The University of Iowa

Oral Health a Critical Component of Physical Health & Well-Being

Thursday, January 10, 2019

For far too long, there have been very few places the most vulnerable members of our community could go for dental care.  Often left to decide between putting food on the table and fixing a toothache, the tooth went untreated.  The creation of Eastern Iowa Dental Center (EIDC), a new component of a Federally Qualified Health Center in Cedar Rapids, hoped to change this reality. 

Missy* was one of those people.  At 67 years of age, she was living on a fixed income and had fought a battle with cancer—and won.  Unfortunately, the chemotherapy and radiation took a large toll on her body and teeth.  With limited income and no dental insurance, it had been years since she had visited a dentist.  EIDC’s Dental Team was able to help Missy sign up for a voucher to cover the cost of her care.  She began to cry tears of joy when she knew she would finally get the dental treatment she so desperately needed.

Another patient, Brian*, came to EIDC with visible decay on his two front teeth.  Before we opened our doors, he didn’t have resources to pay a dental provider. EIDC was able to fix his teeth, much to Brian’s delight. He said, “I can smile again. I haven’t been able to do that for over a year!”

Missy and Brian are just two of thousands of people that EIDC has been able to care for in its first 18 months of operation.

Proper oral health is a critical component of overall health, well-being and quality of life. In the United States, significant disparities in access to dental care exist among low-income and undereducated individuals and families.  According to the Kaiser Family Foundation, adults living at or below 100% of the Federal Poverty Level (FPL) are three times as likely to have untreated tooth decay than adults above 400% FPL[1].  Additionally, in spite of the prevalence of dental insurance coverage for children, approximately one-third of low-income children in the United States suffer from untreated oral decay and disease, with more extreme decay than higher income children[2].

Iowa dental statistics mirror national trends; thousands of individuals and children in Iowa suffer from untreated oral disease and tooth decay.  A disproportionate number of these people are at-risk and living on extremely limited means.  For example, according to a report published by Linn County Iowa Department of Public Health, 14.8% of adults in East Central Iowa experienced poor oral health in 2012 and 45% of low-income adults did not have dental service in the previous year[3].

In 2014, less than half of children ages 1-20 enrolled in a Medicaid program received preventive dental services; only 51% of children ages 1-20 received any dental services, including urgent services to treat tooth decay and pain[4].  Therefore, on March 6, 2017 the EIDC opened its doors, to complement the services provided by Eastern Iowa Health Center (EIHC).  EIHC is a Federally Qualified Health Center that provides Family Practice, Pediatric, OB-GYN and Behavioral Health services—with a focus on unserved and underserved, low-income individuals and families.

By opening EIDC adjacent to EIHC in Cedar Rapids, Iowa, the dental center expanded the oral health safety net and increased access to care among lower-income populations in East Central Iowa.  Current patients at EIHC gained immediate access to oral health education and preventive and urgent dental care services.  Additionally, EIDC serves patients struggling with homelessness and populations who have had little to no access to dental care in the past.

Most dentists in Iowa have stopped taking Medicaid patients or have stopped offering services because the reimbursement is so low—yet the need is so high.  That means people have less access to care.  EIDC also sees people who have been unable to secure a job because bad dental health and rotten teeth can translate into poor employment prospects.  It doesn’t have to be this way, and EIDC is part of the solution.

A USA Today article from August 9, 2015, states, “. . . for many, tooth loss is a symptom of poverty.  Nationally, more than a third of working-age adults have no dental insurance, and rates are higher in rural and impoverished areas. The Affordable Care Act doesn't require health plans to cover dental services for adults.

Patients with the least access to dental care are also the ones most vulnerable to tooth decay and gum disease. Problems begin early in life. Terry Dickinson, executive director of the Virginia Dental Association and founder of its Mission of Mercy program, recalled the youngest patient to have all his teeth extracted . . . was a 19-year-old man. Dickinson said, ‘If somebody doesn't have teeth, they're not going to work in the service industry, where they have to deal with the public all day.’”

EIHC and EIDC live by a simple mission:  Provide a medical home to individuals and families in our service area regardless of ability to pay.  We believe every person deserves access to quality healthcare and are proud to count our medical – and now dental – teams among the best Cedar Rapids has to offer.

Our staff strive to meet each of our patients where they are and where their needs are: offering outreach to the homeless, language interpretation services, social work, care coordination and health coaching all within the walls of our health center locations.  Through our status as a FQHC, we can extend lower costs to our patients and help to connect them to additional resources in the community.  All of this means that our patients receive the care they need when they need it.  Additionally, our patients do not have to wait for months on end while they struggle to save enough money to cover the cost of their care, and emergency appointments are built into our dental providers’ schedules every business day.

The goal of Eastern Iowa Dental Center is to establish good dental hygiene practices from an early age and reduce the prevalence of untreated tooth decay and periodontal disease in the low-income and underserved populations living in East Central Iowa.  This is true throughout the state, as well, as there are 13 FQHCs with 22 dental clinics and four mobile clinics.  In 2017, Iowa FQHCs served 70,733 unique patients in 155,546 visits.  These dental centers provide services to individuals and families with all types of insurance—including serving those with no insurance on a sliding fee scale—as well as those with Medicaid.  There are only a small number of dental practices other than FQHC dental clinics that will serve patients that have Medicaid due to the minimal reimbursement that doesn’t cover costs, let alone allow for profit. 

