As an alum of Lyon College, I was admittedly surprised at the college’s recent announcement of its intent to establish a dental school in Little Rock as part of a new Lyon College Institute of Health Sciences.
Don’t get me wrong. I am in no way skeptical of the grit and perseverance of the institution that miraculously sharpened some of my very rough edges, not to mention those of my classmates. Plus, Lyon College has been the undergraduate educational foundation for many Arkansas dentists, one of whom is my boys’ pediatric dentist.
It’s just that this is such a daring move for the college that has occupied a spot in my memory as a quaint, residential, liberal arts college nestled on a bluff in the foothills of the Ozarks. I shouldn’t have been as surprised as I was, though, because Lyon College has been adapting in response to educational needs and environmental challenges in the more than two decades since my commencement ceremony.
This bold leap into post-graduate, dental professional education will be no different. Arkansas has had persistent dental access issues, particularly in rural areas. A report released this month by the Arkansas Center for Health Improvement (ACHI) found that there were 11 Arkansas counties that had more than 5,000 residents per active dentist in 2019. An area with a ratio of 5,000 or more residents per dentist classifies as a dental provider shortage area, according to the federal Health Resources and Services Administration. ACHI found that two counties — Cleveland and Lafayette — had no active dentist at all.
A contributing factor to these access challenges has been the lack of an in-state dental school option, with Arkansas students obtaining their professional dental education at out-of-state schools and then seeking career opportunities elsewhere once they leave the state. An in-state dental school could mean progress on workforce supply, but there are other contributing factors at play.
Cost is the principal barrier for access to dental care for Arkansans. According to the American Dental Association, among those without a visit to the dentist in the last 12 months, 72% of Arkansans cited cost as their reason for not visiting the dentist more frequently. This is despite the fact that 96% of Arkansans said they value oral health, and 85% said they feel the need to visit the dentist twice a year.
Arkansas has been successful in closing the medical insurance coverage gap over the past decade, with the percentage of the population without coverage dropping by half to about 9%. However, far fewer people have dental coverage. In fact, the ACHI report found that only 54% of Arkansans had dental insurance in 2019.
Even among those with dental insurance, only about 30% of adults and 51% of children used any dental services in 2019. Routine dental care can help patients avoid dental problems that require emergency care, but 92% of patients with dental insurance who sought dental care in an emergency department had not received preventive dental care in the past 12 months.
In the face of these challenges, there are emerging opportunities to eliminate the artificial division between dentistry and other areas of medicine to foster more comprehensive and high-quality care. In 2011, Dr. Atul Gawande wrote about a looming transformation in medicine that would require doctors to operate less like cowboys and more like pit crews, with “diverse people actually work[ing] together to direct their specialized capabilities toward common goals for patients.” Some see a similar transformation in dentistry on the horizon, with the shift away from disease-centric approaches toward holistic, patient-centered approaches, growth of interprofessional education and practice, and acceleration of alternative payment approaches that focus on accountability for health outcomes.
Medical-dental integration has promise to improve patient experience and outcomes through better screening and coordination of care and the potential to reduce avoidable costs through prevention and early treatment. Co-location of medical and dental services has been common in federally qualified health centers, including some in Arkansas. Many states have launched formal medical-dental integration efforts, and the Centers for Disease Control and Prevention launched a partnership in 2020 to develop a national framework for medical-dental integration.
Having a dental school in Arkansas won’t solve all our problems, but it sure gives us something to smile about. It should also serve as a call to redouble our efforts to tackle the dental access challenges we face as a state and ensure that oral health is more commonly addressed as a critical part of our overall health.
Editor’s note: Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author.