Mississippi has a 55 percent loss rate for adults aged 65 and older. Only 52 percent have seen a dentist within the past 12 months. This is the lowest percentage in the nation. This and low scores on preventative measures earned Mississippi zero in A State of Decay’s overall oral health score. Minnesota is at the top of the state rankings, with a score 100. The report is focused on oral health but also discusses how environmental factors such as income and education can contribute to poor health. The data showed a linear, consistent association between household income and oral health. A low household income correlates with poor oral health. According to the Center for American Progress, Mississippi’s 2017 poverty rate was 20.8 percent. This is the highest level in the country. Poor oral health can have a negative impact on income and the economy. Poor oral health can lead to a variety of serious illnesses such as stroke, heart disease, cancer, and gum disease. This makes it harder for people to remain employed. Preterm babies born to women who have not received dental care in pregnancy are more likely than those who do. This increases the likelihood of them having long-lasting health problems. Mississippi has one of the highest preterm birth rates in the country. According to a 2015 study published in the Journal of the American Dental Association, people with missing or damaged teeth are less likely to get employed. If Medicaid requires some beneficiaries to work in order to keep their coverage, this could be a problem. Mississippi requested a waiver from the federal Centers for Medicare & Medicaid Services in January. This would have required certain Medicaid beneficiaries to work in order to maintain their coverage. But State of Decay also ranked states according to the number of dental procedures Medicaid would reimburse, and Mississippi came in close to last here, too, with only two services–tooth extractions and oral examinations–covered by the state’s Medicaid plan. Despite the fact that the report is primarily focused on older Americans, it recognizes that poor preventative measures by younger Americans often lead to poor health. Mississippi is behind most other states in these areas, including access to fluoride-treated water. Mississippi’s 60 percent population has access water that contains fluoride. This is an element that prevents tooth decay. It was added to the public water system after World War II. This average national figure is 72 percent. Mississippi’s struggles with oral health is not new. According to Wallethub’s February report, Mississippi was ranked last among all states in terms of dental health. The Mississippi Dental Association also lobbied for the Division of Medicaid’s increase in its reimbursement rate for dental services. They argued that low reimbursements meant that fewer dentists would accept Medicaid patients and further reduce their access to care. The Centers for Disease Control and Prevention reported that Mississippi had 43 dentists per 100,000 residents in 2015. The national average is 61. Since 2003, the A State of Decay Report has been published. It aims to give states a roadmap to improve their dental care. It has worked in some cases. The report ranked Alabama last year. The creation and implementation a new State Oral Health Plan helped Alabama jump more than 20 spots to number 29. The plan includes partnerships with almost two dozen stakeholders from across the state and outlines a system to increase education about and access to oral care. Dr. Conan Davis, Alabama’s former state dentist director, stated that the report A State of Decay was what prompted them to act. “We were all alarmed.”