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

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

“The consequences of insufficient access to oral health care andresultant poor oral health—at both the individual and populationlevels—are far-reaching,” said Frederick Rivara (pictured), Seattle Children’sGuild Endowed Chair in Pediatrics at the University of Washington Schoolof Medicine, Seattle, and chair of the report committee. “As the nationstruggles to address the larger systemic issues of access to healthcare, we need to ensure that oral health is recognized as a basiccomponent of overall health.”

According to the report, economic, structural, and cultural factorscontribute to this problem. For example, approximately 33.3 millionpeople live in areas with shortages of dental health professionals. In2008, 4.6 million children did not obtain needed dental care becausetheir families could not afford it. And in 2006, only 38% of retireeshad dental coverage, which is not covered by Medicare.

Among the consequences of the lack of regular oral health care is anincreased risk of respiratory disease, cardiovascular disease, anddiabetes, as well as inappropriate use of hospital emergency departmentsfor preventable dental diseases, says the report. The report lays out avision of oral health care in which prevention of oral diseases andpromotion of oral health are a priority and a facet of overall health.

Although all states must provide comprehensive dental benefits forchildren 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 healthcoverage for underserved populations, including dental benefits for allMedicaid beneficiaries is a critical and necessary goal, the reportsays. The committee who wrote the report recommends that the Centersfor Medicare and Medicaid Services fund and evaluate state-baseddemonstration projects that cover essential oral health benefits foradult Medicaid beneficiaries. In addition, the committee recommendedthat Medicaid and CHIP reimbursement rates for providers be increasedand administrative practices be streamlined.

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

The report also encourages efforts to increase recruitment andsupport for dental students from minority, lower-income, and ruralpopulations.

Source: The National Academies