Princess Health and Health ranking of Kentucky seniors moves up, but they are still last in health outcomes, says America's Health Rankings. Princessiccia

Princess Health and Health ranking of Kentucky seniors moves up, but they are still last in health outcomes, says America's Health Rankings. Princessiccia

dental care exercise federal spending health rankings hospitals immunizations local government nursing homes obesity oral health physical activity poverty seniors state government vaccinations

Gusty 12:57 Add Comment

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky moved up three spots, from 48th to 45th, in the fourth annual Senior America's Health Rankings Report. But the state ranked last in health outcomes and 44th in determiners of those outcomes, so it remains one of the least healthy places in the nation for seniors to live.

Among negative measures, Kentucky seniors ranked first in preventable hospitalizations, second in tooth extractions and premature death; and third in physical inactivity and hospital re-admissions within 30 days of discharge.

Among positive measures, the state also ranked poorly: for example, 46th in the percentage (34%) of seniors who reported that their health status was good or excellent and 48th in the percentage (56.9%) who reported having no disability.

The state's best ranking was No. 3 in influenza vaccinations, reflecting an increase to 70 percent from 62 percent of seniors vaccinated in the past two years. It was No. 8 in the percentage of seniors with arthritis who self-report arthritis or joint pain does not limit their usual activities. It tied for 10th in the percentage of seniors with a "creditable prescription-drug plan" and was 17th in the percentage of senior who reported having a mammogram or a colonoscopy or similar screening.

Kentucky ranked low in volunteer activity by seniors (45th) and nursing home quality (43rd) but has fewer people in nursing homes who perhaps shouldn't be there. Only 7 percent of its nursing-home residents, the No. 7 ranking, were considered "low care" and thus candidates for living in less restrictive environments. However, it was 46th in the number of personal-care and home-health aides per 1,000 adults aged 75 or older.

The state tied for 44th in the percentage (32.1) of seniors who reported falling in the previous 12 months. It was 44th in the percentage (42.8) of seniors who were enrolled in hospice during the last six months of life after being diagnosed with a condition that carried high probability of death.

It was also 44th in a related measure, the percentage (16.6) of seniors who spent seven or more days in an intensive- or critical-care unit during their last six months. Generally, use of an ICU correlates with the number of ICU beds, which "could indicate a supply-induced remand," the report says. "Overusing the critical care system often goes against the wishes of dying patients and is costly. Research indicates many patients receive care they would not choose in their final days."

The rankings are based on 35 measures of health, as well as supplemental measures such as education and mental health. Combined, they paint a picture of how individual behavior, our communities and their environments, health policy and access to care influence health.

One area that Kentucky consistently ranks low in is government support for seniors in poverty. It was 45th again this year, spending $382 per senior when federal, state and local funds were all counted. Massachusetts, which ranked first in overall senior health this year, spends $4,053 per senior in this category, more than any other state but Alaska, which has many rural elderly. The national average, which has been declining, is $811.

Kentucky leads the nation in smoking, so it's no surprise that its seniors also rank in the bottom five states for this negative category (47th). Kentucky seniors' smoking rate is 12.4 percent; the national average is 8.8 percent. Both have declined about 40 percent in the last 15 years.

Smoking is the leading cause of preventable death in the United States," says the report. "Cessation, even in older smokers, can have profound benefits on current health status as well as improve long-term outcomes."

Kentucky was fifth from the bottom in dental visits by seniors, but the good news is that the share of seniors having such visits rose to 57 percent from 53 percent last year.

"Poor oral health is associated with such chronic diseases as diabetes and cardiovascular disease, and can have a large impact on quality of life resulting in pain and affecting the ability to chew or speak," says the report.

Kentucky improved its senior obesity ranking, another negative measurement, to 24th from 41st. About two out of every seven Kentucky seniors are obese, or 27.5 percent, the same as the national average. Last year the rate was 29.6 percent.

"Obese seniors experience more hospitalizations, emergency department visits, and use of outpatient health services than non-obese seniors, leading to higher health care costs," says the report. "Physical activity, healthy diet, supportive communities and social networks, and an environment that encourages exercise all play a role in reducing obesity in older adults."

The report says that between 1999 and 2014, Kentucky's middle-aged population (50-64) saw a 34 percent increase in in obesity and a 68 percent increase in diabetes. These findings were similar across the nation.

The report says Kentucky's senior population is expected to increase 44 percent by 2030. "Over the next 15 years, the health of this population will be challenged by large numbers of new people becoming seniors and the additional health challenges, such as diabetes, that this groups brings with them," it says."These higher rates of diabetes and obesity are expected to put significant strains on the Medicare program and the overall health-care system."

The report, sponsored by the United Health Foundation, is a call to action for states, offering specific benchmarks that can be changed to improve health.

