The study, published in the Journal of Public Health Dentistry by a team from the University of Michigan Institute for Healthcare Policy and Innovation, focused on the impact of dental coverage offered through Michigan's Medicaid expansion, known as the Healthy Michigan Plan.
“Many enrollees spoke passionately and sometimes joyously about how having dental benefits had changed, and in some cases, saved their lives,” said Edith Kieffer, Ph.D., lead author of the study and professor emeritus at the University of Michigan School of Social Work. “Some were able to access dental care for the first time ever, or in many years, because of this coverage. The role of getting dentures in literally changing lives was a revelation.”
In all, 60% of the 4,090 enrollees had visited a dentist at least once since enrolling in the Healthy Michigan Plan a year or two earlier, which the researchers verified with state records. Among those who saw a dentist in that time, 57% said their oral health had improved since enrolling.
The percentage who reported better oral health was even higher among Black respondents and those who said they'd been uninsured for a year or more before getting covered.
Half of the respondents had jobs or were self-employed, though their incomes were low enough to qualify for the Healthy Michigan Plan — about $15,600 for an individual during the time studied.
Of those who had jobs and reported improved oral health, 76% said that their Healthy Michigan Plan coverage had helped them do a better job at work, compared to 65% of those who had jobs but hadn't experienced improvements in oral health.
Meanwhile, 60% of the unemployed people who said their oral health had improved credited their coverage with helping them look for a job.
Enrollment has grown to more than 895,000, showing the need for programs such as The Healthy Michigan Plan, Dr. Kieffer said.
“More than 700,000 Michigan residents have contracted COVID-19 with the resulting health impacts of the disease, and the social and economic impacts of quarantine, job and wage loss,” she said. “More than 17,000 people have died and thousands of survivors are suffering longer-term health effects.”
Some enrollees mentioned that previously they had turned to hospital emergency departments for urgent dental needs. The study's authors noted that Medicaid coverage in Michigan improves patients' access to primary health care as well as basic dental care. In both settings, providers can identify patients at risk of oral health problems and suggest treatments for problems so they can be addressed before they worsen.
Study co-author Romesh Nalliah, B.D.S., professor at the university’s school of dentistry, said that the inclusion of adult dental coverage in Medicaid and other plans could help reduce the disparities in oral health that he and others have documented.
In 2019, Dr. Nalliah and colleagues published data showing that while the oral health gap between Black and white Americans had narrowed between 1999 and 2014 — the year before Medicaid expansion took effect under the Affordable Care Act — there were still disparities in dental visits and tooth loss due to caries and gum disease.
“We concluded that although there seems to be evidence of equality, equity still eludes us,” Dr. Nalliah said.
Ultimately, oral health has important influences on people's overall health, Dr. Kieffer said, especially those who are low-income.
“Oral infections, abscesses, ulcerations and inflammation from periodontal disease are important components of overall health, affecting multiple body systems and functioning,” she said. “There is evidence that poor oral health influences diabetes, cardiovascular disease, coronary artery disease and pregnancy-related risks. Poor condition of the teeth and gums affects nutritional adequacy, and mental health due to embarrassment, anxiety and reduced social interaction and self-esteem. Pain disrupts sleep and other aspects of physical and emotional well-being. Good oral health promotes overall physical and mental health.”