Lynnel Beauchesne’s dental office hugs a rural crossroads near Tunnelton, West Virginia, population 336. Acres of empty farmland surround the weathered one-story white building. A couple of houses and a few barns are the only neighbors.
But the parking lot is full. Some people have driven hours to see her, the sole dentist within 30 miles. She estimates that she has as many as 8,000 patients. Before the office closes at 7 p.m., she and her two hygienists will see up to 50 of them, not counting emergencies.
About 43 percent of rural Americans lack access to dental care, according to the National Rural Health Association. All but six of West Virginia’s 55 counties include federally designated “Health Professional Shortage Areas,” “Medically Underserved Areas” or both. Its Oral Health Program found in 2014 and 2015 that nearly half of counties had fewer than six practicing dentists, just half of adult West Virginians had visited a dentist in the previous year, and more than one-fifth hadn’t seen a dentist in five years. In 2015, 64 percent of all American adults ages 18 to 64 saw a dentist in the previous year. The rate of total tooth loss is 33.8 percent among West Virginians over 65, compared with roughly 19 percent for all seniors nationally.
One seemingly obvious solution is to persuade more oral-health providers to come to places like West Virginia — a goal of various public efforts.
But Beauchesne’s patients struggle to afford her all the same. Only 40 percent of adults in West Virginia have access to dental benefits of any kind, compared with about 65 percent of working-age adults nationwide. While the state’s Medicaid program covers preventive care for children, adults get no coverage except for extractions or treatment for infections. Medicare offers no dental benefits, either. As a result, according to the West Virginia Oral Health Coalition, 43 percent of West Virginians ages 55 to 64 have lost six or more teeth because of disease or decay, and 61 percent of residents older than 65 without a high school diploma have lost all their teeth.
Poor oral health has an impact beyond mere toothache. A landmark 2000 report by the U.S. Surgeon General found that oral health is intimately linked to people’s overall physical health and is often associated with serious systemic conditions such as diabetes and heart disease, as well as the likelihood of complications in pregnancy.
Beauchesne often resorts to creative strategies to help her patients afford care. For instance, the practice offers a 15 percent discount for those who pay cash and a 20 percent discount for patients over 80. “I figure if they made it that far, they’re on a really tight income,” she says.
She’ll also barter for services. “If I needed a cow or a (side of) beef or a hog, whatever the normal cost would be, they can get a filling or a crown,” she said. Still, Beauchesne’s office manager and assistant, Alice Deakins, estimates that between 10 and 15 percent of the care the practice provides is given free.
Beauchesne, who is in her late 40s, said she still owes about $35,000 in school debt. Her office is no-frills, and she spends her days off mowing the lawn, painting the walls and carrying out repairs.
Providing dental benefits under Medicare — at least for preventive services such as an annual cleaning — would both benefit seniors and help dentists in rural areas survive. Also helpful to patients and providers would be expanding Medicaid coverage of preventive care to adults instead of ending it at age 21. Covering preventive care would also reduce the amount spent on emergency room dental visits, which the American Dental Association estimates cost the U.S. health system $1.6 billion in 2012.
Still, the dental-care crisis in rural America is closely linked to the broader economic challenges in the parts of the country that have not yet caught up in this recovery. “How you improve access in rural America,” says Richard Meckstroth of West Virginia University, “is to get people jobs.”
Anne Kim is domestic policy director at the Progressive Policy Institute.