Louisiana again ranked last for overall senior health, followed by Oklahoma. Kentucky, West Virginia, Arkansas and Mississippi had similar scores. The top six states for overall senior health are Massachusetts, Vermont, New Hampshire, Minnesota, Hawaii and Utah. Click here for the full report. (Click on chart for another version that may be clearer)

Princess Health and KET programs focus on oral health, 'just as critical to the well-being of Kentuckians' as problems that have a higher profile. Princessiccia

Princess Health and KET programs focus on oral health, 'just as critical to the well-being of Kentuckians' as problems that have a higher profile. Princessiccia

children children's health dental care dental health dentistry oral health seniors

Gusty 07:43 Add Comment

Kentucky Educational Television has turned its attention to oral health, which it says is "just as critical to the well-being of Kentuckians" as the state's "alarmingly high rates of cancer, heart disease, diabetes, and obesity."

KET's John Gregory, in a story about three recent programs, notes that two in five Kentucky children have never been to a dentist and "Poor oral health can contribute to other physical problems like diabetes, cardiovascular disease, and possibly even Alzheimer�s. It can impact how students learn."

�There�s thousands of children on a daily basis attending school with pain that is totally preventable,� Louisville health-care consutant Lacey McNary said on KET's "Connections" with Renee Shaw. �It is really hurting them with their success rates in school and otherwise overall well-being.�

McNary and Dr. Laura Hancock Jones, a dentist with the University of Kentucky's Western Kentucky Dental Outreach Program, blamed the lack of dentists in rural Kentucky and the refusal of many dentists to accept Medicaid, which covers 1.3 million Kentuckians.

But there are more longstanding factors, such as smoking, which makes periodontal disease six times more likely, and eating habits. "Jones says foods rich in carbohydrates and beverages that are high in sugar create the perfect breeding ground for bacteria that feed tooth-eating acids," Gregory reports.

And Jones says we have other bad habits, too: "She says studies show that almost a third of the population never flosses, and brushing and flossing twice a day is recommended. She adds that fear also contributes to bad oral health outcomes."

Other recent reports from KET have reported on a study of the state's oral health, the importance of good oral-health practices to seniors, and how the use of dental sealants in schools with high-risk populations has helped improve oral health.

The latter program featured Dr. M. Raynor Mullins, professor emeritus at UK's College of Dentistry, who "was instrumental in getting dental sealants added to Kentucky�s Medicaid program as a preventive service in the 1990s and has been involved with numerous oral health outreach initiatives across the state during the past 40 years," Gregory reports.

�A tooth has multiple surfaces � smooth surfaces and pit-and-fissure surfaces,� Mullins explains. �Smooth surfaces are the sides of the teeth, and fluorides are very effective about strengthening them. On the other hand, you have these pits, crannies, and fissures on the tops of the teeth and in certain locations on the sides of the teeth, where they are very susceptible to the infection of tooth decay. Sealants are very effective in preventing pit-and-fissure decay.�

Princess Health and Dr. Nikki Stone and mobile dental team in Hazard have helped cut tooth decay in the region 20 percent in a decade of operation. Princessiccia

Princess Health and Dr. Nikki Stone and mobile dental team in Hazard have helped cut tooth decay in the region 20 percent in a decade of operation. Princessiccia

children children's health dental care dental health oral health tooth decay

Gusty 14:03 Add Comment

By Ann Blackford
University of Kentucky

When Dr. Daria "Nikki" Stone, associate professor at the University of Kentucky College of Dentistry, became the director of the Ronald McDonald Care Mobile program in Hazard, she realized she was finally in the right place at the right time, where her piece of the puzzle fit in the big picture.

Growing up in Blackey, in Letcher County about 30 minutes from Hazard, she didn't know she wanted to be a dentist. She was always a good student and loved science classes in school but her passion had always been art. At her father's coaxing, she entered college as a pre-med major, and discovered through the UK Health Careers Opportunities Program that dentistry was a profession that merged her love of art and science.

Dr. Daria "Nikki" Stone (University of Kentucky photos)

"Now, I have a passion and love for what I do, preventing tooth decay in children in elementary schools, preschools and Head Start centers in Eastern Kentucky and advocating for underserved children," Stone said.

Stone married her high school sweetheart, Mark, and they have two children; Ana and Ian, 16 and 13. Her early career included part-time teaching and covering clinics in Prestonsburg and Hazard as a stay-at-home mom and working in New Mexico for the National Health Service Corps to retire a school loan. She got a transfer to be closer to family, and her last year with NHSC was just across the Kentucky border in Virginia.

She had been practicing dentistry for 10 years when UK hired her to head the Mobile Care program, coming full circle to the place she holds most dear.

"I love that I've been able to come home to Appalachia, there is no more beautiful place or more wonderful culture," she said. "I love the way my people talk and hug and laugh, and I love that we are a deeply spiritual people who are deeply connected to one another. My children are 10th generation Appalachians and I wouldn't want to raise them anywhere else."

UK's North Fork Valley Community Health Center's mobile dental outreach program celebrated 10 years of serving children in 2015. Stone has directed the program since its inception. She and several dental hygienists and assistants provide preventive dental care twice a year to 2,400 Head Start children in Perry, Knott, Letcher and Leslie counties and once a year to all public elementary schools in Perry and Knott counties. Children receive dental exams, cleanings, fluoride treatments, sealants and both classroom-based and individualized educational sessions. Dental education is also available to parents and teachers at various community events.

