Alabama’s Dental Crisis: Urgent Action Needed for Better Care!
Alabama is facing a dental emergency, and the stakes couldn’t be higher. Patients are waiting up to a YEAR for essential oral surgeries, while dental practices teeter on the brink of closure.
“The access to care in Alabama is worse than any state I’ve ever practiced in,” states Carson Cruise, a dedicated pediatric dentist in Florence. “Mississippi typically ranks lowest in health metrics, but if Mississippi is the pit, Alabama has brought the shovel.”
As of 2023, Alabama boasts the second-lowest dentist-to-population ratio in the nation, with only 41.6 dentists for every 100,000 residents—just edging out Arkansas. This stark number pales in comparison to the national average of around 60 dentists per 100,000 people.
The most vulnerable populations—children, individuals with disabilities, and those in rural areas—are suffering the most from this dire shortage.
In fact, in two rural counties, Greene and Clay, there are ZERO dental providers available, while another 18 counties are facing a retirement crisis as their dental professionals age out of the workforce.
The statistics speak volumes: in rural Alabama, nearly 3,845 patients are crammed into the care of each dentist, according to an alarming report from the Alabama Department of Public Health.
“This situation puts many Alabama counties at risk of losing crucial dental services in the near future,” warns the health department’s report. “The oral health disease burden in Alabama presents a pressing challenge that demands immediate action.”
Dentists across Alabama highlight a common struggle: low insurance reimbursement rates, particularly from the state Medicaid agency, make it nearly impossible to sustain their practices.
Cruise sees around 60 patients daily, with families often traveling over two hours just to access his care. With over half of his patients relying on Medicaid, he’s forced to maintain an overwhelming caseload just to stay afloat financially.
“While I’m seeing a high number of patients, my earnings have dropped about 10% compared to three years ago, thanks to skyrocketing expenses,” he explains.
In fact, two dental offices nearby have stopped accepting Medicaid due to financial constraints.
With more than 50% of Alabama’s children on Medicaid, the state faces a looming crisis in pediatric oral health, according to health officials.
Cruise relocated to Alabama in 2020, having previously practiced in Virginia, Louisiana, and his home state of Mississippi.
After four long years, he’s finally secured access to a local hospital for surgical cases requiring anesthesia. Low Medicaid reimbursement rates had previously deterred hospitals from granting him operational privileges.
This issue isn’t isolated; it’s a nationwide crisis prompting the Centers for Medicare and Medicaid Services to raise reimbursement rates for dental procedures at hospitals from $200 to $2,000 starting this year.
Next month, Cruise will treat his first patient at Helen Keller Hospital in Sheffield, a long-awaited milestone. Until now, he was forced to send patients two hours away to Birmingham’s Children’s Hospital, where wait times for operations stretch anywhere from six months to a year.
“We care deeply for our patients—that’s why we chose this profession. It’s heartbreaking to feel utterly helpless in meeting the needs of everyone in this state,” says Stephen Mitchell, an associate professor at the UAB School of Dentistry, who performs around three surgeries each week at Children’s Hospital.
For urgent cases, patients can sometimes be seen within four to six weeks, but this forces those with chronic issues to wait longer, leading to preventable pain and infection.
“If a child is in acute pain, we can expedite their appointment. However, this only delays care for others, sometimes resulting in more severe issues,” Mitchell explains.
Cruise emphasizes that many of these emergencies could be avoided with better access to routine dental care.
Mitchell also mentions that he frequently has to extract teeth at the Sparks Clinic, a UAB dental practice focused on patients with disabilities.
Shockingly, Alabama is the only state in the nation that doesn’t offer any dental coverage for adults on Medicaid. This forces them to either find private insurance or pay entirely out-of-pocket.
The state does provide dental benefits for individuals under 21.
For adults with disabilities who often can’t work, this lack of coverage means they’re reliant on their already meager social security checks to pay for dental care.
“I struggle to provide necessary dental care to those who can barely scrape together enough from their social security checks for preventive services,” Mitchell says. “When urgent issues arise, we often find ourselves resorting to tooth extractions because there’s no other viable option.”
Alabama Medicaid officials have yet to respond to inquiries about the absence of dental coverage for adults, but they did note that pregnant adults on Medicaid receive benefits for 60 days postpartum.
While Alabama faces this crisis, other states are thriving. States like Massachusetts and Alaska have nearly DOUBLE the number of dentists per capita compared to Alabama, with Massachusetts hosting around 80 dentists for every 100,000 residents.
The ADPH report starkly illustrates that the ongoing ‘access-to-care issues,’ coupled with inadequate insurance coverage and an increasing disabled population, will impose unprecedented burdens on Alabama’s oral health system in the coming years.
“Ultimately, we are left in a situation where our most vulnerable—our children and those with disabilities—are left to suffer without care,” concludes Mitchell.
