Disparities in Oral Health Are Profound, Especially Among Poor Children and Children of Color; Oral Health Provisions Under ACA Critical to Expanding Care to Children
Atlanta, GA – Twelve years after issuing a landmark report that offered a framework for improving access to oral health, former Surgeon General David Satcher said that profound oral health problems still exist for large portions of the population and issued a renewed call for action to expand access to oral health care, particularly in light of the millions of children expected to gain dental benefits through the Affordable Care Act in 2014.
Speaking at a conference on unmet oral health needs, sponsored by the Morehouse School of Medicine and the Sullivan Alliance to Transform America’s Health Professions, Dr. Satcher addressed progress that has been made since his landmark report on the silent epidemic of tooth decay, but also detailed profound oral health problems that remain more than a decade later.
“We now have an opportunity (with the ACA) to improve access to dental health services,” said Satcher. “But how do we put in place a health care system that meets the needs of all? Can we, in fact, increase the supply of oral health care providers by expanding the opportunity for people to serve? What the ACA said is that people should be able to practice to the full extent of their potential.”
Oral health care in America continues to be a crisis. Tooth decay is the most common chronic disease among children, five times more prevalent than asthma. Close to 50 million people live in areas where they have difficulty reaching a dentist, and millions more can’t get care due to cost.
Satcher expressed concern about the ability of the current dental workforce to meet demands for dental care. As part of the provisions enacted under the Affordable Care Act, more than five million additional children will be entitled to dental health benefits. At issue is the fact that there are not enough providers to meet the need. Currently, just 20 percent of all practicing dentists accept Medicaid patients. In addition, the federal Health Resources Services Administration (HRSA) estimates a current shortage of approximately 10,000 dentists.
“We now have an opportunity to dramatically increase coverage,” Satcher said. “But adding dental benefits will not translate into access to care if we do not have providers in place to offer treatment.”
According to Satcher, states must pursue all avenues to expand access to dental care, including exploring the creation of new dental providers, and building a cadre of ethnically-diverse, culturally-competent dental practitioners, as well as expanding the reach of the dental team with other health care professionals.
Satcher advocated the launching of workforce pilot programs to determine how best to expand access to dental care. “I think we need more dentists and I think we need more professionals who are not dentists but who can contribute to oral health care services,” said Satcher. “The real key is whether or not systems are going to ensure that everyone is allowed to practice to the level of their potential.”
More than a dozen states are exploring creating new midlevel dental providers, also known as dental therapists, to expand access to preventive and routine dental care. Dental therapists currently practice in Alaska and Minnesota. Connecticut and Oregon are launching pilot projects and numerous other states have put forward legislation to allow dental therapists. In Alaska, dental therapists have been able to provide care to 35,000 Alaska Natives who couldn’t access it before.
“Access to oral health is not what it should be in this country,” said Dr. Louis Sullivan, chairman of the Sullivan Alliance to Transform America’s Health Professions, and former Secretary of the U.S. Department of Health and Services. “With the Affordable Care Act, millions more will have access to oral health care. We, as health professionals, must lead the effort so that we are prepared to meet the need. We need now to develop strategies to provide those services.”
Poor oral health can lead to serious health consequences later in life, including diabetes and heart problems. Oral health is critical to overall health. Satcher emphasized that oral health can dramatically affect how we speak, eat, or smile, and more health professionals should be trained in providing elements of oral health care. He also stressed that children, minorities and the poor are disproportionately affected by the oral health care crisis:
37 percent of African American children and 41 percent of Hispanic children have untreated tooth decay, compared with 25 percent of white children
American Indians and Alaska Natives have the highest rate of tooth decay of any population: five times the national average for children ages 2 to 4.
Seventy-two percent of American Indian and Alaska Native children ages 6 to 8 have untreated cavities – more than twice the rate of the general population.
More than a third of all poor youngsters ages 2 to 9 have untreated cavities, compared with 17 percent of children who are not poor.
Satcher, who was joined by Dr. Sullivan, spoke at a day-long forum: “Unmet Oral Health Needs, Underserved Populations, and New Workforce Models: An Urgent Dialogue.” The meeting was held to underscore the oral health disparities that persist and to explore solutions.