"Teaching is actually one of my favorite parts of my job," Stone said. "I also love the practical, day-to-day side of being with children, and I also love the philosophical aspect of why we're doing what we're doing. . . . Children are truly a blessing to work with; they are so very honest and keep us laughing all day. I love that we are preventing tooth decay before it starts and lowering the tooth decay rates in Eastern Kentucky, which has some of the highest rates of tooth decay in the nation."

Stone and patient Wyatt "Bebo" Goins at
Roy G. Eversole Preschool in Hazard

Tooth-decay rates in the center's service area have decreased nearly 20 percentage points, urgent dental needs have been cut in half, and treatment-completion rates for Head Start children with urgent dental needs have increased dramatically, from 8 percent to more than 60 percent.

"When the UK dental outreach team started seeing children in local schools and Head Start centers in 2006, over half the children in Perry County had untreated cavities and 20 percent had painful abscessed teeth," Stone recalled.

Stone said she has found her place in the world. "I once had a very spunky little girl come on the mobile unit and she was very excited to be there," she recalled. "She couldn�t stop talking and she spoke really fast, going from one topic to another without transition. She jumped up in the dental chair and asked me this question, 'Did you wish upon a star to be a dentist?' It really caught me off guard and I had to stop and think about it for a couple of seconds. I realized I probably had not ever wished upon a star to be a dentist, but for some reason God chose to bless me with the opportunity to be a dentist to this beautiful little girl anyway, and to provide preventive dental care services to over 10,000 children just like her who have come on the mobile unit in the past 10 years. And maybe some of them will wish upon a star to become dentists someday."

Princess Health and U of L dental school's general-dentistry and oral-medicine chair elected president of American Academy of Oral Medicine. Princessiccia

Princess Health and U of L dental school's general-dentistry and oral-medicine chair elected president of American Academy of Oral Medicine. Princessiccia

dental health dentists oral health University of Louisville

Gusty 03:09 Add Comment

Wendy S. Hupp

Wendy S. Hupp, associate professor and interim chair of the Department of General Dentistry and Oral Medicine of the University of Louisville School of Dentistry, will be the next president of the American Academy of Oral Medicine.

Hupp joined the U of L dental school in 2007 and is a diplomate of the American Board of Oral Medicine. She lectures nationally on the treatment of medically complex patients, pharmacology, HIV/AIDS, clinical oral pathology, and women�s health. She is widely published.

She is a graduate of the University of Pennsylvania and practiced general dentistry in Wayne, Pa., for nearly six years. She completed residency training in oral diagnosis, oral medicine, and oral and maxillofacial radiology at the Naval Postgraduate Dental School.

Oral medicine specialists are qualified to treat patients for such health conditions as TMJ, burning mouth, sensory disorders and many other oral complications. Hupp said in the news release that she plans to increase awareness of this specialty during her time as president.

Princess Health and More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health.Princessiccia

Princess Health and More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health.Princessiccia

Affordable Care Act dental care dental health dentistry dentists emergency rooms health reform hospitals obamacare oral health

Gusty 19:26 Add Comment

More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)

"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized � and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.

Princess Health and Princess Health andLess than 60% of Kentuckians say they visited a dentist in the past year, ranking the state 43rd in the nation.Princessiccia

Princess Health and Princess Health andLess than 60% of Kentuckians say they visited a dentist in the past year, ranking the state 43rd in the nation.Princessiccia

dental care dental health dentistry health insurance income oral health poll poverty

Gusty 15:04 Add Comment

Kentucky ranked 43rd among the 50 states in percentage of people who told pollsters that they had visited a dentist in the past 12 months. The rankings in the annual Gallup-Healthways Well-Being Index appeared to be driven largely by income and insurance.

"Residents of the 10 states with the highest dental-visit rates are somewhat more likely to say they have enough money to pay for healthcare than residents in the 10 states with the lowest dental visit rates, 84.8 percent vs. 77.6 percent," Lindsey Sharpe of Gallup reported. "Further, the bottom 10 states for dental visits have a significantly higher average uninsured rate, at 20.5 percent, than the top 10 states for dental visits (12.6 percent). Previous Gallup research shows that the likelihood of visiting the dentist annually increases with income."

Kentucky's 58.6 percent rate of reported visits in the past year ranked just below Missouri, at 59 percent, and ahead of Tennessee and West Virginia, with 56.9 and 56.6 percent, respectively. Figures for other adjoining states were Illinois, 66%; Indiana, 61.8%; Ohio, 63.6%; and Virginia, 67.5%.

Ranking below West Virginia were Texas, 56.3%; Arkansas, 56,1%; Louisiana, 55.3%; Oklahoma, 55.2%; and Mississippi, 53 percent. The top state was Connecticut at 74.9 percent, followed by Massachusetts at 74.5 percent and Rhode Island at 73.8 percent.