FQHCs in Iowa receive an enhanced, cost-based reimbursement rate and are good stewards of taxpayers’ dollars.  Overall, FQHCs in Iowa Health centers are efficient and cost-effective Medicaid providers, serving 13.6% of all Medicaid beneficiaries in Iowa, but representing only 1.21% of the state of Iowa’s total Medicaid expenditures.  Further,

  • 46% of Iowa FQHC patients are covered by Medicaid
  • Health centers serve 17% of the Medicaid population in Iowa
  • 17% of patients are best served in a language other than English
  • 24% of health center patients are uninsured
  • 88% of health center patients are at 200% or below the Federal Poverty Level


The statistics at each Iowa dental center vary, and EIDC Medicaid numbers are much higher than average.  In 2017, 69% of our patients utilized Medicaid for their insurance, and 78% are below 100% of the Federal Poverty Level.  For those patients that are the working poor and are underinsured with large deductibles, private fundraising is done to supplement their copays.  Volunteer dentists, hygienists and assistants are also utilized to assist with the tremendous volume of patients seeking care.

While the overall number of patients served may seem adequate, the reality is quite the opposite.  Since the opening of EIDC 18 months ago, and subsequently expanding our capacity by 25% and adding a third full-time dentist and part-time oral surgeon, EIDC sees approximately 900 patients each month.  With this noted, demand significantly exceeds capacity.

According to the Mayo Clinic[5], poor oral health can contribute to wide-ranging health maladies, including:

  • Pregnancy and birth; periodontitis has been linked to premature birth and low birth weight
  • Cardiovascular disease; some research suggests that heart disease, clogged arteries and strokes might be linked to the inflammation and infections that oral bacteria can cause
  • Endocarditis, an infection of the inner lining of the heart
  • Diabetes, which reduces the body's resistance to infection—putting the gums at risk
  • HIV/AIDS; oral problems often occur, such as painful mucosal lesions
  • Osteoporosis, which causes bones to become weak and brittle may be linked with periodontal bone loss and tooth loss
  • Alzheimer's disease; worsening oral health is seen as the disease progresses

FQHC dental clinics provide urgent and preventive services and emphasize the importance of oral health and education from an early age.  Services include screenings, fluoride varnishes, sealants, cavities prevention and repair, diagnostic x-rays, crowns and non-surgical endodontics.  Additionally, it is recognized that oral health services are an integral part of a medical home.  A study conducted by the University of Iowa Public Policy Center outlines the need to define a patient-centered dental home in the era of the Affordable Care Act; the article highlights the importance of integrating patient-centered medical and dental homes and expanding entry points in to the dental system[6]. For example, EIHC is a Level 3 Patient-Centered Medical Home and fully integrates the oral health services of EIDC within the medical home.  Health care providers, nurses and social workers work diligently to identify patients needing to establish dental care and will conduct “warm-handoffs” daily between EIHC and EIDC. The location of the dental center is important, as EIDC is physically next door to EIHC, creating a healthcare campus.

When an exam table is placed in a medical exam room with four walls, about $4,000 is needed to outfit it to be ready to see a patient.  Alternatively, in dentistry, when a dental chair, light, x-ray (now called digital radiography) and a bevy of other mechanical and hand-manipulated equipment is put into an operatory (DDS = Doctor of Dental Surgery) the cost is approximately $45,000.  Cedar Rapids, and much of the rest of the state, needs more access for low-income patients and it takes capital to make that happen. 

EIDC is unique that it was created without federal funds to meet the oral health needs in eastern Iowa. A public-private partnership for this nonprofit entity was created, engaging six for-profit companies, four corporate philanthropic organizations, three private foundations, as well as a considerable number of individual donations of monetary contributions and in-kind equipment.  A supportive and well-informed nonprofit board of directors that oversee fiduciary responsibility was also critical.  Without federal support, a similar effort will need to be undertaken to meet the demand that currently exists throughout the state. 

Nonprofit dental clinics fill a huge void in the health care system and are a critical component of the safety net in Iowa.  Without them, the overall public health of Iowans will be compromised.


[1] Kaiser Family Foundation, "Oral Health and Low-Income Nonelderly Adults: A Review of Coverage and Access,”, 2012.

[2] Kaiser Family Foundation, “Oral Health Coverage and Care for Low-Income Children: The Role of Medicaid and CHIP,”, 2009.

[3] Amy Lepowsky, PhD, MPH, CHES and Scott Seltrect, MPH Candidate, “The Oral Health of East Central Iowa,” Linn County Public Health,, 2015.

[4] Ibid.

[5] Mayo Foundation for Medical Education and Research (MFMER). 1998-2018. “Oral health: A window to your overall health”.

[6] Damiano, Peter C, Julie C Reynolds, Jill Boylston Herndon, Susan C McKernan, and Raymond A Kuthy. 2016 “The Need for Defining A Patient-Centered Home Model in the Era of the Affordable Care Act”. Iowa City, IA: University of Iowa Public Policy Center,



Joe Lock is President & CEO of Eastern Iowa Health Center and can be reached at Eastern Iowa Health Center is a 501(c)(3) nonprofit that provides a medical home by offering patient-focused, quality comprehensive primary, OB/GYN, behavioral, pediatric and oral health care services to individuals and families in our service area, regardless of ability to pay.