By Mississippi Today

JACKSON — More than half of elderly Mississippians grapple with severe tooth loss, a rate higher than anywhere else in the country, according to a new report on the oral health of elderly Americans.

In Mississippi, 55 percent of adults over 65 have lost six or more of their teeth, and only 52 percent had seen a dentist in the last 12 months, the lowest percentage in the country. Because of this and relatively low marks on other preventative measures, the report, A State of Decay, gave Mississippi a score of zero in the overall oral health of its elderly population. Minnesota leads the state rankings with a score of 100.

While the report focuses on oral health, it talks about how much environmental factors, such as a person’s income or education level, can drive poor health.

“(The data) showed a consistent, linear association with household income. Low household income covaries with predicted measures of poor oral health. As income levels rose, so did the probability of good oral health … (And) increased education level correlated with better oral health.”

In 2017, Mississippi had a poverty rate of 20.8 percent, the highest in the country, according to the Center for American Progress.

Conversely, poor oral health can also have an adverse affect on a person’s income and the overall economy. Gum disease and tooth decay increase a person’s risk for a number of debilitating illnesses, from cancer to heart disease and stroke, making it more difficult for a person to stay employed. Women who don’t receive dental care during pregnancy are also more likely to deliver a baby preterm, increasing the risk for lifelong health complications for that child. Mississippi’s preterm birth rate is among the highest in the nation.

People with oral health issues, such as missing teeth, are also less likely to be employed, according to a 2015 study in the journal of the American Dental Association. This could pose a problem if Medicaid requires certain beneficiaries to work to maintain their coverage.

In January, Mississippi applied for a waiver with the federal Centers for Medicare and Medicaid Services that would require certain Medicaid beneficiaries to work to keep their coverage. But State of Decay also ranked states according to the number of dental procedures Medicaid would reimburse, and Mississippi came in close to last here, too, with only two services—tooth extractions and oral examinations—covered by the state’s Medicaid plan.

Although the report is focused on older people, it acknowledges that poor health among older Americans is often the result of poor preventative measures among younger ones. And Mississippi trails most states in those areas too, such as access to water that’s been treated with fluoride. In Mississippi 60 percent of the population has access to drinking water with fluoride, an element that prevents tooth decay and was added to public water systems after World War II. Nationally, that average is 72 percent.

Mississippi’s struggle with the oral health of its residents is not new. A February report from the personal finance website Wallethub ranked Mississippi last in the dental health of all of its residents.

During that same month, the Mississippi Dental Association lobbied hard for the Division of Medicaid to increase its reimbursement rate for dental services, arguing that the low reimbursements mean few dentists are willing to take Medicaid patients, further reducing their access to care. According to the Centers for Disease Control and Prevention, in 2015 Mississippi had fewer dentists per capita than any other state, with just 43 for every 100,000 people. The national average is 61.

The A State of Decay report, which has been published since 2003, aims to provide a road map for states to improve their dental care. And in some instances it appears to have worked. Last year, the report ranked Alabama last. This year, Alabama jumped more than 20 places to number 29 on the list, due in large part to the creation and implementation of a new State Oral Health Plan. That plan, which includes partnerships with nearly two dozen stakeholders across the state, lays out a system for increasing education on and access to oral health.

“The impetus for us to take action was the previous A State of Decay report,” said Dr. Conan Davis, Alabama’s former state dental director. “We were all alarmed.”