I’m a lifelong Kentuckian who has lived in both rural and urban Kentucky. I have seen how access to dental care can be extremely difficult regardless of where you call home.
Early on, my mother drove more than 40 minutes from Washington County to Boyle County to take me to dental appointments. If it weren’t for Medicaid, I would have had no oral healthcare growing up. I watched both of my parents, both who worked low wage jobs, lose their teeth. For them, not only was it difficult to find a dentist, but it was impossible to afford the amount of dental work needed to sustain their teeth after years of not having access to dental care.
At age 30, my mother learned that she had periodontal disease. This was devastating due to the progression that had gone unchecked as a result of being uninsured and unable to pay out of pocket for care. While I am writing today in my professional role, I’m also writing as a Kentuckian whose life has been shaped by what it means to have, or not to have, access to oral healthcare.
HB103 and SB55, under consideration in the Kentucky legislature, would allow local water districts to decide whether or not to continue fluoridating public drinking water that often serves multiple Kentucky counties and even some out-of-state counties. HB103 and SB55 push the decision to the local level, which means community voice and local input must be built into the process, too.
At Kentucky Voices for Health, we visit with communities statewide and we listen —a nd what we hear, over and over, is that Kentucky families cannot get the dental care that they need. That gap makes every tool we have to fight tooth decay that much more critical. Fluoride is one of those tools, and for over half a century, has been beneficial in helping prevent decay through community water fluoridation. Oral health providers agree that prevention is the foundation for healthy teeth, and fluoride is the cornerstone of that foundation. Thankfully, Kentucky’s water systems are carefully monitored and controlled at the lowest and safest effective levels.
When you hear about “local mandates,” it’s important to compare the cost of care to the cost of fluoridating our drinking water. The cost to prevent decay (which in turn helps prevent chronic diseases related to tooth decay, including some cancers) is minimal—we’re looking at less than a dollar per person per year. The projected cost of treating additional decay is far greater. State estimates for increased Medicaid cost projections alone indicate for every 10% of Kentuckians who lose access to fluoridated water, the cost of treating the increased decay in kids alone would be nearly $20 million per year. This does not include costs within Medicare and commercial insurance networks, or, the additional uncompensated care and emergency room burdens.
I think we need to be honest with ourselves about our current capacity. Even if we wanted to “treat our way out” of more decay, we don’t have enough dentists and dental professionals to do so, especially in rural areas. Building a stronger workforce takes time, intention, and in recent years, only minimal progress has been made to grow Kentucky’s oral health workforce pipeline. While we invest in our workforce, we cannot afford to strip away preventive measures that are helping us hold the line.
What’s more is that the federal EPA recently announced what it calls a “gold standard” scientific review of fluoride exposure and health effects. This review could help us more academically inform future protective recommendations and standards. You don’t build a house from the rooftop down, so we need to give the process time.
As reports of findings and recommendations are released, Kentuckians deserve a chance to be heard. If HB103 or SB55 advance, there must be a clear process in place that guarantees a body elected by its community to provide public notice, and allow time for public comment and participation so the community has a true say in the decisions that affect their health. That should be Kentucky’s “gold standard” review.
Kentucky families are already struggling with a number of economic issues, including accessible dental care. This is not the moment to leave them voiceless in the decisions for their community’s water fluoridation, one of the very few resources that reaches everyone equally. Now is the time for Kentuckians to urge our state legislators to protect our families with what we know works.
Brittany Elam is a policy specialist for Kentucky Voices for Health.