Tompkins County survey reveals challenges in accessing dental care, sparking push for solutions

By Jaime Cone Hughes

A survey of 645 residents of Tompkins County, conducted by the county’s Whole Health department between February and April 2024, highlighted significant disparities in oral health care across the county.

More than half of the survey respondents reported difficulties finding a dentist in Tompkins County. Among those who struggled to find dental care, 40% had trouble locating a dentist who accepted their child’s insurance, and 36% found it difficult to access a pediatric dentist.

Nearly half of the survey respondents reported traveling outside of the county to obtain dental treatment for their children. This includes traveling about an hour or more for dental care.

Among the 43% that go outside of the county for care, 78.5% visit dentists in Broome County, (67% of them visit Dinosaur Dental in Endicott).

About 14% see a dentist in Cortland County, and about 7% go to counties such as Chemung, Cabarrus, Rockland, Seneca, Steuben, Schuyler and Monroe.

Tompkins County Board of Health, at its Feb. 25 meeting, unanimously accepted the findings of the survey. Board of health President Christina Moylan said the survey is “exactly the kind of data-driven approach that you should be using to make decisions about where to focus.”

Moylan said that the board’s acceptance of the survey also sends a message to county health department staff that oral health should be elevated as a priority.

County officials are focused on starting an oral health steering committee to address these issues, said Sangarika Vemprala, a trained dentist from India who earned her Master of Public Health degree from Cornell University in 2023 and has been working with Tompkins County Whole Health since she graduated.

“My fellowship mostly focuses on the oral health project,” she explained. The project began a little over a year ago.

“We started looking at the oral health status of the county. And then we realized that there was not really enough data in the county,” Vemprala said. The most recent data that we had before this was from 2011.

Whole Health thought it was important to collect more current data on the status of oral health in the county, especially in children.

“So that’s how we started working on the survey and got the results,” Vemprala explained. Though the survey included people from all over Tompkins County, most of the respondents resided in Ithaca, she said.

The results showed that systemic problems plague the country’s health care system and are affecting people’s ability to obtain care locally. 

Tompkins County has a lower-than-average number of dentists for its population, with a ratio of one dentist for every 1,700 residents, which is significantly less than the national ratio of 1 dentist for every 1,300 people, Vemprala said.

Vemprala and Rachel Buckwalter, Director of Community Health for Tompkins County Whole Health, agreed that, overall, dentists are likely not attracted to more rural areas like Tompkins County, where there are also no college dentistry programs, simply because of the lack of population compared to big cities. 

In addition to the lack of options, those seeking dental care are often confronted with the fact that dental insurance is split from regular health insurance, which creates a struggle for patients who would like to have dental insurance but cannot afford the extra payments, said Buckwalter. 

Those looking for a dentist in Tompkins County are likely to encounter statements on dentists’ websites saying that the practice is not in-network with any insurance plans. 

“We accept most traditional insurance plans as an out-of-network provider; however, we are happy to file insurance for your reimbursement as long as you are free to choose your own dentist,” states the website for Northeast Family Dental in Ithaca, adding that it “does NOT participate in Managed Care Plans,” but does offer flexible financing plans.

“We are an ‘out-of-network’ provider,” states the website for Gorges Dental, also located in Ithaca. “As a courtesy to our patients, we still submit claims to your insurance on your behalf.”

The website adds that if an insurance company requires pre-authorization in advance of treatment, the dental office can handle that paperwork, too. “Please note,” the website states, “that due to the fact that we are an out-of-network provider, we are a fee-for-service practice. Payment is expected at the time of service.”

“The benefits of any plan are determined by an agreement made between an employer and an insurance company and often have little to do with an individual’s actual dental needs,” reads a statement on the website for McCutcheon, Patel, Livermore, and Associates, practicing dentists with an office in Ithaca. “Although insurance can certainly be helpful in defraying the cost of care, we feel that treatment decisions should be arrived at following informed discussion between you and your dentist rather than dictated by the insurance company.”

The website goes on to state that the dentists are not in-network with any insurance providers and that payment at the time of service is requested.

The websites for Ithaca dentistry practices Jeremy J. Zobel General & Cosmetic Dentistry, Ithaca Dentistry, and Integrative Oral Health all state that they are out-of-network for most, if not all, insurance companies.

Vemprala said that dentistry involves high overhead costs. Dentists have to hire hygienists, assistants and office managers. They need expensive equipment such as scanners and X-ray machines. “Those are all very, very expensive,” she said.

Dr. William Klepack, Tompkins County Medical Director, agreed that the high cost of running a dental practice is a factor.

“For a lot of dental practices, when you’re trying to run an office, the overhead expense is always a threshold they have to get over to provide care, and it matters a great deal what that overhead is, since reimbursement for Medicaid and [New York state] Child Health Plus is not particularly robust,” Klepack said. Child Health Plus is a state-sponsored program for children under the age of 19.