Princess Health and Princess Health andHealth reform law isn't as sweeping when it comes to dental coverage, but Appalachian dentists say it should help.Princessiccia

Princess Health and Princess Health andHealth reform law isn't as sweeping when it comes to dental coverage, but Appalachian dentists say it should help.Princessiccia

dental care dental health dentists health reform Medicaid obamacare oral health Patient Protection and Affordable Care Act rural-urban disparities

Gusty 20:28 Add Comment

Dr. Heather Whitt explains costs to Anita Slone at the Eula Hall
Health Center in Floyd County. (C-J photo by Jessica Ebelhar)

In Floyd County, almost 40 percent of adults have lost six or more teeth to decay or gum disease, more than 50 percent of adults have had at least one tooth pulled, and 25 percent of people older than 65 have lost all of their teeth. But "When it comes to dental care, the Affordable Care Act's reach is limited," Laura Ungar reports for The Courier-Journal.

The Patient Protection and Affordable Care Act requires health plans to cover children's oral health, but adult coverage is optional. Kentucky's Medicaid benefits only cover certain services, such as oral exams, emergency visits, X-rays, fillings and extractions, and rural areas are dealing with a shortage of dentists who increasingly do not accept Medicaid.

Despite these obstacles, Dr. Heather Whitt, director of dental services for a network of health centers called Big Sandy Health Care, said she thinks the reform law will help people who live in Central Appalachia, a hotbed of bad oral health. She said the number of uninsured�which for a long time was almost 75 percent of her patients�is finally beginning to decrease. "Now, there are more adults having Medicaid. It's definitely improved the patients we see here. . . . We stay very busy," she said. "I'm excited more people have benefits."

"She and other dentists said Medicaid, which is covering most of the area residents newly insured through the ACA, does not cover every service they might need," Ungar writes. Whitt noted that Medicaid doesn't cover costs for dentures or root canals for patients older than 21, and some dentists said Medicaid managed-care organizations do not send reimbursements quickly enough.

Whitt said that she and her staff try to teach patients about brushing, flossing and regular checkups. They also teach those things in schools, encouraging children to visit dentists. Dentists say that if the law and Medicaid can get more people to visit the dentist, they'll learn to take better care of their teeth. "A lot of our patients just kind of fall through the cracks," said Dr. James Stambaugh, another dentist at the clinic. "Small problems just grow exponentially." (Read more)

Princess Health and Princess Health andGroup overseeing effort to make state healthier hears of 'dire need,' tools for improvement.Princessiccia

Princess Health and Princess Health andGroup overseeing effort to make state healthier hears of 'dire need,' tools for improvement.Princessiccia

cancer cardiovascular disease dental care dental health diabetes drug abuse drugs health rankings mental health obesity oral health state government

Gusty 20:23 Add Comment

Kentucky's health is "in dire need of improvement," but the state has some tools to do that, including health-care reform and the insurance program for its own employees, the group of officials charged with improving the state's health heard at its first meeting Thursday.

Mayfield

Dr. Stephanie Mayfield, commissioner of the Department of Public Health, told the group overseeing "Kyhealthnow" that the state is near the bottom of national rankings on nearly every goal set for the effort, but "is poised to make strong progress through school-based programs and the fact that federal health reform has made preventive services free," a state press release said.

The goals are that by 2019, Kentucky will reduce its smoking, obesity and uninsured rates by 10 percent; cut its death rates from cancer and cardiovascular disease by 10 percent; reduce deaths from drug overdoses and the average number of poor mental health days by 25 percent; reduce the percentage of children with untreated dental decay by 25 percent, and increase adult dental visits by 10 percent.

The effort is overseen by state cabinet secretaries, other key state officials, Mayfield as co-chair and Lt. Gov. Jerry Abramson as chair, by appointment from Gov. Steve Beshear. They are to meet quarterly.

The oversight group also heard from Department of Employee Insurance Commissioner Joe Cowles, whose agency provides health insurance coverage for 266,000 members, including employees of state agencies, school boards and local government, as well as retirees under age 65 and their dependents.

Cowles talked about the two insurance plans that contain a wellness component designed to encourage plan members to lead healthier lifestyles. "These plans provide lower coinsurance, deductibles and out-of-pocket maximums," Cowles said. "But more importantly, those who choose a LivingWell plan are required to complete an online health assessment. This helps them become more aware of their current well-being and understand their health risks. And, they get a personalized plan of action so they can get or stay healthy."

The department also offers a diabetes prevention program at no cost, and it has shown encouraging results, as participants are improving their physical activity and overall health, Cowles said. And it has anti-fraud measures that track the distance members drive to fill prescriptions, what drugs they are buying, how often, and so on.

