Tuesday, July 06, 1999

Ky. second in U.S. for toothlessness

The Cincinnati Enquirer

        Kentucky has the dubious distinction of being second in the nation for toothlessness, and health professionals say the state's use of tobacco and lack of access to health care in rural areas are to blame.

        “It's the poverty and there's also a lack of access to care, particularly in southeastern Kentucky and western Kentucky,” said Dr. James Cecil, a University of Kentucky dental professor and director of a company that manages the Medicaid program in central Kentucky.

        He noted that many residents of rural, impoverished areas may have Medicaid coverage, but that many dentists don't accept it. And, while the Medicaid coverage covers ba sic cleanings, it encourages teeth extractions by not covering much else.

        And Kentucky is No. 1 in smoking.

        “It's all those things together,” said Dr. Cecil. “I'm hoping that all that's going to change in time.”

        He and Northern Kentucky health professionals agree that various outreach programs, which target rural areas and youngsters, and basic improvements in dental care could make a difference.

        Meanwhile, 44 percent of Kentucky's elderly, 65 years and older, are dealing with edentulism — or the complete loss of their teeth — according to a report released this spring by the Centers for Disease Control and Prevention in Atlanta. The Bluegrass State was second only to West Virginia, another tobacco state, where 47.9 percent of their elderly have lost their teeth. Louisiana was third with 43 percent.

        These were the only states to go past the 40-percent mark. Hawaii was at the bottom of the ranking at 13.9 percent.

        The study also shows that, nationwide, toothlessness is more prevalent among people who haven't graduated from high school (42.1 percent) and those without dental insurance (27 percent).

        Regarding smoking, in the 65 and above age bracket, 41.3 percent of everyday cigarette smokers have lost their teeth. It's 28.9 percent for occasional smokers, 25.7 percent for former smokers and 19.9 percent for those who have never smoked.

        As part of a 2-year-old program, Dr. Cecil visits rural elementary schools where most of the students receive free or reduced-price lunches. More than 50 percent of them have never had a dentist, dental hygienist or other health professional examine their teeth.

        A lot of those children will lose their teeth in their 20s.

        “It's definitely more than just a health issue. That's where toothlessness starts,” Dr. Cecil said. “It's not unusual to find children under 21 without their teeth. The tragedy of each one of those is that the child is doomed to a life of dealing with facial collapse, poor chewing skills and digestion problems.”

        Health professionals say the good news is that Kentucky's rate of edentulism has been steadily decreasing. They tie that to the 1950s, when Louisville's municipal water supply became fluoridated and that trend spread throughout the state.

        Dr. Charles Kenner of Florence remembers being a dental student at the University of Louisville in the 1970s and witnessing the successes of the fluoridated water supply.

        “Kids in Louisville had the least decay, and their fillings were smaller,” he said. “Louisville just really stood out.”

        He concurs that Kentucky's impoverished and rural areas are the reason Kentucky isn't faring so well when it comes to residents keeping their teeth. But he believes that improvements will come because of im proved treatments for periodontal disease and outreach programs into the rural areas.

        He noted that people are living longer, so there is a greater need to take care of one's teeth.

        “Hey, you're going to have to deal with them,” he said.

        Northern Kentucky Family Health Center of Covington provides dental care to those in a lower-income bracket. Dr. Tracey Ross said she's actually been noticing that more older people are keeping their teeth.

        She also expects future improvements because of a greater emphasis on dental care for youngsters.


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