2010 Feb; health coverage that includes a dental plan. prospective study. Journal of Dentistry. 2014; 42(8): 952-958. 33(2): 421-427. She is potentially an unwitting contributor to Florida’s state of poor oral health — a precursor to a bevy of extended health diseases. The Jacksonville Urban League played an integral role in Florida's Oral Health Crisis by hosting a Town Hall meeting in April 2022. The organiza-
Impacts Beyond the Mouth
tion's core vision is to be a leading advocate for promoting access to quality education, economic opportunity, civic engagement, health, and wellness. The following statistics emerged from the oral health gathering: 1. More than five-million Floridians live in areas that have limited or no access to dental care and more than 23% of third graders in Florida have untreated tooth decay, making Florida sixth in the nation for the highest percent of third-grade children with unfilled cavities. 2. 34% of senior citizens have lost six teeth due to tooth decay or gum disease. 3. In 2019, hospitals in Florida billed more than $630 Million for preventable ER visits and hospital admissions stemming from preventable oral health issues. 4. Poor dental health has been said to be the cause of 57 systemic diseases and illnesses. 5. Patients with serious dental conditions are 25% more likely to suffer from heart disease and have an increased chance of autoimmune diseases, anemia, gastrointestinal disorders, and renal disease. The largest burden of disease occurs among marginalized groups such as those living inDementia poverty and members of Black, Indigenous, and People ofyears Color (BIPOC) commu- was Having 10 of chronic gum disease (periodontitis) associated with a higher risk of developing Alzheimer’s disease. nities. Low-income families spend 10 times of Researchers report that uncontrolled periodontal disease their total income on dental the care than that “could trigger or exacerbate” neuroinflammatory phenomenon seen families. in Alzheimer’s disease. of wealthier Without dental coverage or the ability Respiratory to afford care, Health many adults delay treatResearch shows that improving oral hygiene among mentmedically whichfragile leads to more expensive seniors can reduce the death rate from 11 pneumonia. andaspiration extensive oral care than they Patients with ventilator-associated pneumonia (VAP) who would require had they seen a dentist engaged in regular toothbrushing spent significantly less time on mechanical ventilation than other VAP patients.12 earlier in the disease process. Improving veterans’ oral hygiene reduced the incidence of Lloyd has valiantly rebounded hospital-acquired pneumonia (HAP) by 92%, preventing about 13 136 HAP casesdropped and saving 24off lives.the from being Medicaid roll. Her employer offers a Blue Cross Blue Shield of Florida plan and Adverse Birth Outcomes Delta Dental, but cumulative payroll Gum disease among pregnant women is associated with preterm deductions are near $100. Withouta pregnancy births, low birthweight babies and preeclampsia, complication that can cause organ damage and can be fatal.14 Medicaid, she will also have to budget co-pays for appointments. “My health is already not good,” Lloyd said. “I have high blood pressure, and if I go to the dentist and it’s high, they won’t treat me. I am headof-household. It’s just me, so one entire paycheck goes to rent and the other pays JEA electric and car insurance. With food skyrocketing and two kids, it’s hard, but I am determined to make it work.” 9
10
9. Chen CK, et al. (2017). Association between chronic periodontitis and the risk of Alzheimer’s disease: a retrospective, population-based, matched-cohort study. Alzheimer’s Research & Therapy, 9(1), 56.
13. Munro S, Baker D, 2018. Reducing missed oral care opportunities to prevent nonventilator associated hospital acquired pneumonia at the Department of Veterans Affairs. Applied Nursing Research, 2018; 44: 48-53.
10. Teixeira FB, et al. Periodontitis and Alzheimer’s Disease: A Possible Comorbidity between Oral Chronic Inflammatory Condition and Neuroinflammation. Frontiers in Aging Neuroscience. 2017 Oct; 9:327
14. Daalderop LA, et al. Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews. Journal of Dental Research Clinical and Translational Research. 2018; 3(1): 10–27.
11. Müller F. Oral Hygiene Reduces the Mortality from Aspiration Pneumonia in Frail Elders. Journal of Dental Research. 2015 Mar; 94(3 Suppl.): 14S–16S.
Citation: Penny Dickerson isSuggested innovation and entrepreneur CareQuest Institute for Oral Health. Impacts Beyond the Mouth. Boston, MA; June 2020. DOI: 10.35565/CQI.2020.4002 reporter for the Jacksonville Business Journal. Copyright © 2021 CareQuest Institute for Oral Health, Inc. Reporting for this story in ONYX Magazine was made possible by a health equity fellowship sponsored by The Commonwealth Fund and Association of Health Care Journalists.
12. de Lacerda Vidal CF, et al. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infectious Diseases. 2017 Feb 27; 17(1): 173.
ONYX MAGAZINE 15
