Oral Health: It’s time to put the mouth back in the body

By Tara Mancini

Yes, it is time to put the mouth back in the body.  This paraphrases comments of Dr. Greg Nycz, a panelist at Kaiser Family Foundation’s screening earlier this summer of the PBS FRONTLINE documentary “Dollars and Dentists.” The film takes a hard look at the nation’s flawed dental care system, highlighting the consequences of treating oral health as separate from the rest of our well-being: millions of children and adults who lack access to dental care. Child advocates know well that painful tooth decay and dental diseases can often be severe enough to diminish one’s quality of life.

The high cost of dental insurance and out-of-pocket health costs contribute to low dental coverage, which is disproportionately experienced by those in poverty. While a high percentage of children living at or under the poverty level are covered by Medicaid, many dentists do not take Medicaid beneficiaries.  In Florida, a state with one of the lowest Medicaid reimbursement rates for dentists, only 10% of dentists accept Medicaid.  As a result, the documentary notes, only 25% of children who are on Medicaid in Florida have had a visit to the dentist. Nationally, the median is 33%, and the percentage of children with any dental care visits does not exceed 50% in any state, according to an analysis of 2007 Medicaid dental claims that recently appeared in the journal Pediatrics.

What can be done to stop the pervasive lack of preventative and routine oral health care?  After the screening, a panel of experts discussed solutions.  One opportunity, highlighted in the video, is using dental therapists to fill gaps in dental care.  Dental therapists are required to have much of the same level of training as dentists to perform simple dental procedures.

So far, two states have begun to experiment with this model: Alaska in 2005 and Minnesota in 2011.  Ten other states are working to create similar programs.  Seeing the need to expand access to oral health has sparked interest in dental therapist training—a recent study from the University of Connecticut hints that adding this new tier of dental professionals to Federally Qualified Health Centers could drastically increase the availability of dental care for children.

To aid these and other efforts, the ACA builds on investments in HHS’ Oral Health Initiative 2010 by moving funds to critical community access points for oral health care.  These include community health centers; the National Health Services Corps, which places health care providers—including several thousand dentists and dental hygienists—in high-need areas; and school-based health clinics.

One clear theme that emerged from the panelist discussion was the need for engagement and collaboration across health providers, government agencies, and the larger community.  While the trend has been to address oral health separately, its connection to our overall health is increasingly recognized in the public health and medical communities. Hopefully, this documentary will raise the profile of what the Surgeon General has called a “silent epidemic” and foster even more creative solutions.