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.”

The U.S. Centers for Medicare and Medicaid Services (CMS) has a goal to increase the number of Medicaid and Children’s Health Insurance Program participants who receive annual preventive dental services by the year 2015, as well as the number of children who receive a dental sealant on a permanent tooth—an important step in preventing tooth decay.

States are creating their own oral health care action plans, CMS Chief Dental Officer Lynn Mouden, DDS, MPH, said, analyzing their systems and identifying areas for improvement, including access to care, collaboration with dental schools, electronic health record use, and alternative oral health care providers and models.

The American Dental Association (ADA) is looking into non-traditional oral health care providers, said Monica Hebl, DDS, chair nominee of the American Dental Association’s (ADA) Council on Access, Prevention and Interprofessional Relations. The organization is evaluating the use of a “community dental health coordinator” who will serve as a link between patients and dentists by helping patients navigate the system and overcome barriers to care like transportation and child care.  These coordinators also will provide basic preventive services.

“ADA is increasingly involved in interprofessional activities because we realize the advantages of expanding the number of health professionals capable of assessing oral health and the importance of linking medical and dental homes in order to reach kids before they have [dental] disease,” Hebl said.

Another example of a non-traditional oral health provider is an advanced dental therapist. Christy Fogarty, RDH, MSOHP—one of the first licensed dental therapists in the country—spoke to the audience about her education and scope of practice. Fogarty, who works for Children’s Dental Services in Minneapolis, Minnesota, has received a master’s degree and is currently completing the required 2,000 residency hours required before she can take a certification exam. As an advanced dental therapist, she can practice without a dentist on site, making it easier to bring care to patients outside of the office who might otherwise not be able to access it.

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