Illinois correctional facilities: More dental hygienists needed, and other barriers to care
Like many underserved populations, there’s a dire need for oral health care in the Illinois correctional system. The system has several critical factors that have led to the current lack of preventive and restorative services available to inmates. These factors are the demand for care, the supply of people who can provide these services, and the frequency services are needed.
Dental hygienists provide the same services to inmates that are available to patients outside of correctional facilities. Currently, facilities are required to have at least one dental hygienist, but more can be added depending on the needs of the facility.1 Hygienists’ role in correctional facilities is critical to the oral and systemic health of inmates. There are a limited number of dental hygienists available for correctional facilities, which is a barrier to patient care. A lack of providers increases inmate wait times for treatment, which leads to an increase in emergency situations.2
Why the hygiene shortage in prisons
Dental hygienist attitudes regarding the safety and benefits of the job must be improved to increase the number of qualified providers. Outside perceptions about the job being unsafe or unsuccessful as a full-time career can deter potential employees. There’s a big concern about inmates being violent. But there are strict rules to help with this, such as instrument counts, limited personal information exchanged between inmate and provider, and an on-site officer in case of an emergency.3
According to the Federal Bureau of Prisons, hygienists must be experienced in performing oral prophylactic care, providing oral health education services to patients, and performing advanced therapeutic procedures on patients with periodontal diseases or other existing medical or dental problems.4 These requirements are basic, but the lack of hygienists applying is largely due to the concerns surrounding safety. Supply due to social attitudes must be addressed as a barrier to the success of oral health care in the Department of Justice and their facilities.5
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.
References
1. Dental Services. U.S. Department of Justice. Federal Bureau of Prisons. 2016. https://www.bop.gov/policy/progstat/6400_003.pdf
2. Sawyer W. How much do incarcerated people earn in each state? Prison Policy Initiative. April 10, 2017. Accessed September 17, 2024. https://www.prisonpolicy.org/blog/2017/04/10/wages/
3. Dame C, McCormick A. Dental hygiene care for inmates. RDH. August 22, 2014. Accessed September 17, 2024. https://www.rdhmag.com/career-profession/article/16404335/dental-hygiene-care-for-inmates
4. Dental Hygienist. Federal Bureau of Prisons. https://www.bop.gov/jobs/positions/index.jsp?p=Dental%20Hygienist
5. Dental Care of Jail Inmates. U.S. Department of Justice. https://www.ojp.gov/ncjrs/virtual-library/abstracts/dental-care-jail-inmates
6. Illinois compiled statutes. Illinois General Assembly. https://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=022500250K18
7. Nathe CN. Dental Public Health & Research: Contemporary Practice for the Dental Hygienist. 4th ed. Pearson; 2017.
