Dental hygienist Amy Satterfield strives to provide a positive dental experience for her patients.
During an afternoon cleaning, she encouraged an elementary school student in her chair by promising lip balm as a reward for their bravery.
Satterfield serves children and families at the Hopewell East Clinic in Rio Grande City, Ohio.
The school-based health center opened in 2021. Before then, families had difficulty accessing nearby dental services. “Providing these services in schools is a huge opportunity,” she says.
Southeastern Ohio is federally designated as a dental health professional shortage area. Satterfield, the clinic’s only dental hygienist, returned to work part-time after retirement.
Many families still have to travel long distances to access care, especially since few clinics accept Medicaid. Recent cuts to federal Medicaid have raised concerns about declining access to care.
Hopewell East Clinic is one of the few local clinics that provides school-based services, reducing barriers such as transportation and absenteeism. As a safety-net dental clinic, it provides treatment to all patients who can pay and is often the only option for Medicaid recipients.
However, six counties in southeastern Ohio have no safety-net dental clinics at all, and many have fewer than 10 dentists.
Recruiting dentists and staff remains a challenge. “Some of our clinics don’t even have full-time dentists,” says Amber Johnson, manager of the East Clinic.
Due to staff shortages, dentists often take on routine cleanings, reducing their ability to handle complex treatments. This leads to longer wait times, and attracting new staff is difficult due to lower wages and greater challenges in rural areas.
Programs that train and invest in local staff have proven more effective. Hocking College’s dental hygiene program is expanding and enrollment has doubled, and students often choose to stay in the area.
Clinics also rely on state incentives, such as loan repayment subsidies for dentists serving low-income patients in areas facing shortages.
Even with federal funding, safety-net clinics still face low Medicaid reimbursement rates. “Reimbursements often don’t even cover our costs,” said Darcy Cook, a dentist in Hopewell. Many private practices limit the number of low-income patients they accept.
Advocates worry that federal Medicaid cuts will force states to reduce optional services like adult dental care, exacerbating access issues. Left untreated, minor dental problems can lead to root canals, extractions, or expensive emergency room visits.
From 2016 to 2019, Ohio spent an estimated $738 million on dental-related emergency room visits—most of which were for conditions that could have been treated in a dental office.
“Losing access means more patients end up in the emergency room, which is the most expensive and least effective setting for dental care,” said Mara Morse, president of the Ohio Oral Health Association.