The officials also heard from Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, which has made the health and wellness of Kentuckians one of its top three priorities because health-insurance costs have increased and an increasing share of companies� tax dollars go to pay for health care. He said the state's health problems have reached �epidemic proportions.�

�We commend Governor Beshear for engaging his entire administration in a comprehensive effort to improve Kentucky�s health problems,� Adkisson told Kentucky Health News. �Health costs are a major issue among Kentucky businesses. But containing those costs can be like turning an aircraft carrier around in open water. We are glad state government as a huge employer has stepped up its efforts to encourage wellness among state employees and their family members who are covered by the state�s health insurance program. By being aggressive on wellness, prevention and disease management, tens of thousands of lives will be improved and health care costs paid by taxpayers will be contained.�

Princess Health and Princess Health andOne of every three Kentucky adults didn't see a dentist last year; key factors are overall health, insurance and income.Princessiccia

Princess Health and Princess Health andOne of every three Kentucky adults didn't see a dentist last year; key factors are overall health, insurance and income.Princessiccia

dental care dental health oral health poll

Gusty 08:23 Add Comment

More than a third of Kentucky adults say they didn't go to a dentist last year, and one in six said they hadn't in five years or more, according to the latest Kentucky Health Issues Poll.

The results show the challenges Kentucky adults who are lower income, uninsured or living in rural areas face in getting dental care, said the Foundation for a Healthy Kentucky, which sponsors the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati. �Oral health is critical to overall health,� said Dr. Susan Zepeda, president of the foundation.

The poll, taken Oct. 25 through Nov. 26, found that 64.4 percent of Kentucky adults went to the dentist in the past year. Another 8.5 percent said they had been in the previous year, 10.4 percent said their last visit was three to five years ago, and 14.6 percent said it has been more than five years. Two percent of Kentuckians polled said they had never been to a dentist.

Among those who defines their overall health as very good or excellent, 73 percent had a dental visit in the previous year while only half of those who said their overall health is fair or poor said they did.

Only 24 percent said their physician has asked about their oral or dental health. Those whose physicians did ask about their oral health (73%) were more likely to visit a dentist than those who were not asked (62%).

Dental insurance is relatively rare, so income is a major factor in seeing after oral health. Among Kentucky adults with incomes at or below 138 percent of the federal poverty threshold, making them eligible for Medicaid, 48 percent reported seeing a dentist in the past year. Among those with incomes more than double the threshold, the figure was 81 percent. Among those who said they had insurance, 70 percent reported a dental visit, while only 43 percent of the uninsured said they did.

Just over half (51%) of adults who live in Appalachian Kentucky visited a dentist in the past year compared to seven in ten (71%) of adults living outside Appalachia.

The poll surveyed a random sample of 1,551 adults from throughout Kentucky by telephone, including landlines and cell phones. The poll has a margin of error of plus or minus 2.5 percentage points.

Princess Health and Sick of all the bad facts about Kentucky's health? Here's encouraging news about oral health and drug treatment.Princessiccia

Princess Health and Sick of all the bad facts about Kentucky's health? Here's encouraging news about oral health and drug treatment.Princessiccia

alcohol abuse dental care dental health dentists drug abuse drug treatment oral health prescription drug abuse recovery substance abuse

Gusty 17:39 Add Comment

Despite the plethora of bad news about Kentucky's poor health status, there are many positive initiatives for Kentucky's oral health and substance abuse treatment, which were stories buried under health news headlines about Medicaid expansion and low health rankings.

The Kentucky Board of Dentistry recently established the position of public heath dental hygienist, permitting hygienists to go into Kentucky schools to assess teeth on the front lines, which will provide basic preventive dental care to underserved kids with tooth problems through local health departments, Al Smith, left, reports in an opinion piece for the Lexington-Herald Leader.

"These hygienists will be able to do school fluoride varnish programs, place sealants, refer kids in pain, and promote dental health programs (like brushing and better nutrition) in the schools without being supervised by a dentist," Dr. Rankin Skinner, director of the Clark County Dental Health Initiative, told Smith. "I think this is a major step in developing dental health program like ours across the state and moving our kids towards better health in general."

The initiative, comprising 17 dentists and 127 volunteers, was selected as a national model by a national association of all the health departments. "It isn't often that a private volunteer program in Kentucky sets a national standard," Skinner told Smith.

Meanwhile, in Florence, Kentucky's first lady, Jane Beshear, a Democrat, joined her Republican co-chair of Recovery Kentucky, Lexington homebuilder Don Ball, to celebrate the Brighton Recovery Center's fifth birthday and nearly 800 graduates.

Brighton is one of the 10 new homes for Recovery Kentucky, a program that is also becoming a national model, Smith writes. Since its inception during the Fletcher administration, the program has provided supportive housing and addiction recovery programs to over 10,000 men and women, writes Smith.

Beshear said the next steps are for her and Ball to create more drug-free housing and jobs for graduates of the program, Smith reports. This goal creates hope for other successful initiatives and shines a ray of light at the end of a dark and dreary tunnel.

