More than half of elderly Mississippians grapple with severe tooth loss, a rate higher than anywhere else in the country, according to a new report on the oral health of elderly Americans.

In Mississippi, 55 percent of adults over 65 have lost six or more of their teeth, and only 52 percent had seen a dentist in the last 12 months, the lowest percentage in the country. Because of this and relatively low marks on other preventative measures, the report, A State of Decay, gave Mississippi a score of zero in the overall oral health of its elderly population. Minnesota leads the state rankings with a score of 100.

While the report focuses on oral health, it talks about how much environmental factors, such as a person’s income or education level, can drive poor health.

“(The data) showed a consistent, linear association with household income. Low household income covaries with predicted measures of poor oral health. As income levels rose, so did the probability of good oral health … (And) increased education level correlated with better oral health.”

In 2017, Mississippi had a poverty rate of 20.8 percent, the highest in the country, according to the Center for American Progress.

Conversely, poor oral health can also have an adverse affect on a person’s income and the overall economy. Gum disease and tooth decay increase a person’s risk for a number of debilitating illnesses, from cancer to heart disease and stroke, making it more difficult for a person to stay employed. Women who don’t receive dental care during pregnancy are also more likely to deliver a baby preterm, increasing the risk for lifelong health complications for that child. Mississippi’s preterm birth rate is among the highest in the nation.

People with oral health issues, such as missing teeth, are also less likely to be employed, according to a 2015 study in the journal of the American Dental Association. This could pose a problem if Medicaid requires certain beneficiaries to work to maintain their coverage.