Arkansas Dental Health Crisis: Solutions Are Harder Than They Seem!

At the crack of dawn on a brisk April Friday, Katheryn Newton and her friend Michelle Conrad stood at the front of a lengthy queue that wound around the Conway Expo Center. Having made the drive from Bradford the night before, they were eager to secure their spots for the Mission of Mercy, a remarkable two-day dental clinic that offers free services to those in need. They were fueled by determination, having scrimped on gas money, and arrived by 5 a.m. to find a crowd already forming. “There were already umpteen people ahead of us,” Michelle remarked as they braced themselves for the wait.

As the sun began to rise, the line transformed into a sea of hundreds, with some bringing camp chairs to make the wait more comfortable. When these two women returned for follow-up care on the clinic’s second day, their commitment shone through—they arrived at 2:30 a.m. but still weren’t at the front.

Katheryn, a 48-year-old native of Bradford, faced a significant dental battle, enduring the extraction of nine teeth that weekend. Despite being sober for 14 years, her past struggles with addiction and inconsistent healthcare led to a grim dental situation. “The loose teeth were a big problem,” she shared with a heavy heart. “I could only eat soup and ended up losing 20 pounds.”

“The pain was off the charts,” Katheryn added, speaking of her ordeal with palpable frustration and sadness.

The Arkansas chapter of Mission of Mercy operates under a faith-based model, with the symbol of an angel soaring above the state. Terry Fiddler, the dedicated executive director and a practicing dentist, passionately expressed his commitment: “I truly believe we’re here to help others.”

With nearly twenty years of operation under their belt, this clinic has become an efficient lifeline for thousands. On the day I visited, Fiddler was directing traffic over a microphone while volunteer dentists scrambled to attend to patients lying on portable exam tables. A buzz of activity filled the air as staff screened incoming patients in a triage area, and volunteers moved between stations marked by large banners announcing services like “RESTORATIVE,” “SURGERY,” and “PARTIALS.” The sounds of dental tools whirring and autoclaves sanitizing equipment created a symphony of healing, all while “Uptown Funk” played from a little boombox in the corner, matching the event’s high-energy vibe. I couldn’t help but ask Fiddler what kept him coming back year after year. “They got me at the right price,” he chuckled. “Zero dollars.”

By the end of the 2024 session, the clinic had assisted a staggering 2,290 patients, performing nearly 6,000 extractions, showcasing the immense need for such services.

A Deep Divide

Arkansas consistently ranks at the bottom in national oral health surveys. A report from the Arkansas Department of Health revealed that in 2018, only 56.1% of Arkansas adults visited the dentist within the past year, well below the national average of 67.6%. Alarmingly, 51% of adults had undergone permanent tooth extractions, compared to 41% nationwide. Among Arkansans aged 65 and older, 21.6% had no natural teeth left, versus the national figure of 13.6%.

These disheartening statistics echo a familiar story of neglect for low-income and food-insecure households, who desperately need urgent dental care. The Office of Oral Health found that in a 2022 behavioral risk study, 62.5% of Arkansas adults living in households earning less than $15,000 annually had experienced tooth extractions, compared to only 37.3% from households earning $50,000 or more.

Oral health is intricately linked to overall well-being. The mouth serves as the entry point for both the respiratory and digestive systems, making it a vital area for health management. Infections originating in the mouth can spread throughout the body. Chronic dental pain can hinder one’s ability to chew, swallow, and even speak. Alarmingly, pregnant individuals facing periodontal disease may encounter risks such as premature births and low birth weight. A 2018 study found that only 48% of adult Arkansans with diabetes had visited a dentist in the past year, lagging behind the national average of 60%.

The disparities in dental health are pronounced, affecting not just socioeconomic groups but also racial and geographic lines. In 2023, a screening of third-graders in 51 public Arkansas schools found that Hispanic children exhibited the highest rates of tooth decay, while Black children had the lowest occurrences of dental sealants—protective coatings designed to prevent cavities on molars. Furthermore, children eligible for free or discounted meals showed a higher prevalence of tooth decay compared to their peers from higher-income families.

So, what brought us to this troubling state? Why does Arkansas’s dental health consistently lag behind?

First and foremost, many Arkansans are underinsured. A 2022 study revealed that while only 10% of Arkansans lacked general health insurance, a staggering 54% had no dental insurance as of 2019. Dental insurance often falls into the ‘optional add-on’ category, leaving many families to prioritize health premiums over dental coverage.

Shockingly, even those with insurance are not utilizing their dental benefits. Data from the Arkansas Center for Health Improvement pointed out that in 2019, only about one in three Arkansans aged 19 or older with dental insurance accessed any dental services. This trend is not merely a result of the pandemic—many Arkansans still only seek dental care when they experience pain.

Billy Tarpley, the executive director of the Arkansas State Dental Association, emphasizes that cultural factors play a significant role. “Many Arkansans aren’t raised in households that prioritize oral health,” he explains. “They’ll go to the dentist only when they’re in pain, which is how I was raised too.”

Another critical issue is that many individuals resort to emergency rooms for dental problems. “A significant number of people end up in the ER for issues that could have been handled in a dental office,” Tarpley noted. Severe pain or bleeding due to untreated cavities can lead people to seek emergency care, sometimes for conditions that could easily have been addressed by a dentist.

‘A Tough Sell’

Healthcare experts highlight the challenges posed by low dentist-to-population ratios as another factor in the state’s poor oral health. A 2019 Department of Health review revealed that six Arkansas counties had no permanent dental offices at all, while 13 additional counties boasted fewer than one dentist for every 2,000 residents. Against a national average of 61 dentists per 100,000 residents, Arkansas struggles with merely 42. This distribution creates significant barriers for rural residents, particularly those already facing financial difficulties.