Princess Health and Oral health care for the poor in Kentucky suffers under managed care as dentists leave Medicaid; how about your county?.Princessiccia

Princess Health and Oral health care for the poor in Kentucky suffers under managed care as dentists leave Medicaid; how about your county?.Princessiccia

data dental health dental school dentistry dentists oral health rural rural-urban disparities

Gusty 08:12 Add Comment

Kentucky's serious oral-health problems are getting worse because fewer dentists are participating in the Medicaid program -- a result of "new paperwork issues compounding Medicaid's reputation" for low payments to providers, Laura Ungar reports for The Courier-Journal.

Ungar's source for that is Dr. Raynor Mullins of the College of Dentistry at the University of Kentucky, who told her that only 700 to 800 of the state's nearly 2,500 dentists, about 30 percent, accept Medicaid patients.

That makes now seem like a good time for journalists to ask their local dentists if they accept Medicaid -- and if not, why not; and if so, whether they are considering dropping it.

Ungar notes that 28 of Kentucky's 120 counties are deemed not to have enough dentists to serve the local population. Most if not all of them are rural. You can find out which counties are under-served by physical, dental or mental health providers at this federal Health Resources and Services Administration website.

Princess Health and Poll shows more than half of Ky. adults have no dental insurance and many go without essential dental care.Princessiccia

Princess Health and Poll shows more than half of Ky. adults have no dental insurance and many go without essential dental care.Princessiccia

dental care dental health Foundation for a Healthy Kentucky health care access health insurance insurance oral health

Gusty 13:35 Add Comment

Routine dental care is essential to overall health, but a new poll shows 1.7 million Kentucky adults do not have dental insurance. That is more than times the number of people who will be at Churchill Downs for the Kentucky Derby, notes the Foundation for a Healthy Kentucky, which co-sponsored the poll.

The poll also showed that many Kentucky adults are going without the dental care they need. While the poll found that few owe money for dental bills, only 61 percent said they visited a dentist or dental clinic within the past year. The national figure is 70 percent.

�Oral health is essential to overall health,� said Dr. Susan Zepeda, president and CEO of the foundation. �Yet, our research indicates a majority of Kentuckians do not have dental coverage, so it is not surprising that a large number of adults do not have a personal dentist or oral health provider.�

Poor oral health or oral pain can lead to poor nutrition and can reduce someone's quality of life by making it difficult to sleep, work or interact with others, and having dental insurance is an important factor in determining whether someone is getting the dental care they need.  More than 50 percent of poll respondents indicated not having dental insurance of any kind, and almost half of that group said they skipped getting dental care or check-ups in the past year due to its cost.

Whether or not someone has a normal source of care is also an important factor in determining health care outcomes because those with a personal dentist or doctor are more likely to seek care. Almost 40 percent of poll respondents, however, said they do not have a personal dentist or oral health provider, and almost 80 percent of those respondents said its been more than five years since they last visited a dentist or dental clinic.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted last year from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or minus 2.5 points.

Princess Health and New oral health coalition expected to spur changes in state.Princessiccia

Princess Health and New oral health coalition expected to spur changes in state.Princessiccia

dentistry dentists health policy oral health state law tooth decay

Gusty 06:10 Add Comment

By Tara Kaprowy
Kentucky Health News

For the past 30 years, Dr. Fred Howard of Harlan has been seating patients in his blue dental chair and telling them to open up. When they do, he's seen all kinds of scenarios, from toddlers whose teeth are already rotten from sucking on bottle filled with soft drinks to 20-year-old adults with no teeth at all. On some occasions, children walk in with such a severe abscess in their mouth their eyes are swollen shut.

Though the view can be grim, Howard said he has seen some improvements in his decades of practice, but with new changes in Medicaid managed care, the overwhelming prevalence of children and teens drinking soda pop and an embedded cultural belief in some areas that "teeth are just something to get rid of," Howard concedes that making headway can feel like one step forward and two steps back.

Enter the newly re-established Kentucky Oral Health Coalition, a statewide force whose goal is to ensure Kentuckians have happy, healthy smiles.

Dozens of organizers and stakeholders met in March to discuss the coalition's aims, and a membership drive is underway to build financial momentum. The coalition will promote oral health education, statewide partnerships statewide and advocate oral-health legislation. "I think they will turn into the advocacy group for dental change," said Dr. Julie McKee, dental director for the state Department of Public Health. "They're working hard to come up with a plan. They've got their heads on straight."

One of the major issues facing the dental profession is possible expansion of the scope of practice for mid-level providers, such as dental therapists who can assess, clean teeth, replace sealants, provide fluoride as well as fill cavities and extract teeth. As nurse practitioners do in the medical field, having such providers could help address shortages in rural areas, said Dr. Jim Cecil, former state dental director and coalition steering committee chair. The concept is in practice in 54 other countries, but the only U.S. states with it are Minnesota and Alaska, mainly because of opposition form dentists.

Andrea Plummer, coalition member and senior policy analyst for Kentucky Youth Advocates, acknowledged that scope-of-practice issues "can be a very tense subject" and "there would have to be buy-in" from members of the committee, who include dentists, but discussion is ongoing. Cecil said the issue is "something we'll need to look at and take a stand on eventually."

