The Role of the Workforce in Access to Oral Health Care
By David Krol, MD, MPH, FAAP, Robert Wood Johnson Foundation Human Capital Portfolio Team Director and Senior Program Officer
For many Americans, a visit to the dentist is a rarity—not by choice, but because their health plans don’t cover dental care, they can’t afford it, or because there is no dentist anywhere near where they live or work. If you’re on Medicare, you know that dental isn’t covered. If you’re part of the VA system, you know that dental benefits are treated differently. If you’re an adult on Medicaid or serve adult patients who are on Medicaid, you know the chances are slim that there’s great coverage for dental care, unless you are lucky to be in a state that still covers it. Why does this happen and what can result?
A study recently released by the Pew Center on the States offers startling data on the scope of the problem and its consequences. In 2009, some 830,000 Americans visited an emergency department for a preventable dental condition. It should be obvious that the emergency department isn’t the best place to seek dental care. The same year, 56 percent of Medicaid-enrolled children got no dental care whatsoever, not even a routine exam. That’s no care even with insurance for it!
Those numbers are alarming for many reasons, but mostly because they reveal a significant public health challenge confronting the nation: Many Americans simply aren’t getting the oral care they need, at any age, including the basic preventive services and education that can detect oral disease in early stages. They are putting their health at risk, and increasing the strain on an already-overwhelmed health care system.
Over the past two months, oral health has received a lot of press. I mentioned the Pew report above. A recent New York Times article pointed out the challenges for some kids. The NBC Nightly News picked up on the story. Water fluoridation, one of the 10 great public health achievements of the 20th century, is also back in the news as New Jersey tries to improve its terrible water fluoridation rate. See stories here and here.
The challenges of access to oral health care are many and there is definitely not one solution. The July 2011 Institute of Medicine report, “Improving Access to Oral Health Care for Vulnerable and Underserved Populations,” said as much and more. One area where access to care might be improved is with the oral health workforce.
For both preventive oral health services as well as dental treatment, making sure we have enough providers, producing providers who are capable of and competent in delivering services, and developing a workforce that is used as efficiently and effectively as possible are important parts of the solution.
Of course, the Robert Wood Johnson Foundation (RWJF) has a longstanding commitment to increasing Americans’ access to health care services, including oral health care. That's why RWJF recently launched a new Oral Health Workforce initiative aimed at identifying promising and innovative workforce practices that will increase Americans’ access to preventive oral health services.
A health care workforce ready to meet the population’s needs is essential to improving oral care, and we are looking for novel, replicable models that make the best use of the health and health care workforce to provide preventive oral health services. The projects we're looking for might utilize dental or non-dental providers in any of a variety of settings:
• Dental providers in non-dental settings, including WIC, Head Start, classrooms, congregate meal sites, public health and social services centers.
• Non-dental providers in non-dental settings, including physicians, nurse practitioners, physician assistants, nurses, nutritionists, childcare and outreach workers, and others. Such programs might train care providers to prompt, assist or perform oral health prevention services.
• New types of dental professionals trained to provide preventive services, including, for example, aides, health coordinators, advanced dental hygiene practitioners, dental health therapists or other professionals.
• Dental providers focused on prevention of oral health diseases, including care models focused on preventive services in their practice.
After a review by an expert panel, up to 25 of the nominated projects will be selected for the next phase of consideration: an assessment of whether the practice is suitable for a formal evaluation of its effectiveness and methods. The eventual result, we hope and expect, will be a number of thoroughly evaluated, evidence-based innovations that can be disseminated and replicated around the nation.
We’re confident that great ideas are percolating out there, and we want to hear about them. We can—and must—take action to improve the country’s oral health so that everyone, no matter their income or where they live, has access to the kind of basic care many Americans take for granted.
If you know of a program or practice that you think might be suitable, please let us know!