Low insurance reimbursement rates make it prohibitive for dentists to be in-network, said Buckwalter.

“Requirements for billing to insurance are pretty intense, and so you can provide care for someone and then turn around and ask insurance to pay for it, and then they’ll write back, ‘Well, you exceeded the cost for the service. We only reimburse up to this much. You didn’t use the right code. You didn’t use the right treatment.’” Buckwalter said. “There’s a lot of energy spent on billing for an increasingly smaller reimbursement, so dentists just say, ‘We want to be paid up front, because then we know at least we’re getting the full amount.’ … But then it’s like, ‘Well, why do we even have insurance?’”

“Then the Medicaid problem is also a pretty big one,” Buckwalter added. “The Medicaid reimbursement rate to dentists is pretty poor. It doesn’t really cover much.”

Buckwalter said the feedback she has received from dentists is that they would lose money based on current Medicaid reimbursement rates.

“We want to get more dentists on our committee, to hear from them directly. But my understanding is that, you know, [Medicaid reimbursement rates are] just not good enough to help them meet their bottom line in terms of operating expenses,” Buckwalter said. “So, there’s very few dentists that accept [Medicaid] within Tompkins County, and then out of that subset of dentists, many don’t want to deal with kids, because pediatric dentistry is a whole different thing in terms of managing kids’ anxieties.”

Pediatric dental practices like Dinosaur Dental in Elmira end up acquiring Tompkins County patients who are unable to find closer options that take their health insurance.

The survey results showed that approximately 57.8% of children had visited a dentist in the last six months, indicating a relatively good level of access to dental care and regular check-ups. The 24.5% of children who visited a dentist between six months and a year ago suggests a moderate level of dental care access.

“Of particular concern is the 10.6% of children who reported never visiting a dentist. Among the 10.6%, 0.7% are in the less than 1 year age group, 3.8% are in the 1-2 age group, 2.4% in the 3-4 age group, 1.1% in the 5-12 age group, and 0.9% in the 13-18 age group,” according to the “Discussion” section of the survey, which adds, “This suggests that some children may not have visited a dentist due to a lack of awareness about the importance of early dental visits, or possibly due to a shortage of pediatric dentists in the area.”

The proposed steering committee would include people from the community, local organizations, local dentists and whoever is interested in contributing and talking about oral health. “We are having all of them come together so that we can all talk about it, create solutions, see what the gaps are and how to create more accessible care,” Vemprala said.

“We’ve also been reaching out to other counties just to learn from them, because a lot of more rural counties have been dealing with this problem for a long time, the access-to-care problem in particular,” added Buckwalter. “There are various creative solutions — mobile dental vans and those kinds of things — so we’re just trying to sort of feel our way through what’s going to work in our county. What’s going to be the best solution for our population?”

“If we could find a way to somehow lower that overhead for practitioners,” Klepack said, “we could maybe have that service provided, so that’s why we’re looking at a mobile unit as attractive, especially for people challenged by transportation problems in some way.”

Madison County recently launched an oral health partnership. “We reached out to them and got more information on what they’re doing, what worked for them,” Vemprala said, adding that Tompkins County officials have also reached out to Jefferson County. Like Tompkins, both of those counties are struggling with access-to-care issues. Madison has formed a committee to address the results of its own recently conducted survey, and the hope, said Vemprala, is that Tompkins County can use some of their tactics to form effective partnerships within the community, as well.

Findings have been shared with the 6th District Dental Society, which represents the majority of dentists in our region, and the health department has extended an invitation for their participation in working toward these solutions. Interested potential partners are asked to contact Whole Health at publichealth@tompkins-co.org.

Tompkins County Whole Health will promote these efforts to community members at upcoming events and on social media.

Klepack added that he would like to tell the public that fluoride treatments are very beneficial for the oral health of both children and adults.

“I think it’s been unequivocally shown to make a big impact on children being able to have teeth free of cavities and able to get into adult life with teeth that are of the right number,” Klepack said.

Vemprala added that studies show that areas that have fluoride in their municipal water supply have 40% fewer cavities than those that do not. Though Ithaca does not have fluoride in its water, there are many ways to obtain fluoride treatments, she added, whether it is through the dentist or pediatrician or with fluoride toothpaste or mouthwash at home.

Children should, ideally, start visiting the dentist when their first teeth start coming in, usually around six months to one year old, Vemprala said.

Adults and children, even young children with baby teeth, should brush their teeth twice per day and floss daily, she recommended.

The survey results showed that 10% of respondents faced challenges in obtaining reliable information about available dental providers in the county.

For more information about proper oral hygiene and proper dental care, including a map of Tompkins County dental offices, visit www.tompkinscountyny.gov/health/oralhealth.