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More Americans Visiting Emergency Departments for Dental Care

May 22, 2013, 9:00 AM

A new research brief from the American Dental Association’s Health Policy Resources Center finds that an increasing number of Americans visited emergency departments (ED) for dental-related care between 2000 and 2010, as a percentage of total dental visits. ED visits for dental care increased from 1.1 million in 2000 to 2.1 million in 2010.

The increase was primarily among young adults (age 21 to 34), which the researchers hypothesize is due to a decline in dental benefits among this age group. Young adults were more likely than others to report that they could not afford dental care in the past 12 months, the brief says, and recent studies have shown that there has been a shift in the pattern of dental benefits.

“Unfortunately, the Affordable Care Act (ACA) did little to address the issue of dental utilization in emergency departments,” the brief says. The law does not mandate dental benefits for adults, and insurance plans sold through most states’ exchanges are unlikely to include dental benefits. However, pilot programs in some states have shown promise for diverting patients with dental complaints from EDs and increasing their access to dental care.

“In the coming years, advocates for oral health will have to consider other innovative ways to increase access to dental care in order to decrease dental care utilization in hospital emergency departments,” the brief concludes. “Without further interventions from policy makers, dental ED visits are likely to increase in the future, straining our health care system and increasing overall health care costs. Now more than ever, innovative solutions are needed to improve access and oral health.”

Read the brief on patients visiting emergency departments for dental care.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Oral Health: Putting Teeth Into the Health Care System

Aug 22, 2012, 9:00 AM

Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.

The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”

In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”

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Making Oral Health Care Accessible

Apr 10, 2012, 1:05 PM

Former Health & Human Services Secretary Louis Sullivan, MD, penned an op-ed in yesterday’s New York Times making the case for devising more effective ways to deliver dental care to poor or rural communities across the nation.

The Secretary notes that, in 2009, 83,000 emergency room visits resulted from preventable dental problems. “In my state of Georgia,” he writes, “visits to the ER for oral health problems cost more than $23 million in 2007. According to more recent data from Florida, the bill exceeded $88 million. And dental disease is the No. 1 chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.”

He goes on to list several reasons: 50 million of us live in poor or rural areas without a dentist; most dentists do not accept Medicaid; and we have a dentist shortage that will only be exacerbated when 5.3 million children are added to Medicaid and the Children’s Health Insurance Program by way of the Affordable Care Act.

Sullivan argues that the federal government should put programs in place to train more dentists. But more than that, he argues for training dental therapists “who can provide preventive care and routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist’s office.” He says such an approach has been particularly effective in Alaska, where the state has recruited and trained dental therapists to serve many of that state’s most remote communities, including many that are accessible only by plane, dogsled or snowmobile.

A recently announced effort by the Robert Wood Johnson Foundation (RWJF) takes aim at the very same problem. The Oral Health Workforce initiative is designed to improve access to oral health care by identifying and studying replicable models that make the best use of the health and health care workforce to provide preventive oral health services.

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The Role of the Workforce in Access to Oral Health Care

Mar 30, 2012, 1:00 PM, Posted by David Krol

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.

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How Central Massachusetts Increased Access to Oral Health Care for Low-Income Children

Feb 21, 2012, 1:00 PM, Posted by John Gusha

February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.

Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?

John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.

HCB: Tell us about the school-based programs you put in place.

Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.

We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.

HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.

Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.

The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.

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Fifth in a Series: Advancing a Vision of Access to Quality Oral Health Care for Everyone

Aug 15, 2011, 12:00 PM, Posted by David Krol

By David Krol, M.D., M.P.H., F.A.A.P.

 

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“Everyone has access to quality oral health care across the life cycle.”

That was the vision formed by a varied group of individuals from dentistry, dental hygiene, medicine, public health, nursing, economics, law, social work and philanthropy as they wrote the second of the Institute of Medicine’s reports on oral health, “Improving Access to Oral Health Care for Vulnerable and Underserved Populations.” I had the privilege of being a member of that committee. Our report was released on July 13th, 2011.

