Position Statement on Increasing Access to
and Use of Oral Health Care Services
What is the Academy of General Dentistry? The Academy of General Dentistry (AGD) is a professional organization for general dentists with more than 35,000 members. The AGD focuses on continuing dental education and seeks to participate in policy issues that impact general dentists and their patients.
What is the difference between the AGD and the American Dental Association? The AGD represents general dentists exclusively, while the American Dental Association (ADA) represents all dentists—generalists and specialists alike. The two groups work closely together in an effort to best represent the interests of dentists, their patients, and their staff.
Who are general dentists? AGD members are primary care providers. The dental profession has a ratio of 80 percent general practitioners to 20 percent specialists. General dentists deliver most dental care, steering patients to more expensive specialists only when necessary. General dentists tend to be self-employed, small-business owners, as many dentists own and manage their own practices. The average general dentist employs three to four full-time employees.
Dentistry: A Success Story for the Nation
Patients in the United States enjoy the highest quality dental care in the world. The dental profession has managed to maintain a high level of quality while keeping costs low, compared to most other sectors of the health care system.
Dentistry is paid for primarily with private sector dollars. In 2004, for example, state, local, and federal government programs paid less than $4.9 billion for dental care, compared with $81.5 billion paid through personal health care expenditures, such as out-of-pocket payments, third-party payments, or private health insurance, according to the Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
Among the health professions, dentistry is singularly oriented toward preventive health. Nearly 65 percent of all dental procedures are diagnostic or preventive. The National Institute of Dental and Craniofacial Research (NIDCR) estimates that dentistry’s emphasis on preventive oral health measures saved nearly $39 billion during the 1980s. In addition, the Centers for Disease Control and Prevention said in an August 2000 letter to Congress that community water fluoridation, which was introduced in public water supplies in the 1940s to help prevent tooth decay, is “one of the greatest public health achievements of the 20th century.”
Challenges Now Face the Profession
Despite dentistry’s past successes, significant challenges lie ahead. The profession is eager to work with private sector groups, and state, local, and federal lawmakers to reduce disparities in oral health status and to increase access to, and utilization of, oral health care services and therefore reduce dental disease.
Dental disease is important because it impacts both children and adults physically, functionally, emotionally, and socially. It also affects the nation’s productivity. The following are a sampling of the reasons why good oral health is so important:
Oral Health Is Key to General Health. Oral health is an important part of overall health, and the mouth reflects general health and well-being. Oral infections can be the source of systemic infections in people with weakened immune systems. In addition, research has found associations between chronic oral infections and other health problems, including diabetes, heart disease, and adverse pregnancy outcomes.
The need for dental care cannot be ignored. Unlike many medical conditions, dental problems are not self-limiting. Dental diseases grow progressively worse without treatment, requiring increasingly costly interventions. On the other hand, most dental diseases are easily prevented at little cost through regular examinations. In addition, the initial diagnosis of life-threatening conditions such as HIV infection and oral cancer are frequently made in the dental office.
Oral Infections Take a Toll on the Nation. Each year dental disease results in the loss of 164 million hours of work. Annually, dental-related illnesses account for 6.1 million days of bed disability, 12.7 million days of restricted activity, and 20.5 million lost work days. Appropriate dental care and good oral health, however, enhance employability among adults on Medicaid and increase the likelihood that they will get a job, keep their job, and achieve independence from the welfare system. Given the fact that individuals without dental coverage are less likely to see their dentist as those with dental coverage, it is imperative that the current level of dental coverage be expanded.
Oral health has a direct impact on military readiness as well. The 1994 Tri-Service Comprehensive Oral Health Survey found 92 percent of military personnel required some form of dental care. In 2005, the Army, for example, found that 20 percent of its citizen soldiers arrived at mobilization sites with dental conditions that made them non-deployable.
According to a December 2001 article in the New York Times, one-third of the reservists affiliated with the Naval Reserve Center in the Bronx, New York, the Navy’s only installation in the city, would be categorized as having serious enough dental problems to preclude them from active duty.
Oral Disease Impacts Children’s Futures. Oral conditions and diseases affect people throughout their life span. Nearly every American has experienced the most common oral disease: dental caries. Among children, dental caries is the single most common chronic disease; it is five times more common than asthma and seven times more common than hay fever. Dental caries affect about half of all second graders (ages six to eight) and more than 80 percent of children by late adolescence.
While most children experience only the minor inconvenience of an occasional cavity or other oral problem, state and national epidemiologic data show that an estimated 4 to 5 million children experience dental disease sufficiently extensive and severe enough to cause chronic dental pain. Pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning.
Further, more than 51 million school hours are lost each year to dental-related illness. Research shows that children from low-income families suffer nearly 12 times more restricted-activity days than children from higher-income families.
Among parents who feel that their children have unmet health care needs, 57 percent report that the unmet need is for dental care while only 12 percent report similar need for eyeglasses or prescriptions, according to the Centers for Disease Control and Prevention’s National Health Interview Survey.
Tackling the Problem
There are many different factors contributing to disparities in, lack of access to, and low utilization of oral health care services. Given the complexity of the issue, any solution will require a multi-factorial approach that strengthens the parts of the dental delivery system that are working and creates new opportunities to improve the oral health of the nation.
