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The Status of Oral Health in Hawaii
What is the problem?
Oral health statistics for Hawaii are among the worst in the nation. Hawaii’s children have more unmet dental needs, more baby-bottle tooth decay, and more decayed and filled teeth than the nation as a whole. The Hawaii rate of baby bottle tooth decay is nearly three times the national rate; the Hawaii rate of dental caries—the most common childhood disease—is nearly twice the national rate.* Hawaii’s children have 33% more unmet treatment needs than children nationally.
These statistics are even worse for Filipino, Southeast Asian, Native Hawaiian and other Pacific Island children. For example, Filipino children have dental caries at a rate nearly three times the national average.
More than 350,000 Hawaii residents have no dental insurance and an additional 75,000 children have coverage under the state Medicaid program (QUEST), which has few participating dentists. In other words, 37% of the State population (nearly 430,000 residents) have limited or no access to dental care.
Why is there a problem?
A statewide Oral Health Task Force identified the following barriers to dental health for Hawaii’s people:
- A small number of dentists actively participate in insurance programs that target the underserved. An extremely low percentage of Hawaii dentists (30%) care for patients covered by QUEST and Medicaid. Hawaii is ranked near dead last—46th out of 47 states with available data—for the proportion of dentists who offer services to publicly-insured individuals[i]. Hawaii’s low-income children, who have serious oral health needs, are entitled to receive dental services through Medicaid and QUEST. Yet few dentists will serve them, due to low reimbursement rates and the excessive paperwork involved in getting payments.
- The Medicaid and QUEST programs provide no routine dental coverage for adults. These programs more fully cover children, but offer very limited coverage for adults, who are entitled to services only in emergencies. In other words, adults with limited resources must wait until their condition is dire—and more costly—before their coverage kicks in.
- On the whole, the Neighbor Islands have greater need and fewer available dentists than Oahu. Many areas have an acute shortage of dentists willing to serve QUEST, Medicaid and uninsured patients. Not surprisingly, these same areas have the highest rates of poverty, uninsured, and QUEST participation. For example, 58% of the population on Molokai and 55% of the population on the Big Island are either uninsured or covered by QUEST/Medicaid, compared to 34% on Oahu.[ii]
How do we solve the problem?
The Oral Health Task Force made these five key recommendations:
- Fluoridate community water systems – Honolulu is one of the few remaining major metropolitan areas in the nation with no fluoridated water supply. Community water fluoridation reduces tooth decay by as much as 65%. [iii]
- Restore dental benefits for adults participating in Medicaid/QUEST – The State of Hawaii should restore the routine adult dental services it cut from Medicaid and QUEST in 1996. The mouth, teeth, and gums are as essential to health as any other part of the body. Coverage limited to emergency-only services threatens the overall health of an individual: Recent research points to associations between chronic oral infections and diabetes, heart and lung disease, stroke, and low-birth-weight births—conditions that are more complicated and costly to treat than effective oral health care. [iv]
- Develop and support dental safety net providers – While private practice dentists remain the primary source of dental care for the public, they meet only some of the needs of the underserved. Safety net providers—including community health centers, Native Hawaiian Health Care Systems, and other non-profits—play a key role in meeting the oral health needs of low-income families. These providers need support: They need capital funds for new and expanded programs, and they need public subsidy for the uncompensated services they provide.
- Increase the supply of dentists participating with Medicaid/QUEST – National studies indicate that the participation of dentists in State insurance programs has a lot to do with rates of reimbursement.[v] Compared to other regions nationally, Hawaii’s reimbursement for public dental insurance is low. In addition, the red tape governing QUEST reimbursement discourages provider participation, suggesting a need to simplify and streamline the process. [vi] Finally, safety net providers need help recruiting qualified dentists committed to working in primary care centers for the underserved. Such dentists are in short supply, suggesting the need for more creative recruitment, training, and incentive programs.
- Educate the public about oral health self-care, nutrition, and regular preventive dental care – Knowledge is power. Hawaii needs culturally-competent oral health education campaigns on multiple fronts—in schools, community centers, health clinics, and other settings. Public education campaigns employ multiple strategies that target all Hawaii residents, including immigrants, Native Hawaiians, low-income families, and other underserved groups.
This fact sheet is based upon the findings of the Oral Health Task Force, a coalition of 40 hospitals, health and human service agencies, health maintenance organizations, professional associations, State departments, and individuals. For a complete copy of the coalition’s report, "Oral Health 2001: A Strategic Plan for Oral Health in Hawaii," call the Hawaii Primary Care Association at (808) 536-8442.