Our task was an expansive one. We were asked to:

  • Assess the current U.S. oral health system of care;
  • Explore its strengths, weaknesses and future challenges for the delivery of oral health care to vulnerable and underserved populations;
  • Describe a desired vision for how oral health care for these populations should be addressed by public and private providers (including innovative programs) with a focus on safety net programs serving populations across the lifecycle and Maternal and Child Health Bureau programs serving vulnerable women and children; and
  • Recommend strategies to achieve that vision.

Piece of cake right?!

Well, as you might guess, we found numerous, persistent and systemic barriers and challenges that vulnerable and underserved populations face in accessing oral health care. Those barriers include social, cultural, economic, structural, and geographic factors. We also recognized that these barriers contribute to profound and enduring oral health disparities in the United States. Americans who are poor, minority, or have special health care needs suffer disproportionately from dental disease and receive less care than the general population. It’s a sobering reality in that many of us take oral health care for granted or don’t even think about it at all until we are forced to.

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Fourth in a Series: A Call to Action on Oral Health Care, Bringing Dentistry to Children Who Need It

Aug 8, 2011, 12:00 PM, Posted by Kris Volcheck

On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Kris Volcheck, D.D.S., M.B.A., a 2010 Robert Wood Johnson Foundation Community Health Leader, discusses community-specific solutions to oral health care disparities. Volcheck is director of the CASS Dental Clinic for the homeless and the Murphy Kids Dental Clinic in Phoenix, Arizona.

Kris Volcheck, D.D.S., M.B.A. Kris Volcheck, D.D.S., M.B.A.

Just down the street from the CASS Dental Clinic for the Homeless in Phoenix are four elementary schools, in the very impoverished Murphy school district. Although this is the urban core, it might as well be rural America. The families in these neighborhoods live on minimal incomes and don’t have transportation, making everything a long distance hike – grocery stores with fresh produce, medical centers and, not surprisingly, dentists. When basic health care is secondary to just surviving, oral health care falls by the wayside.

Last year we decided to open a dental clinic for impoverished children, as an extension of the homeless clinic we’ve had in place for more than 10 years, and in collaboration with a community funded health center already in the works. But the tough economic times meant the Murphy elementary schools we had planned to serve were unable to pay for transportation and chaperones to bring students to our clinic. And because the schools’ funding is closely tied to student performance, they were hesitant to disrupt the school day to bring children to our site.

So we refocused, and decided to bring the dental clinic straight to the children.

We now operate a portable, school-based dental clinic in the elementary schools twice a year. The Murphy Kids Dental Clinic brings oral health professionals, supplies and technology into the elementary schools to provide comprehensive dental care to children who would otherwise go without it.

The care available to underserved and vulnerable populations –in rural settings and in the middle of a city alike – lags behind those available in middle- and high-income communities. There’s a high density of dentists in high-dollar areas, but we’re scarce in the urban core.

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A Q/A with RWJF's Denise Davis: Diversity and Oral Health

May 19, 2011, 12:00 PM, Posted by Denise Davis

Denise Davis, Dr.P.H., is an RWJF program officer, and the guiding force behind RWJF’s Pipeline, Profession & Practice: Community Based Dental Education program (the Dental Pipeline program). The program ran from 2001 to 2010, working to increase diversity in the dental profession and to increase access to oral health care among underserved populations. Davis gave the following interview to the Human Capital Blog on May 16, 2011, as part of our RWJF Leaders series of blog posts.

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Human Capital Blog: Now that RWJF’s Dental Pipeline program has been completed, how would you assess its impact?

Denise Davis: One focus of the program was to expand the pipeline of diverse applicants to dental schools. Among the most important things we did was to look carefully at admissions committee processes. We hoped to discover how we could retool and retrain admissions committees. And, in fact, we’re still funding the work of the American Dental Education Association in that area, even after the Dental Pipeline program has ended. In any event, we succeeded in this first goal of extending access to a more diverse group of applicants. Quite simply, the number of minority students went up.

The other thing we focused on was expanding the clinical rotations of dental students. Dental schools have their own clinics, and they typically require students in their junior and senior years to practice what they’ve learned there. But they rarely extend those rotations to community clinics. So we required schools participating in the program to create contractual relationships with community clinics, and extend the time that students were engaged in these rotations.

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