Other barriers to sufficient care
Perceptions are not the only barriers to inmates receiving oral health care treatments. There may be financial barriers in facilities that prevent inmates from seeking preventive care, which leads to them needing emergency care. Correctional facilities may require a copayment for someone to be seen by the dentist or dental hygienist. Prisoners may receive wages for working a job in the facility, but that income is often miniscule compared to the cost of dental or medical care.
According to Dawn Chiarello with the American Medical Association, services may be fee-for-service. This may be difficult for inmates who don’t have outside support to receive biannual check-ups. Prevention of tooth loss, infection, cavities, pain, or detection of other abnormalities is often not possible without a dental appointment.
A bill was passed in 2019 ending copayments in Illinois for inmates.6 This is positive progress because inmates were paid between “0.09 and 0.89 in regular facility jobs and under a ‘correctional industry’ they make from 0.30 to 2.25” according to Prison Policy.2 This meant that the services were widely unused due to cost.
Another important barrier to inmate care that should be addressed is the quality of care provided. While inmates have the choice to seek treatment, not all treatment is equal. Due to financial costs of some procedures, dentists who work in prisons often opt to extract decayed, carious, or infected teeth. This over-provided service can lead to malocclusion, difficulty eating, and increased treatment needs after release from a correctional facility.
Providing crowns or implants is often viewed as a cosmetic procedure and is denied for most patients. This leads to services not being used to their fullest potential. Inmates may not know about their need for dental services yet should be able to receive quality educational, preventive, and restorative services like anyone else. Dental hygienists should approach disparities with the intent to provide early intervention and improve the overall health of patients.
This is described in Chapter 3 of Nathe’s Dental Public Health & Research textbook regarding the delivery of care in alternative health settings. It is stated on page 40 that “providing dental hygiene to this population decreases cost by decreasing the need for restorative services.”7
These restorative services require time and money for material and labor costs in these institutions, so it’s important to reduce the need for them by implementing regular cleanings, periodontal services, images, and exams. Since cost is a barrier to oral health care access, knowing how to apply preventive treatments saves labor and money in the correctional system. Reform on correctional system policies is ongoing, but enacting these types of practices will encourage more hygienists to apply.
Discussion of how oral health care is delivered in the correctional system highlights the need for more dental hygienists. The financial and social attitudes surrounding inmate dental health care have improved greatly, but still have a long way to go to be considered adequate. The quality of care is still deficient, but progress is being made as new research and conversations happen at the legislative level regarding the impact of preventive care. Altogether, it’s possible to see how oral health care can be delivered in an alternative setting and how barriers to care can affect the use of services rendered.
link