The AGD believes health policymakers at the local, state, and federal levels should continue their efforts to collaborate with the private sector to develop strategies for increasing access to and use of dental services and for decreasing oral health disparities and low oral health literacy. The groundbreaking release in May 2000 of the U.S. Surgeon General’s report, Oral Health in America, recommended such public-private partnerships. Following are examples of some recent activities the AGD has undertaken in an effort to address the Surgeon General’s Call to Action and to achieve the Healthy People 2010 oral health objectives:
AGD and HHS Launch a New Partnership. The AGD embarked on an exciting new initiative in 2003, joining forces with the U.S. Department of Health and Human Services in an effort aimed at eliminating oral health disparities, increasing the public’s understanding of oral health issues, and expanding access to and utilization of dental care services. This was the first time that HHS entered into a Memorandum of Understanding with a dental professions organization. The federal health agencies signing the MOU include the Centers for Disease Control and Prevention (CDC), the Office of Public Health and Science, the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), and the National Institutes of Health’s (NIH) National Institute for Dental and Craniofacial Research (NIDCR).
Why Oral Health? Why Now?
The AGD recognizes that there are many weighty issues facing Congress. The AGD believes, however, that there are compelling reasons for Congress to address the oral health crisis in America—and address it now. Here’s why:
Definitive research exists. There is a vast body of research substantiating the problems of access to, use of, disparities in, and literacy about oral health. There is also ample information about potential solutions. While public-private partnerships have resulted in oral health policy changes in many states, federal intervention is needed to effectively address these problems.
The issue is non-partisan—a win-win for lawmakers and their constituents. It is rare for a health policy issue to be uncontroversial, but the oral health issues now before Congress are just that. Most legislators—both democrats and republicans—agree that all Americans need and deserve access to oral health care. Yet access to these dental services still remains a serious problem nationwide. Funding programs, such as the Title VII Health Professions Programs, which helps place dentists and other health care providers in underserved areas, should be one of the easiest decisions Congress makes as it debates our nation’s health policy programs.
Congressional action will have a real impact on constituents’ quality of life. Improving the nation’s oral health is not an esoteric issue. It speaks to the growing problem constituents are having in obtaining dental care for their children. As noted by the Surgeon General’s Report on Oral Health, oral health is an integral part of overall health.
A minimal investment of funds now will save millions later. Dentistry is a prevention-oriented profession. As noted in the Surgeon General’s Report on Oral Health, “Oral diseases are progressive and cumulative and become more complex over time.” Fortunately, “Most common oral diseases can be prevented.” In fact, “The application of science to improve diagnostic, treatment, and prevention strategies has saved billions of dollars per year in the nation’s annual health bill.”
Each statistic is a child. Perhaps the most compelling reason for immediate congressional action is the fact that children are suffering. Poor oral health is a societal problem that cannot, ethically, be ignored any longer.
The Need for Congress to Focus on Oral Health Issues
Congress could help reduce the incidence of oral diseases, saving health care dollars, and alleviating unnecessary pain and suffering by developing new initiatives and focusing on solutions to America’s oral health crisis. All lawmakers need to recognize that oral health care is an essential component of any overall health care regimen. It should not be viewed as an ancillary part of our health care system.
DID YOU KNOW?
Tooth decay is the most common, and the most preventable, disease in children. It is five times more common than asthma and seven times more common than hay fever. Nearly one-in-five children two to four years of age have visible tooth decay. By late adolescence, more than 80 percent of children have dental caries (cavities).
Tooth decay is an infectious disease that is transmitted through the saliva. The relationship between a mother’s oral health and that of her infant is important, since mothers transmit tooth decay to their babies through their saliva. Reducing a mother’s cavity-causing bacteria will limit the amount of bacteria that is transmitted to her child.
Preventive dental care saves billions of dollars. Past advances in the prevention and treatment of oral diseases have been estimated to generate savings of $5 billion a year in dental expenditures alone.
Dental costs are largely preventable. Dental expenditures in 2002 exceeded $70 billion, the majority of which were associated with the repair of teeth and their surrounding tissues—and which could have been prevented by regular professional dental care and daily dental hygiene practices.
There is an association between oral infections and heart disease, respiratory infections, diabetes, and the birth of premature, low-birth-weight babies. For example, women with severe gum disease are seven times more likely to have a premature delivery and a low-birth-weight baby. The destructive inflammatory processes that define periodontal disease are also closely intertwined with diabetes. Periodontal diseases are exacerbated in individuals with uncontrolled diabetes.
Funding Title VII Dental Residency Programs
The General and Pediatric Dentistry Residency programs funded by the appropriations bill for the Departments of Labor, Health and Human Services, and Education as part of the Health Professions Program under Title VII of the Public Health Service Act are proven cost-effective primary care residency programs. They are a small investment with clear benefits.
Over the 20-year history of the Title VII support for general dentistry training, 59 new dental residency programs and 560 new positions were created. About 305 of the dentistry graduates from these programs established practices and spent 50 percent or more of their time in health professional shortage areas or settings providing care to underserved communities.
The benefits of General Dentistry Residency programs include:
More primary care providers. General dentistry residency programs provide dental graduates with broad skills and clinical experience, allowing them to rely less on specialists. Residents are trained to provide dental care to patients requiring specialized or complex care, such as developmentally disabled individuals, the elderly, high-risk medical patients, and patients with HIV/AIDS. Eighty-seven percent of the graduates of General Dentistry residency programs remain primary care providers after graduation.
Better distribution of care. General Dentistry residency programs improve distribution into underserved areas. A 2001 HRSA-funded study found that postdoctoral general dentistry training programs, which typically are either dental school- or hospital-based, generally serve as safety net providers to underserved populations.
The General Dentistry Residency program is a model for the kind of program the government should support during times of scarce resources: (1) it is cost-effective; (2) it targets and provides care to underserved populations; and (3) it trains practitioners to become generalists, thus keeping future health care costs to a minimum.