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Oral Health Care Needed For Underserved Populations

July 14, 2011

New analysis from the Institute of Medicine (IOM) finds that fewer than half of all Americans see a dentist each year and millions live in areas where access to dental care is limited at best.

A severe shortage of dentists, especially in rural areas and minority settings, is contributing to the “persistent and systemic” barriers to oral health care, IOM’s report notes.

Various factors create barriers, preventing access for vulnerable and underserved populations, such as children and those on welfare and disability. The Health Resources and Services Administration and the California Healthcare Foundation has asked IOM and the National Research Council to assess the oral health care system, develop a vision for ways to improve oral health care and to recommend ways to achieve this vision.

About 33 million people live in areas where there are shortages of dental care professionals, and in 2008, 4.6 million children went without dental care because it was too costly, the report found.

“The consequences of insufficient access to oral health care and resultant poor oral health — at both the individual and population levels — are far-reaching,” Frederick Rivara, chair of the IOC committee that wrote the report and the chair of pediatrics at the University of Washington School of Medicine in Seattle, told Huffington Post in a statement.

“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,” he said.

Health risks from lack of good dental care reach further than just cavities and gum disease. Bad oral health care increases the risk of heart disease, diabetes and respiratory disease, according to the report.

The IOM committee concluded that nearly 9,600 additional dentists are needed to meet the oral healthcare needs of all Americans.

“We have the lowest ratio of dentists to population that we have had in 100 years,” said Shelly Gehshan, who directs the Pew Children’s Dental Campaign and serves on the IOM committee. “This is a serious problem that leaves 40 to 50 million people out of reach of a dentist at any given moment.”

Gehshan told WebMD that millions of Americans lack dental coverage or the ability to pay for necessary dental care.

Committee chairman Frederick P. Rivara, MD, a professor of pediatrics at the University of Washington School of Medicine in Seattle, added that barriers to dental services disproportionately affect children, the elderly, and minorities.

“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,” he said in a news release.

IOM’s report included recommendations to federal and state policy makers to improve the nation’s dental care structure. The report calls for state changes to the way dental hygienists, assistants and professional practice and train in order to give the best access to dental care in their communities.

For example, increasing recruitment of dental students from low-income, minority or rural communities could help increase the number of people serving in those places, Kaiser Health News reported.

Expanding dental coverage to adults under Medicaid (only kids are currently covered by Medicaid for dental) could also increase the number of people who get regular checkups, the report said. States must provide dental benefits for children enrolled in the Children’s Health Insurance Program (CHIP), but are not required to provide benefits to adults.

Gehshan said while the committee members agreed that dental benefits should be available to all Medicaid recipients, the group recognized that this is not likely to happen in today’s struggling economy.

“A growing number of dental professionals will not take people on [Medicaid] because reimbursements are just too low,” Rivara said.

To further address the shortage of dentists in undeserved inner city and rural settings, the report calls for dental professional education programs aimed at increasing enrollment of African-Americans, Latinos, and people from rural areas into dental schools.

“Most dentists are white men,” Gehshan told WebMD. “Research shows that dental students from rural or underserved areas are more likely to go back to these areas to practice.”

Gehshan said innovative ways of delivering dental services will be needed to address the shortage of dentists.

The IOM report called for more research into new approaches to care, including use of mobile vans staffed by dental hygienists or practitioners who have had years of dental training. Known as dental therapists, these practitioners, who are not actual dentist professionals, are the oral health equivalent of nurse practitioners.

Currently only two states — Alaska and Minnesota — license dental therapists. Gehshan said that at least 50 other countries also license dental therapists.

The American Dental Association (ADA) strongly discourages surgery performed by non-dentists.

ADA President Raymond F. Gist, DDS, said in a statement that he praises the IOM report for highlighting the dental care access issue. He noted that the ADA continues to support exploring new ways to expand dental healthcare.

“We must, however, restate our opposition to allowing so-called “Ëœmidlevel providers’ to diagnose disease or perform such surgical, irreversible procedures as extractions. Everyone deserves a dentist,” he added.

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