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A smile is a powerful tool. How often has your day been brightened by a smile? What would you do if you were afraid to smile because of missing or damaged teeth? Consider dating or trying to find a job without front teeth. This is an emotional and economic hindrance as well. Imagine you were in pain from an infected tooth? You would go to the dentist, right? Unfortunately, not all Iowans have that option.

Oral healthcare impacts overall wellbeing. It is my responsibility as a dentist to support my fellow community members by providing services to those who need them. As a small business owner, I am responsible to my staff and the other businesses who depend on my office to stay afloat. To balance these roles, I am forced to limit the number of Medicaid patients I can see.


It is not that I don’t want to see Medicaid patients. I would see new Medicaid patients if the reimbursement fees were not so dismal that they do not cover the basic cost of a procedure. For example, to replace a broken tooth on a denture, I have to pay an outside lab $120-$130, and I am reimbursed $51.17. This is a 2-appointment procedure, and it means I am essentially paying to provide this care and not covering my costs at all (i.e. keeping the lights on, paying my staff). This is not sustainable and forces me to limit the number of Medicaid patients I can see simply because it’s impossible for offices to absorb that loss for a high number of patients.

This issue has forced the more than 700,000 Iowans relying on Medicaid dental services to often travel long distances for care and get on “wait lists” to receive care. Iowa’s Medicaid rates have not been increased in 20 years, which has led to more and more providers discontinuing to serve Medicaid patients altogether.

I, and hundreds of Iowa dentists, provide free care through multiple programs, like the Iowa Mission of Mercy (IMOM), a two-day free dental clinic. I also donate care through Donated Dental Services, Stand Down, Smile Squad, and international dental mission trips. I believe it is a privilege to use my skills as a dentist to heal our community at no charge, and I think we all have a responsibility to give back to our communities. Unfortunately, these charity programs are not the solution to the underlying problem that is facing the low-income Iowans who need regular oral healthcare provided by a dental office, commonly referred to as a dental home. A dental home is a place to get a cleaning and regular check-up, but also to ensure that issues like cavities do not develop into something worse, resulting in infection or tooth loss.

It is time that we join our neighbors in Minnesota, Wisconsin, and South Dakota and substantially increase dental Medicaid rates so patients can get the care they need. Achieving this should make every Iowan smile!

Zach Kouri, DDS, practices in Des Moines and is the current President of the Iowa Dental Association, as well as the President-Elect of the Iowa Dental Foundation. Dr. Kouri treats Iowans in need on a daily basis, and he has served as the Clinic Chief of the Iowa Mission of Mercy for many years. IMOM will be held in Des Moines November 4-5, 2022, and over 1,000 patients are expected to receive free oral healthcare during the course of the two-day dental clinic.

Author: Zach Kouri

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