4.6 million children in America in 2008 did not see a dentist because their parents did not have enough money to pay, and only 38% of seniors had dental coverage in 2006, says a new report by the Institute of Medicine (IoM) and National Research Council. The authors say that 'persistent and systemic' obstacles undermine people's access to oral health care.
These obstacles need to be removed, the authors insist, and suggest the following should occur: The funding and reimbursement for dental care should changeTraining for doctors, nurses and other non-dental professionals should be expanded so that signs of oral diseases may be better identifiedAdministrative, educational and regulatory practices should be revamped Chair of the committee that wrote the report, Frederick Rivara, said:
"The consequences of insufficient access to oral health care and resultant poor oral health - at both the individual and population levels - are far-reaching. As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health."
The problem is exacerbated by a combination of cultural, geographic, structural and economic factors, the report explains. For example, 33.3 million Americans live in areas where there are not enough dentists.
People who do not look after their teeth and gums properly have a greater risk of developing: Respiratory diseaseCardiovascular diseaseDiabetes Focusing more on the prevention of oral diseases combined with more emphasis on oral health care promotion would result in improved overall public health.
Although children have to receive comprehensive dental benefits if they are enrolled in CHIP (Children's Health Insurance Program) or Medicaid from state funds, this is not the case for adults.
As underserved populations rely on publicly-funded programs as their primary source of health cover, authorities should include dental cover for all Medicaid beneficiaries as well, the authors state.
The authors wrote:
"Toward that end, the committee recommended that the Centers for Medicare and Medicaid Services fund and evaluate state-based demonstration projects that cover essential oral health benefits for adult Medicaid beneficiaries. In addition, Medicaid and CHIP reimbursement rates for providers should be increased and administrative practices need to be streamlined to increase use by both dental providers and patients."
In order to improve dental health care access, state laws should be altered so that hygienists, assistants and other dental professionals can work to their full extent in a variety of situations under suitable evidence-based supervision levels.
Even though the USA has national accreditation standards for training and education of oral health professionals, regulations regarding what they can and cannot do vary widely across states.
Dentists should be allowed to supervise work being done using current conferencing technology, the writers add.
The report explains that the geographic variations in available dentists and specializations are a "long-recognized challenge". Recently graduated dental students say they are ill-equipped to treat older patients, as well as individuals with special needs.
The authors write that:
"Efforts should be made to increase recruitment and support for dental students from minority, lower-income, and rural populations, as well as to boost the number of dental faculty with expertise caring for underserved and vulnerable populations.
In addition, the Health Resources and Services Administration should dedicate Title VII funding to aid and expand opportunities for dental residencies in community-based settings. These residencies should take place in geographically underserved areas and include clinical experiences with young children, individuals with special health care needs, and older adults.
"Improving Access to Oral Health Care for Vulnerable and Underserved Populations"
Frederick Rivara (Chair), Paul C. Erwin, Caswell Evans, Jr., Theodore G. Ganiats, Shelly Gehshan, Kathy Voigt Geurink, Paul Glassman, Jane Perkins, Margaret A. Potter, Renee Samelson, Phyllis Sharps, Linda H. Southward, Maria Rosa Watson, Barbara Wolfe
Institute of Medicine of the National Academies, National Research Council of the National Academies
These obstacles need to be removed, the authors insist, and suggest the following should occur: The funding and reimbursement for dental care should changeTraining for doctors, nurses and other non-dental professionals should be expanded so that signs of oral diseases may be better identifiedAdministrative, educational and regulatory practices should be revamped Chair of the committee that wrote the report, Frederick Rivara, said:
"The consequences of insufficient access to oral health care and resultant poor oral health - at both the individual and population levels - are far-reaching. As the nation struggles to address the larger systemic issues of access to health care, we need to ensure that oral health is recognized as a basic component of overall health."
The problem is exacerbated by a combination of cultural, geographic, structural and economic factors, the report explains. For example, 33.3 million Americans live in areas where there are not enough dentists.
People who do not look after their teeth and gums properly have a greater risk of developing: Respiratory diseaseCardiovascular diseaseDiabetes Focusing more on the prevention of oral diseases combined with more emphasis on oral health care promotion would result in improved overall public health.
Although children have to receive comprehensive dental benefits if they are enrolled in CHIP (Children's Health Insurance Program) or Medicaid from state funds, this is not the case for adults.
As underserved populations rely on publicly-funded programs as their primary source of health cover, authorities should include dental cover for all Medicaid beneficiaries as well, the authors state.
The authors wrote:
"Toward that end, the committee recommended that the Centers for Medicare and Medicaid Services fund and evaluate state-based demonstration projects that cover essential oral health benefits for adult Medicaid beneficiaries. In addition, Medicaid and CHIP reimbursement rates for providers should be increased and administrative practices need to be streamlined to increase use by both dental providers and patients."
In order to improve dental health care access, state laws should be altered so that hygienists, assistants and other dental professionals can work to their full extent in a variety of situations under suitable evidence-based supervision levels.
Even though the USA has national accreditation standards for training and education of oral health professionals, regulations regarding what they can and cannot do vary widely across states.
Dentists should be allowed to supervise work being done using current conferencing technology, the writers add.
The report explains that the geographic variations in available dentists and specializations are a "long-recognized challenge". Recently graduated dental students say they are ill-equipped to treat older patients, as well as individuals with special needs.
The authors write that:
"Efforts should be made to increase recruitment and support for dental students from minority, lower-income, and rural populations, as well as to boost the number of dental faculty with expertise caring for underserved and vulnerable populations.
In addition, the Health Resources and Services Administration should dedicate Title VII funding to aid and expand opportunities for dental residencies in community-based settings. These residencies should take place in geographically underserved areas and include clinical experiences with young children, individuals with special health care needs, and older adults.
"Improving Access to Oral Health Care for Vulnerable and Underserved Populations"
Frederick Rivara (Chair), Paul C. Erwin, Caswell Evans, Jr., Theodore G. Ganiats, Shelly Gehshan, Kathy Voigt Geurink, Paul Glassman, Jane Perkins, Margaret A. Potter, Renee Samelson, Phyllis Sharps, Linda H. Southward, Maria Rosa Watson, Barbara Wolfe
Institute of Medicine of the National Academies, National Research Council of the National Academies
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