- Nearly half of New York’s 62 counties struggle with full or partial dental care shortages.
- Rural communities on average have four dentists per 10,000 people, while metro areas have nine dentists per 10,000.
- Growing dental care deserts, gaps in dental insurance contribute to millions of Americans who have suffered minor oral infections that festered and turned into life-threatening ordeals.
Dr. Maricelle Abayon expected better from America.
Having emigrated to Rochester from the Philippines, she planned to work as a dentist in a wealthy country — one a world away from the pain and suffering she witnessed as a missionary in her native home.
But instead, Abayon discovered untold New Yorkers were being ravaged by the same scourge of dental care inequality that plagued many Filipinos.
The parallels were striking, she said, when comparing her dental patients in undeveloped villages in the Philippines to those arriving almost daily at the Eastman Institute for Oral Health dental clinic in downtown Rochester.
Inside the landmark Sibley Tower on Franklin Street, Abayon now treats a seemingly endless parade of pain-stricken patients who had to wait months to access dental care, including a woman who recently tried to yank her own aching tooth out with pliers, only to crack the tooth and suffer further. “It becomes more heartbreaking when you hear similar stories from patient after patient,” Abayon said, then asking, “In a very advanced, prosperous country like this…How are they suffering this way?”
Few New York doctors accept new patients or Medicaid
Most of Abayon’s walk-in patients get dental care through Medicaid, which contributes to their lengthy waits for care. Only one-third of dentists across New York accept Medicaid, the state and federal taxpayer-supported insurance plan.
These Medicaid patients are also far more likely than the general population to end up in an emergency room for an untreated dental problem — increasing societal costs and their risk of suffering other serious health complications linked to oral infections.
Tens of thousands of patients have spent months suffering on the growing wait list at Eastman Institute for Oral Health in Rochester, underscoring New York’s growing dental care crisis.
Dr. Eli Eliav, director of the institute’s care network and school, could barely walk through one of its overcrowded dental office waiting areas one morning this past fall. At the time, its wait list included about 30,000 additional patients from across the state seeking dental care. Today, it’s ballooned to over 32,000.
“Parents are calling crying and asking for help,” Eliav said, referring to kids on the wait list.
The dental institute, which is part of UR Medicine, takes patients from dozens of counties across the state due to growing dental care deserts and gaps in dental insurance. Eliav said these challenges have contributed to millions of Americans suffering minor oral infections that have festered and turned into life-threatening ordeals.
Nearly half of New York’s 62 counties struggle with full or partial dental care shortages, according to the Rural Health Information Hub. Rural communities on average have four dentists per 10,000 people, while metro areas have nine dentists per 10,000.
“We really feel helpless,” Eliav said. “We don’t know how to help all the patients.”
New York’s dental crisis has thousands waiting for care
The stakes, in some ways, become clearer through the lens of the Eastman Institute’s waiting list statistics obtained by USA TODAY Network. They include:
- About 20,480 adults from 55 counties were on the dental care waiting list at one point in recent weeks, while more than 11,500 children were waiting for care
- About 75% of patients on the waiting list are under public health coverage plans, including Medicaid, while 15% are uninsured, with the remainder under other dental plans, such as employer-provided.
- New Yorkers are waiting a year to 18 months for routine dental exams through the institute, which is one of the few networks taking Medicaid-covered dental patients. Waits for advanced dental care requiring anesthesia through the institute can stretch even longer.
For Abayon, the need to place dental care on par with general health care has been etched into countless faces of patients she sees with festering oral pain, which leaves them struggling to sleep, eat and go about their daily lives.
“This kind of dental emergency is urgent; it’s a situation that is debilitating,” she said, adding, “I feel that a country that is resource intensive like (the U.S.) would hopefully be able to provide for the basic needs of people.”
What New York is doing about dental crisis
Eastman Institute has plans to use a $20 million state health care transformation grant to expand its services, including adding 30 additional dental care chairs that would allow for treating an additional 22,000 patients per year, said Holly Barone, chief operations officer.
The institute expected to learn if its plan was approved in October, she added, but has yet to get the green light from state officials despite the mounting backlog of patients, which exploded during the pandemic as walk-in visits at the institute’s urgent care facility spiked 76%, rising from about 17,000 per year pre-pandemic to over 30,000 per year today.
At Touro College of Dental Medicine in Westchester County, dental care access barriers are most acute for Hudson Valley patients who have intellectual and developmental disabilities, said Dean Ronnie Myers. These patients struggle to allow a dentist to look inside their mouths, requiring anesthesia for many visits. Some are unable to verbalize their dental pain to relatives or caregivers.
Touro has plans to open a new center for treating patients with intellectual and developmental disabilities, which would also help train more dentists to care for the more than 128,000 New Yorkers statewide with these specialized dental care needs.
Fundraising has begun for the center, which Touro aims to open within 18 months at a cost of up to $5 million. It would be located inside Touro’s current space on the New York Medical College campus in Hawthorne, Myers said, adding it would build upon a state taxpayer-supported fellowship program at Touro that seeks to reduce oral health disparities.
State lawmakers this year also pushed legislation seeking to boost the ranks of dentists and remove barriers to dental care. The bills included dental school loan forgiveness for dentists working in underserved areas, insurance transparency upgrades and expanding services that can be performed by hygienists.
But the legislation, as well as efforts to increase the Medicaid reimbursement rate for dental care, stalled as lawmakers prioritized addressing other flaws within the health care system, including approving billions of dollars for supporting hospitals and nursing homes.
Dental care advocacy groups are expected to renew their lobbying effort this year, aiming to spotlight, in part, the fact Medicaid rates for dental care have been stagnant since 2012. By contrast, health care’s Medicaid funding increased repeatedly over that span.
“Dentistry is not on the top of the food chain, and we need to work on it,” Eliav said, noting Medicaid funding today falls about $50 short of the cost of providing care at an ordinary dental visit.
About one-third of dentists in New York serve Medicaid patients, leaving millions of poor and low-income New Yorkers struggling to find dental care, a Center for Health Workforce study found.
At the same time, millions of older New Yorkers have poor access to dental care due, in part, to the fact Medicare lacks a dental benefit.
Nationally, more than half of adults don’t have consistent access to dental care.
Why isn’t dental coverage added to Medicare?
The push to add dental coverage to Medicare and address other barriers to dental care has gained little traction from political leaders across the country. Debate has instead focused on other health issues like abortion and nursing home failures.
Meanwhile, ongoing efforts to fill gaps in New York’s dental care system have offered little relief to many patients. While Eastman Institute and some other networks used urgent dental clinics to help curb emergency room visits, many patients needed anesthesia that was unavailable at dental urgent care centers.
Addressing the dental system failures that impacted so many, Eliav said: “It’s about time we got into a position where we really need to do something.”
Ken Alltucker of USA TODAY and Nancy Cutler of USA TODAY Network contributed reporting.
David Robinson is a veteran health reporter for the USA TODAY Network’s New York State Team. Reach him at [email protected].
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