By Dr. David Satcher
America’s Wire Writers Group
ATLANTA - As states wrangle with whether or not to pursue Medicaid expansion under the Affordable Care Act, they should look carefully at the serious implications for oral health, especially for poor and minority children if Medicaid services are not expanded as originally envisioned under the ACA.
Twelve years ago, as Surgeon General of the United States, I issued a report calling attention to the profound disparities in oral health care across the country. I called it a silent epidemic. Twelve years later, some progress has been made, and it is no longer silent – but for many across the country, it is still a serious epidemic causing pain and harm to millions of poor and minority children.For instance, data from Georgia exemplifies the challenges that poor and minority children face in getting access to appropriate dental care.
In 2008, 15.9 percent of Georgians did not have health insurance and almost half – 41.5 percent – did not have dental insurance (Georgia Population Survey 2008). In 2007, visits to Georgia emergency rooms for preventable dental disease cost more than $23 million. The proportion of children with untreated tooth decay has dropped from 27 percent in 2005 to 19% in 2011, but that still means that close to a fifth of our state’s children suffer unnecessary pain and health risks for something that is truly preventable. The majority of these children are poor or minority or can’t see a dentist because of financial or geographic reasons.
When I issued my report, tooth decay was the single most common chronic childhood disease – five times more common than asthma. It still is. There were striking disparities in dental disease across the country. There still are. Thirty-seven percent of African American children and 41 percent of Hispanic children have untreated tooth decay, compared with 25 percent of white children. More than 50 million Americans live in areas where dentists do not practice and millions more can’t gain access due to cost reasons.
It is time to get serious and pursue the framework for action that I set forth in my 2000 report. All health care professionals need to understand that good oral health means more than sound teeth. The mouth is really a window to the whole body. Oral health affects everything from the ability to speak, eat or smile. Poor oral health is linked to heart disease, stroke and other long-term illnesses. We need to engage other health professions in working to prevent oral disease.
As a country, we have made great strides in prevention, particularly with fluoride and sealants. But many do not have regular access to a dentist or school-based programs that offer some preventive care. That is why it is critical to expand access by seeking innovation on a number of fronts: in oral health policies, how we train our providers, exploring the creation of new dental providers, and building a cadre of ethnically-diverse, culturally-competent dental practitioners, as well as expanding the reach of the dental team with other health care professionals.
The country has a great opportunity to increase access to dental care under the ACA, which calls for extending oral health benefits to an additional five million children in 2014. Expansion of coverage, however, won’t translate into access to care if we don’t have enough providers to meet the need. Currently just 20 percent of practicing dentists treat Medicaid patients. How can we provide services to an additional five million children in 2014?
States need to think about this now. States should explore all options that could expand access to care, including allowing midlevel dental providers such as dental therapists to practice. They are trained to provide routine services, freeing up dentists to attend to more complicated procedures. These practitioners already work in Alaska and Minnesota. And in just a number of years, they have been able to expand access in Alaska alone to an additional 35,000 people who could not get regular care in their own communities.
It is imperative that everyone have access to the dental care they need. Different professionals can provide different, yet appropriate, levels of service. Our concern and approach to a solution ought to focus first on the patient, not the dental profession. We have an opportunity with the ACA to expand access. Will the medical and dental communities be ready?
Dr. David Satcher, M.D., Ph.D.,is a public health administrator, who served simultaneously as the 10th Assistant Secretary for Health at the US Department of Health and Human Services, and the16th Surgeon General of the United States.