Last Updated: August 2023

Author: Office of Oral Health, Vermont Department of Health

Tracking the percentage of adults with household income less than $75,000 who visited a dentist in the last year will help us to understand if our efforts to reduce barriers to dental care for low- and middle-income Vermonters are working. Adults with more education and higher incomes are more likely to have accessed care in the previous twelve months than those with less income and less education. Adults with higher education and higher income levels are also more likely to hold dental insurance that sufficiently covers preventive and restorative dental care. We need to close the gap on these oral health disparities to achieve health equity. 

Due to infection control concerns, practices were limited to providing emergency dental care for about two months during the COVID-19 pandemic. Practices also saw increases in the amount of PPE required to treat patients, increasing the cost of providing care. Lastly, infection control concerns contributed to early retirements and dental care providers leaving the profession. These issues have led to a “perfect storm” of long wait times for appointments, fewer practices accepting Medicaid insurance, and workforce shortages throughout the state, all of which affect access to dental care, which may help explain the decrease seen here.

Good oral health is an important part of overall health and can affect speaking, smiling, eating, and school and work performance. Although preventable, more than 1 in 4 adults nationwide have untreated tooth decay and nearly half of all adults over 30 years old shown signs of gum disease. Oral disease can lead to pain, missing teeth, and infection that often results in a lower quality of life. There are proven methods of prevention and treatment for good oral health, however many people struggle to access oral health care. 

Many Vermonters face obstacles that make it difficult for them to commit the necessary time and resources to seeing their provider on a regular basis. Transportation and getting time off work can get in the way of making and keeping dental appointments. Lack of understanding about the importance of oral health or fear of visiting the dentist may lead to oral health care being a low priority. Access to care is another barrier to good oral health. Vermonters may have trouble accessing care because they lack the financial means, do not have dental insurance or they may live in a dental professional shortage area. Reducing barriers to accessing preventative oral health care is an important part of addressing oral health disparities. 

Partners include but are not limited to:

• Vermont State Dental Society 
• Vermont Dental Hygiene Association
• Vermont Department of Health Access
• Bi-State Primary Care Association

The US. Department of Health and Human Services Oral Health Strategic Framework, 2014-2017 outlines a number of strategies that can be employed to reduce barriers to care and improve oral health in lower income adults. 

• Providing quality dental care in nontraditional settings (such as medical offices or community centers) and using teledentistry allows for timely access to oral health prevention, education and dental health care and can help address barriers such as transportation and getting time off from work for dental appointments.
• Integration of oral health screening, assessment, and preventative measures into primary care strengthens the primary care system and makes oral health care more accessible to all Vermonters. 
• Co-location of dental services (hygienist, expanded function dental assistant) in patient centered medical homes and/or inclusion of dental professionals on the medical care team. 
• Support the expansion of Federally Qualified Health Centers that include oral health services, especially in underserved and rural areas.
• Cultural competency training for dental professionals to improve knowledge, understanding and skills for treating patients from diverse backgrounds. 

This dental visit question is asked every other year. 

Vermont tracks risk behaviors using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention. Several thousand Vermonters are randomly and anonymously selected and called annually. An adult (18 or older) in the household is asked a uniform set of questions. The results are weighted to represent the adult population of the state. The results are used to plan, support, and evaluate health promotion and disease prevention programs. 

Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior. 

This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont were age adjusted. For more detailed information on age adjustment, visit cdc.gov/nchs/data/statnt/statnt20.pdf. 

The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Currently, ICF Macro with an office in Burlington, Vermont, is the interviewing contractor for the Vermont BRFSS.

Beginning in 2009, Vermont started interviewing adult residents on cellular telephones as well as landline telephones. This change ensures the survey is conducted among a representative sample of Vermont adults and was made due to changing telephone patterns with more households using primarily cellular telephones.

1. US Department of Health and Human Services Oral Health Strategic Framework, 2014-2017
2. Qualis White Paper: Oral Health: An Essential Component of Primary Care
3. Rural Health Information Hub (RHIH): Oral Health-Primary Care Integration Model
4. County Health Rankings: Evidence for Cultural Competence Training for Health Care professionals