A new report by the Institute of Medicine (IOM) and National Research Council has found that millions of Americans are not receiving needed dental care services because of “persistent and systemic” barriers that limit their access to oral health care.

To remove these barriers—which disproportionately affect children, seniors, minorities, and other vulnerable populations—the report recommends changing funding and reimbursement for dental care; expanding the oral health work force by training doctors, nurses, and other nondental professionals to recognize risk for oral diseases; and revamping regulatory, educational, and administrative practices.

“The consequences of insufficient access to oral health care and resultant poor oral health—at both the individual and population levels—are far-reaching,” said Frederick Rivara, Seattle Children’s Guild Endowed Chair in Pediatrics at the University of Washington School of Medicine, Seattle, and chair of the report committee. “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.”

According to the report, economic, structural, and cultural factors contribute to this problem. For example, approximately 33.3 million people live in areas with shortages of dental health professionals. In 2008, 4.6 million children did not obtain needed dental care because their families could not afford it. And in 2006, only 38% of retirees had dental coverage, which is not covered by Medicare.

Among the consequences of the lack of regular oral health care is an increased risk of respiratory disease, cardiovascular disease, and diabetes, as well as inappropriate use of hospital emergency departments for preventable dental diseases, says the report. The report lays out a vision of oral health care in which prevention of oral diseases and promotion of oral health are a priority and a facet of overall health.

Although all states must provide comprehensive dental benefits for children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), they are not required to provide such benefits for adults. Because publicly funded programs are the primary source of health coverage for underserved populations, including dental benefits for all Medicaid beneficiaries is a critical and necessary goal, the report says. The committee that wrote the report recommends 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, the committee recommended that Medicaid and CHIP reimbursement rates for providers be increased and administrative practices be streamlined.

To maximize access to dental care, the committee further recommended that state legislatures should amend existing laws so that hygienists, assistants, and other dental professionals can practice to the full extent of their training and can work in a variety of settings under appropriate evidence-based levels of supervision. The committee also recommended that legislation should also allow dental professionals to collaborate and supervise remotely via conferencing technology.

The report also encourages efforts to increase recruitment and support for dental students from minority, lower-income, and rural populations.

Source: The National Academies