Howard (pictured with Gov. Steve Beshear at signing of the bill that requires dental exams for students starting school) favors the expansion, but doesn't feel Kentucky's oral-health problems can be solved just by putting more boots on the ground.

"The bottom line is: We can have twice as many dentists, have more dental hygienists, but if we don't change the mindset, if we don't provide the education, I don't think we're going to solve the problem," he said.

To that end, the coalition is also investigating ways to expand school-based health and dental education, either by finding funding, collaborating with groups that are already in place or advocating legislation changes, Plummer said.

A recently enacted state law requires children to get a dental screening before entering kindergarten, but there is little else in the way of legislation that requires schools to offer services to help students with dental problems, Plummer said. "Kentucky law says that students' health does affect their learning and schools should take steps to affect their learning but it's fairly broad," she said.

An analysis by KYA last year showed school districts spend less than 1 percent of their budgets on school health services.

Examining how to get more dentists to accept Medicaid patients is another hot-button issue. Of about 2,200 dentists statewide, only about 600 are enrolled in Medicaid, Cecil said, and "They feel like they're working for free" because of the program's low reimbursements. "In many cases, they're really not meeting overhead."

The administrative burden that comes with these patients has also gotten worse since Medicaid transitioned to managed care, Cecil said. "Everything they do has to be pre-authorized," he said. "That delays approval, delays treatment, delays payment."

Under managed care, Howard said, patients now need to come in twice to get a full complement of X-rays and radiographs done, which can not only make it hard on dental practices, but for patients as well. "The more times they have to come, that gives them more opportunities to miss appointments," Howard said.

The Oral Health Coalition also sees a need for "quality, updated data," Plummer said. Getting data was one of the successes of the first coalition, formed in 1990. Run by volunteers and funded by the dental schools at the University of Kentucky and University of Louisville, it was formed after the General Assembly told the schools that they either needed to work together or one could "risk being shut down," Plummer said. The group had several successes, including working with the state to conduct an oral health survey, lobbying legislators for oral-health measures and holding an annual symposium. But after more than 15 years, "It kind of just fizzled out a little bit," Plummer said. The group went inactive in 2006 but had some assets that the new group will take over.

The group's rebirth began in 2009, when Kentucky Youth Advocates was approached by the DentaQuest Foundation, which is connected to DentaQuest, one of the largest managed-care organizations in the country that administers dental benefits. DentaQuest officials were interested in seeing the coalition resurrected and offered $80,000 to KYA so it could provide the manpower to run it, Plummer said. It was the first time the coalition had funding to back it up. The KYA talked to state stakeholders and discovered "there really did seem to be an interest in putting a coalition back together," Plummer said. Planning began in earnest and in January the steering committee drafted by-laws. In March, 70 people showed up to the first meeting.

That gathering was not just made up of dentists, oral-health advocates and experts, Howard said. Members of the media were present, along with parents, health department officials, school nurses, students and educators. That made all the difference to Howard, who said he is inspired by what changes might occur and what education can take place. "When we have people from all these different venues, we have more of an opportunity to make a difference," he said.

The coalition's next meeting will be July 25. Those interested in attending or becoming members of the coalition can contact Andrea Plummer at aplummer@kyyouth.org or 502-895-8167. Dues for individual members are $25. Government organizations pay $100, nonprofit organizations pay $250 and for-profit organizations pay $500.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Diabetes can cause gum disease and tooth decay.Princessiccia

Princess Health and Diabetes can cause gum disease and tooth decay.Princessiccia

dental care dental school dentistry dentists diabetes nutrition obesity oral health

Gusty 14:27 Add Comment

Though it's commonly known that diabetes can affect organ function and eyesight, an oral-health expert points out that the disease can also cause tooth decay and gum disease.

"Diabetics with uncontrolled glucose levels tend to develop more gum disease and may lose more teeth than diabetics who have good control of their glucose levels," writes Dr. John Novak, associate director of University of Kentucky's Center for Oral Health Research, in an op-ed piece for the Lexington Herald-Leader. A high carbohydrate/sugar diet can also lead to high levels of sugar in the blood, which can hamper the way the body deals with infection, he writes. Gum disease may be the result because the gums are inflamed by the increased levels of bacteria living in the mouth.

Diabetes can also cause dry mouth, which "creates the perfect environment for the growth of bacterial plaque and for fungal infections such as thrush," he writes. To avoid these problems, Novak recommends brushing teeth and gums twice a day with a fluoride toothpaste, flossing every day and using fluoride mouth wash before going to bed.

Signs of tooth decay or gum disease include tender gums that bleed easily when brushing or flossing; teeth sensitive to hot or cold temperatures; loose or broken teeth; sores, ulcers or a burning sensation in the mouth; and bad breath or a bad taste. (Read more)

Princess Health and Like nurse practitioners in medical field, dental profession needs mid-level providers, expert argues.Princessiccia

Princess Health and Like nurse practitioners in medical field, dental profession needs mid-level providers, expert argues.Princessiccia

dentistry dentists oral health

Gusty 11:48 Add Comment

With 50 million Americans living in poor or rural areas where there are no dentists to go to � and that number expected to rise by more than 5 million if the Affordable Care Act stands � states and the federal government should be training dental therapists to help solve the problem, argues Louis W. Sullivan, a physician and former secretary of the Department of Health and Human Services, in an op-ed piece in The New York Times.

