“I had better dental care when I was in prison. When you come in, they give you an examination and they say that the tooth might need to be pulled. And then they can see if they can save it and they will work to try to save the tooth.”

Recently, we were given the opportunity to work with the Health Care Foundation of Greater Kansas City to complete a comprehensive oral health system assessment. We wanted to understand the challenges and successes related to oral health in the region, and how the community can more effectively address regional oral health needs.

We began by working with focus groups of approximately 60, low-income community residents, who discussed how they juggle numerous competing economic and health priorities, and how overcoming the many barriers to oral health care is incredibly challenging.

Residents identified their biggest barriers to oral health care as lack of insurance (especially for adults), cost of care, the number of providers who take Medicaid, and the difficulties of even getting to the facility, including transportation challenges and limited weekend and evening hours for visits.

The cost of services and affordability of dental services emerged as a prominent theme. Many focus group members do not access dental care because they are unable to pay. As one member reported, “I have Medicaid and Medicare. A lot of dental offices don’t accept that. And even when they do, they need a co-pay and I can’t pay that.”

Many focus group participants who did not have dental insurance talked about forgoing preventive dental care since they could not afford it, creating a situation where a small dental issue progressively worsened. Only once the problem had deteriorated were they able to seek care, usually from the emergency room.

Several uninsured focus group participants said they have waited for nearly an entire day at some of the local organizations or dental school that offered free service on select dates. While the care was free, the wait still resulted in a significant cost for patients, in the form of lost wages for an entire day.

Quality of care also emerged as an issue. Participants were concerned they were receiving incomplete care because their provider would only focus on one aspect of the problem. Additionally, they talked about providers’ focus on pulling teeth rather than trying to find a longer-term solution.

Several focus group members reported that, in their experiences, providers would rush through the appointment and tended to prescribe antibiotics and painkillers rather than address underlying issues. As one participant stated, “they just give you antibiotics and call it a day.”

A related concern was the need to have multiple appointments to address dental issues, translating into further costs. While patients report that this is because of the high demand for services and long waits, it is important to note that this may, in fact, reflect a need for more extensive dental treatment than patients might perceive.

Finally, some focus group members expressed concern about painkillers and addiction. As one focus group member shared, “I’ve also seen people who don’t do drugs getting addicted to pain meds their dentist prescribed because they didn’t get the care they needed. They just got something for the pain.”