Dental insurance is available in Arkansas as an additonal cost option under private and group health insurance plans. The state's expanded Medicaid program, Arkansas Works, provides optional access to dental insurance as well, as do Medicare advantage plans. Traditional Medicaid only covers emergency medical oral health. Plus, not all dentists in Arkansas accept Medicaid. And based on national data, a majority of Arkansans on Medicare may go without dental coverage.
So if you ask dental care providers in Arkansas about options for people who either don’t have dental insurance or can’t afford dental care, one of the first things most mention is Arkansas Mission of Mercy, or, as most dentists, like Dr. Marcia Wheeler from the University of Arkansas for Medical Sciences call it, ARMOM.
"ARMOM," Wheeler says. "It's an activity put together by the Arkansas Dental Association where free dental care is provided by several different hundred dentists who participate with dental hygienists, students and any other volunteers to get free dental care for two days."
The annual ARMOM event has been held in different cities around the state since 2006. Last April it was in Springdale and planning for next year's event in Conway is already underway. An estimated 2,000 low-income or uninsured people are served by ARMOM each year.
The need for free dental services has always been high, says Loretta Alexander, the Health Policy Director for Arkansas Advocates for Children and Families, and recent changes to the Affordable Care Act have caused the numbers of uninsured people in Arkansas to rise over the past two years, creating an even greater need and more obstacles to oral health.
"In Arkansas, with dental care in particular, we don't have a dental school, so we have a shortage of dentists. And we have a greater shortage of pediatric dentists," Alexander says. "And equally important is a lot of people don't see dental care or oral health as important as their medical care so even let's say you have a medical policy you may not pick up that dental policy if you’re buying insurance."
According to a 2016 report from the Health Policy Institute of the Amercian Dental Association, dental care has the highest level of cost barriers compared to other health care services. In other words, for a greater percentage of Americans, affordability stopped them from going to the dentist's office more often than it stopped them from getting prescription drugs, eye glasses, mental health services, or visiting a doctor for general medical needs. Part of those prohibitive costs may also include taking time off to travel long distances to a dentist because significant regions of the state don't have a dentist nearby. Lack of consistent oral health care may result in to higher rates of dental caries and edentulism -- toothlessness.
For Arkansans who can't afford dental care and need treatment outside of the two-day window of ARMOM, there are some options provided by a number of free and sliding-scale clinics around the state, like the 12th Street Health and Wellness Center in Little Rock.
The 12th Street clinic, which opened in 2013, is staffed almost entirely by medical and dental students from UAMS. The students work in interprofessional teams and collaborate on diagnosis and treatment of patients under the supervision of doctors, dentists, and pharmacists. Dr. Melissa Clark, a pharmacist and the clinic’s director, says the need for dental services is consistently high.
"We've got a huge demand, but we're not going to be able to meet that demand," Clark says. "When we first opened the dental clinic we tried to do a waiting list and once we hit 300 we realized that's just not going to work for us and we hit that within the first few months. So the need is there. It's just how much of a dent can we make in that."
Monika Fischer-Massie, the executive director of WelcomeHealth in Fayetteville, says her clinic in northwest Arkansas faces similar challenges.
"Right now we have a waiting list for our restorative dental clinic," she says, "so the word does get around. But also keep in mind that we have an extraction clinic one evening per week and patients can call once a month to make appointments for that month. But then the following month it starts all over again. So for extraction services patients have to wait anywhere from one day to perhaps three-and-a-half weeks."
Many free clinics are restricted to accepting only those patients who lack insurance, but the WelcomeHealth website states: "We are here for the uninsured, underinsured and the insured alike. You can rest assured that we will welcome you regardless of your ability to pay."
Fischer-Massie says even when more Arkansans secured healthcare coverage through the state's health insurance marketplace, that didn't always include insurance for their oral health needs.
"Most of our patients are the working poor. It's a great thing that, because of the Affordable Care Act, a lot of people now have health insurance, however, that does not cover dental insurance. Since those folks are low income anyway, there's no way they can afford to go to the dentist. So access to care, access to free dental care is a problem in the state of Arkansas."
With the help of volunteer medical and dental professionals, WelcomeHealth serves about 2,700 patients a year on a slim budget that includes no federal funding. Their services are free to anyone whose income is no more than 200% of the federal poverty level, which is $12,490 for an individual in most states.
Harmony Health Clinic is another of the Little Rock free clinics that operates with a small staff of 4, but a large pool of 450 medical professional volunteers. Lucy Hagberg, a dental hygienist, has been volunteering in the dental wing of the clinic since 2013. She says she focuses on educating patients on proper oral health practices while performing cleanings.
"Our standard is to clean their teeth fully and completely. And then that gives me my time to review all the nuts and bolts regarding their specific needs for their dental education. I clean as many sets of teeth as possible, as time will allow."
In addition to cleanings and complete oral health and oral cancer screenings, patients like 38-year-old Maleika Summerville are also able to get partial or full dentures through Harmony Health Clinic.
"Being my age and not having any teeth, you know that'll kind of really, really bring you down. And so they are helping me get my confidence and my smile back," Summerville said.
The clinics interviewed for this report all stressed having more patients than they can accommodate. Services for certain oral health services, like extractions, or dentures, are limited to Fridays, when most dentists are off from their private practices and able to volunteer in free clinics. Justin Wise, executive director of Harmony Health Clinic, says he's always looking for more volunteers.
"Our dental clinics are so packed and jam-packed on Friday. We know out there there are dentists who have another off-day other than Friday. We need those dentists to say, 'Hey, yes, I'll come in on Monday, or I'll come in on Wednesday and volunteer.'"
With the number of uninsured Arkansans on the rise, the dental clinics who serve them are likely to get even busier.
This story is produced by Arkansas Public Media, a statewide journalism collaboration among partner stations KUAR, KUAF, KASU and KTXK, and community partners AETN, and the Butler Center for Arkansas Studies. Arkansas Public Media’s series on oral health in Arkansas is funded through a grant from the Delta Dental of Arkansas Foundation, and with the support of its partner stations. You can learn more about Arkansas Public Media’s reporting at arkansaspublicmedia.org.