How America's Dental Health Crisis Created Mexico's "Molar City"

How America's Dental Health Crisis Created Mexico's "Molar City"
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Immigration and the Mexican border have been in the news for months. But all the stories have been about people coming to the United States. The untold story is how many Americans are leaving the U.S. for Mexico. Not to stay but to get dental care.

So many Americans are making the trip across the border to see a dentist that one small border town, Los Algodones, is now better known by its nickname: Molar City. The demand has become so great that a website has been created to help Americans make appointments with Mexican dentists before they leave home.

If you’re like me and are able to see a dentist regularly, you’ve probably never heard of Molar City. I hadn’t until I read about it in an eye-opening report written by researchers at the conservative Arizona-based Goldwater Institute. The Goldwater Institute is one of a growing number of groups on both sides of the political aisle advocating for the licensure of midlevel providers in dentistry, similar to nurse practitioners and physician assistants, as a means to improve access to affordable dental care in the U.S.

Los Algodones, population 5,500, is the northernmost town in Mexico, a stone’s throw from the international border at Andrade, California, and just 10 miles west of Yuma, Arizona. But this is no typical border town. It has far more dentists per capita than any city or town in Mexico. Or the United States for that matter. In fact, it reportedly has the highest density of dentists in the world. By some estimates, just about one of every 15 residents is a dentist.

Tens of thousands of Americans are now going to Los Algodones every year not only because dental care in the United States has become so expensive but also because a growing number of U.S. communities have few if any dentists.

Not only are there not enough dentists in the United States—the Health Resources and Services Administration (HRSA) estimates that we need thousands more just to meet current demand—most of the dentists we do have now work in prosperous parts of our cities and suburbs. That’s understandable when you consider the amount of student loan debt many dental school graduates now face. Of dental school graduates with student loans, the average debt grew to $261,149 last year, according to the American Dental Education Association. More than 30 percent of graduates reported debt exceeding $300,000.

Ballooning student debt and the high cost of setting up a dental practice have contributed to a growing maldistribution of dentists. As of last year, more than 50 million people lived in the 5,493 officially designated Dental Care Professional Shortage Areas in the United States. HRSA estimates we need more than 8,000 dental practitioners to meet demand in those areas, where there are one or fewer dentists per 5,000 people.

Adding to the problem is that an estimated 130 million Americans have no dental coverage, according to the National Association of Dental Plans. One reason is the fact that Medicare doesn’t cover routine dental care.

Yet another problem is that few dentists are willing to treat people who receive Medicaid benefits because of relatively low reimbursement rates. Nationally, fewer than 20 percent of dentists are accepting new Medicaid patients.

Low-income children and adults are especially disadvantaged, but even middle-income families are now having a hard time paying for the dental care they need. A poll by the Kaiser Family Foundation a few years ago found that one of every three Americans reported skipping dental checkups and care because of the cost.

It’s little wonder, then, why so many Americans are crossing the border to get affordable dental care. Here are some statistics from the two states closest to Molar City:

In California, several counties have either no dentists participating in the state’s Medicaid dental program (Denti-Cal) or only one for every 1,000 to 3,000 children. As a consequence, half a million school children go to a hospital emergency room in California every year for care that could be provided more appropriately and less expensively in dental offices.

In Arizona, one of every three of the state’s 7 million residents live in dental shortage areas, according to the Goldwater Institute’s report. Forty percent of Arizona preschoolers have untreated tooth decay and are in immediate need of dental care. The problem of access to dental care is most severe among the state’s Native American children. Among Native American third graders in Arizona, 75 percent have a history of tooth decay.

When it released its report this spring, the Goldwater Institute said midlevel dental practitioners—often called dental therapists—should be able to practice in Arizona and every other state.

“The safety and quality track record for dental therapists is long and well-documented,” the Goldwater Institute’s researchers wrote. “In addition to decades of experience in more than 50 countries around the world and in a growing number of states in the U.S., more than 1,000 studies and evaluations confirm that dental therapists provide safe and high quality care for dental patients.”

The report called state scope-of-practice laws governing the licensing of dental practitioners so “overly restrictive” that they limit the availability of providers and services.

“Limiting the supply of providers not only increases the cost of care services, it forces consumers and government payers to pay prices higher than they might otherwise,” the researchers wrote.

They were critical of the American Dental Association and state dental associations for opposing dental therapists. “The dental establishment has actively resisted this reform and usually cites unfounded concerns over patient safety,” they wrote.

Arizonans and other Americans wouldn’t have to go to Molar City for needed dental care, they added, if it weren’t for the unwarranted protection the “special interests of medical professionals” receive in Arizona and elsewhere.

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