"We have two years to prepare before millions of children will be entitled to access to dental care," he writes of the impending eligibility expansion under the ACA. "Access means more than having an insurance card; it means having professionals available to provide care. Public officials should foster the creation of these mid-level providers � and dentists should embrace the opportunity to broaden the profession so they can expand services to those in need."

Dental therapists provide preventive care and "routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist's office," Sullivan writes. While they are "common worldwide," only Alaska and Minnesota allows them to practice. Legislation is pending in five other states. Generally, dentists have been opposed to such changes.

Sullivan points to Alaska as a model example for how these therapists can fill gaps in places like remote villages "only accessible by plane, snowmobile or dogsled, where high school seniors once graduated with full sets of dentures." In 2003, the state sent students to New Zealand to be trained as therapists. Now, therapists serve 35,000 Alaskans. They "travel to small clinics and schools, often carrying their equipment with them. They consult with a supervising dentist from the region but do most procedures themselves. Many were raised in the communities in which they now work, so they understand the culture," Sullivan writes.

Sullivan points out dental disease is the No. 1 chronic childhood disease in the country, responsible for more children needing treatment than asthma. In 2009, more than 830,000 visits to the emergency room were due to preventable dental problems across the nation, he points out. But dentists are in short supply and will be even harder to see if the ACA is upheld by the U.S. Supreme Court. "In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay," he writes. (Read more)

Princess Health and Effort to boost oral health in nursing homes gets tangled up with industry's attempt to insulate itself from lawsuits; both bills die.Princessiccia

Princess Health and Effort to boost oral health in nursing homes gets tangled up with industry's attempt to insulate itself from lawsuits; both bills die.Princessiccia

dental care dentistry General Assembly legislation legislature long-term care nursing homes oral health teeth

Gusty 11:00 Add Comment

A bill to get nursing-home residents better dental services "appears to be dead after the Senate added language from another bill designed to shield the nursing-home industry from litigation," Deborah Yetter reports for The Courier-Journal.

House Bill 510 would have created a pilot project for the state's two dental schools to create "a program to provide better oral-health services to nursing home residents," Yetter writes. "But on Wednesday, the Senate Health and Welfare Committee added language from another bill that had stalled in the House that would require people who want to file malpractice lawsuits against nursing homes to first submit the complaint to a 'medical review panel'." (Read more) 

Princess Health and State starting free training for dentists in pediatric dentistry.Princessiccia

Princess Health and State starting free training for dentists in pediatric dentistry.Princessiccia

dental care dentistry dentists federal grants oral health state government

Gusty 08:00 Add Comment

One of the many problems with Kentucky's oral health is that not enough dentists are willing to accept children as patients, or lack proficiency in treating children when they are around age 1, the recommended time for a child's first dental visit.

Next week, the state Department of Public Health will start to offer free continuing education for dentists and other oral-health professionals who need or want training in pediatric dentistry, funded by a federal grant.

The Access for Babies and Children to Dentistry (ABCD) program will have one-day training sessions in Lexington on Friday, April 6, at the Embassy Suites on Newtown Pike next to the interstate, and in Somerset on Wednesday, April 11, at the Hampton Inn on US 27. Both sessions will start at 8:30 a.m. The sessions offer 8 continuing education units out of a possible 20 in the program.

For more information about the training, and to register for it, contact Meghan Towle at Meghan.Towle@ky.gov or 502-564-2154.

Princess Health and More young kids going under anesthesia to fix bad dental problems.Princessiccia

Princess Health and More young kids going under anesthesia to fix bad dental problems.Princessiccia

children's health dentists oral health

Gusty 13:03 Add Comment

Preschoolers are increasingly having to undergo extensive surgery to get fix the cavities they've gotten from lack of brushing, get root canals or have teeth extracted.

Five years ago, the Centers for Disease Control and Prevention found the number of preschoolers with cavities had increased � the first time that had happened in 40 years. "Dentists nationwide say they are seeing more preschoolers at all income levels with 6 to 10 cavities or more," reports Catherine Saint Louis for The New York Times. "The level of decay, they added, is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake." (Times photo by Stuart Isett)

"We have had a huge increase in kids going to the operating room," said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Me., and a spokesman for the American Dental Association. "We're treating more kids more aggressively earlier."

Causes for the increase can be linked to lots of snacking and juice or other sugary drinks before bedtime; kids drinking bottled water rather than tap water; a lack of knowledge that infants should go to the dentist by age 1 to be assessed for cavity risk.

Parents can sometimes confused dental decay with teething and don't realize there is a problem until teeth break or the pain becomes so bad the child cannot sleep. (Read more)