Yet there is a glimmer of hope on the horizon. Lyon College in Batesville is set to open the state’s first dental school in Little Rock’s Riverdale neighborhood, with plans to welcome its inaugural class in the summer of 2025. This initiative hopes to attract both Arkansas residents and out-of-state students alike, fostering a new generation of dental professionals committed to serving the community.

However, whether these new dentists will choose to practice in underserved areas remains uncertain. Tarpley raises a valid concern: “It’s difficult to attract new graduates who come out with $350,000 in student debt and ask them to set up shop in the Delta or other low-population areas. It’s just not appealing.”

Other states have found success by offering debt-reduction programs to new dentists in underserved regions. Could Arkansas adopt a similar strategy? “That’s happening at the federal level,” Tarpley notes, “but it hasn’t been implemented at the state level yet. We do it for physicians, but not for dentists.”

Putting Our Money Where Our Mouth Is

Arkansas dentists have pointed to another barrier: financial constraints related to third-party billing. While dentist salaries in the U.S. rank relatively high compared to other wealthy nations—median pay was $170,910 in 2023, with Arkansas dentists earning a median of $168,760—many practitioners are grappling with high operational costs. Maintaining a dental office resembles running a mini-operating room, leading to elevated expenses that rural dentists often cannot shoulder.

Moreover, many patients in these remote areas are often uninsured or underinsured, relying heavily on Medicaid, which has notoriously low reimbursement rates. This creates a cycle of hardship for both providers and patients, as over 800,000 Arkansans with Medicaid dental insurance struggle to find dentists willing to accept their coverage. Only 61% of the state’s dental professionals are part of the Medicaid network, according to the Winthrop Rockefeller Institute.

“We are dealing with a Medicaid fee schedule that hasn’t been updated in 16 years,” Tarpley emphasized.

Streamlining paperwork could also make a significant difference. Health policy advocates argue that while higher Medicaid reimbursement rates can lead to increased dental service usage, simplifying administrative requirements would enhance accessibility even further.

For children, ARKids, the Medicaid program covering most kids in Arkansas, ensures most medically necessary dental services are covered, with minimal co-pays. Unfortunately, for adults, Medicaid caps dental coverage at just $500 per fiscal year, making it difficult for those needing extensive care. Once that cap is reached, patients must find a way to cover the costs themselves.

This leaves many in a tough spot. They can seek financial assistance from nonprofits like the Denver-based Dental Lifeline Network, provided their care is deemed medically necessary and they reside in eligible counties. Alternatively, they might turn to charitable options like Mission of Mercy, which assembles volunteer dentists for temporary care. Some organizations, including the University of Arkansas for Medical Sciences, offer affordable preventative care, while others, like College Station Clinic in southeast Little Rock, provide a sliding scale based on income.

No More Middlemen

Recently, Arkansas made a significant change in how Medicaid compensates dental providers. Moving away from a “managed care” model, which began in 2018 and involved private insurers, the state has reverted to a “fee-for-service” approach as of November. Now, dental providers can bill Medicaid directly, allowing patients to check in using their Medicaid ID rather than relying on private insurance cards.

This shift may not immediately impact patients, as the Department of Human Services indicated that “most services are still covered as they were under managed care,” and claims data showed less than 5% of adult Medicaid beneficiaries exceeded the $500 cap on dental services. However, removing private insurers from the equation has reignited important conversations about how dentists are compensated.

The pressing question remains: will the state increase reimbursement rates? “The state needs to ensure a fee schedule that reflects the rising costs of dental supplies and fairly compensates dental professionals,” Tarpley urged.

A 2022 survey by the Arkansas Dental Association revealed that 84% of dentists accepting Medicaid would likely withdraw from the program by 2025 if rates do not improve. “We are actively collaborating with DHS to review the Medicaid fee schedule,” Tarpley shared. “Our last three proposals were overlooked, and we were told there weren’t enough funds available. We know the funds are there; they just need to be allocated. We are striving to prevent a crisis.” For now, at least, the line for care remains open.

The review process, as stated by a DHS representative, will cover everything from rates and procedure codes to billing rules and service limits, with a target implementation by June 2025.

A Wish List

Alongside a reevaluation of the Medicaid fee schedule, advocates for dental health outline several desired changes:

• Simplifying insurance billing for dental practices, regardless of whether it involves Medicaid or private insurers.
• Implementing initiatives that educate new parents on infant dental care.
• Providing regular dental screenings at public schools.
• Offering state-funded grants, loans, and tax incentives for safety-net clinics serving low-income communities and for dental school graduates relocating to high-poverty areas.
• Educational initiatives focused on tobacco cessation.
• Increasing participation in the Seal-the-State program, which provides cavity-preventing sealants for children.

Water fluoridation remains a contentious issue as well. Since 2011, Arkansas has mandated fluoride addition in municipal water systems of certain sizes, leading to one of the nation’s highest increases in fluoridation rates. A January 2023 report stated that 86% of Arkansans benefit from optimally fluoridated water. However, recent legislative efforts aim to repeal this requirement, jeopardizing the state’s progress.

Dental health advocates stress the importance of addressing broader economic issues impacting low-income Arkansans, including low wages, access to nutritious food, barriers to maintaining Medicaid eligibility, insufficient public transportation for dental visits, and lack of broadband for telehealth.

The timeline for potential changes and their effects on individuals like Katheryn Newton remains uncertain. For now, she plans to return to the Mission of Mercy clinic in 2025 and seeks dentures after the remaining extractions. “It would boost my confidence,” she said, looking ahead. “It’s hard to smile when you don’t feel good about your teeth.”