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Erie Family Health Center, VNAF’s Oral Health Initiative (OHI) partner, prepared the following summary that outlines the oral health needs of underserved patients. Although our first OHI efforts at Erie’s Helping Hands Health Center will focus on the patients visiting that clinic, we remain well aware that these same barriers to oral health care are experienced by thousands of others among Chicago’s underserved, and we will continue both to work to raise awareness of citywide oral health needs, and create means of addressing them.
Oral Health Need among Chicago ’s Underserved
Prepared by Erie Family Health Center
Oral health is an undisputed and nearly unrivaled need among the uninsured. People without health insurance have four times the rate of unmet dental need as the insured, and in Illinois only 25% of Medicaid-covered children have received oral health screenings or care. The impact of poor oral health is far reaching and has, in fact, been proven to substantially influence everything from learning in children to chronic disease control in adults.
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 Lack of Access to Services
Addressing the Needs
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Lack of access to services
Lack of access to preventive and restorative services is a major barrier to oral health care. Some “safety net” facilities, such as community health centers or Chicago Department of Public Health clinics, are scattered throughout Chicago but many neighborhoods have no facilities available to serve low-income uninsured patients. The Sinai Health System’s 2004 report, Improving Community Health, reported that as many as 34% of residents in some community areas did not obtain necessary dental care because it was too costly—demonstrating that the need in some Chicago communities may be much greater than that seen nationally.
Private dental offices often exist in even the most impoverished areas of the city, however, as in the case of Erie Family Health Center’s (EFHC) target area, 75% of them do not accept Medicaid, 90% do not offer a sliding fee scale for uninsured patients, and 94% do not speak Spanish. Additionally, recent community health profiles compiled by the Chicago Department of Public Health revealed that the northern (1/3) areas of Chicago have the least total capacity to meet the oral health needs of people living at or below poverty.
Addressing the needs
In addition to the lack of access to quality affordable oral health services, EFHC has found that the current oral health system is not addressing the oral health needs of the broader population. Illinois residents have high rates of cavities and periodontal disease and a lack of access to preventive oral health services such as sealants. Dental cavities disproportionately affect minority populations of lower socioeconomic status and among Erie’s patients, for example, 63% have untreated cavities . Recent studies by the Centers for Disease Control and Prevention also demonstrate that 35% of Latino children ages 2-5 have untreated dental cavities, averaging over twice the rate for Caucasians ages 2 to 5 (14.5%).
Adults are also impacted by the paucity of affordable and culturally appropriate oral health services. Periodontal diseases are a common problem among Latino adults; and EFHC has found that 52% of its adult patients and 35% of pregnant women suffer from the disease and its consequences. For example, p eriodontal disease in pregnant women can lead to preterm labor and low birth weight babies, and diabetic adults are at risk for advancing periodontal disease and subsequent tooth loss as a result of their condition. Furthermore, 46% of Illinois ’ Latino children suffer from gingivitis.
An important protective tool to prevent cavities in children is the use of sealants; however, many low-income patients do not have access to them. Nationally, 55% of children are in need of sealants and among Hispanic children, the need soars to 96%. Only 4% of Latino children in Illinois and 3% in Chicago have received sealants as compared to 18% of Illinois’ Caucasian children.
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Following is a list of additional oral health statistics that demonstrate the urgent need for quality and affordable oral health services for low-income, uninsured, and ethnic/racial populations.
Dental Caries
Dental caries disproportionately affects groups of lower socioeconomic status. In a survey conducted by the State of Illinois, evidence of dental caries was found in 54% of children on their primary or permanent teeth and 38% of children ages 6-8 had untreated dental caries. In Erie’s oral health needs assessment in 2003, 63% of patients had untreated caries.
Edentulism
Erie determined through its oral health needs assessment that 56% of its adult patients and 38% of pregnant women were missing teeth.
Fluoridation
All residents of Chicago receive fluoridation through the public water system. Despite this, children in Chicago have poor access to recommended preventive supplemental fluoride treatments such as fluoride varnishes and prophylactic fluoride treatments.
Oral Cancer Screening
When detected early, the survival rate for patients with oral cancer is high. Illinois cancer statistics show, however, that less than 40% of oral cancer cases were diagnosed at an early stage, and when diagnosed later, the five year survival rate drops to less than 50%. Furthermore, in a recent study conducted by the American Dental Association, the mortality rate from oral cancer among most ethnic/racial populations decreased while the rate among Hispanic women increased.
Emergency Services
There is a lack of affordable and reasonably accessible emergency oral health services in Chicago. Stroger Hospital of Cook County provides extractions, regardless of ability to pay, but limits the procedure to 38 per day. The University of Illinois at Chicago College of Dentistry offers reduced fee emergency services on a first come, first serve basis, but promises only to relieve pain the same day.
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