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

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

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



“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.

The process we followed was a strict, evidence based, well-informed one that included five committee meetings, one public workshop with 19 speakers, three commissioned papers, 15 external reviewers and many, many internal reviews, conversations, rewrites and emails.

Throughout the process we followed two guiding principles – two givens that kept us on the path to completion of our task:

  • Oral health is an integral part of overall health and, therefore, oral health care is an essential component of comprehensive health care.
  • Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care.

By keeping a sharp focus on those guiding principles, we came to four overall conclusions.

  1. Improving access to oral health care is a critical and necessary first step to improving oral health outcomes and reducing disparities.
  2. The continued separation of oral health care from overall health care contributes to limited access to oral health care for many Americans.
  3. Sources of financing for oral health care for vulnerable and underserved populations are limited and tenuous.
  4. Improving access to oral health care will necessarily require multiple solutions that use an array of providers in a variety of settings.

We focused our recommendations in six areas to provide a roadmap for creating an integrated delivery system that provides quality oral health care to vulnerable and underserved people where they live, work and learn through changes to education, financing and regulation of oral health services.

  1. Integrating oral health care into overall health care
  2. Creating optimal laws and regulations
  3. Improving dental education and training
  4. Reducing financial and administrative barriers
  5. Promoting research
  6. Expanding capacity

My IOM experience was a great one and I hope that if our recommendations are acted upon in a coordinated and comprehensive manner, we’ll achieve our vision of access for everyone to quality oral health care across the life cycle.

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