Breaking Down Barriers to Oral Health

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The American Dental Association (ADA) today released the first in a series of papers examining the challenges and solutions to bringing good oral health to the millions of Americans—including as many as one-quarter of the nation’s children—who lack access to dental care, many of them suffering with untreated disease. The paper focuses on workforce, an umbrella term for the numbers, location and makeup of the teams comprising dentists, dental hygienists, dental assistants and other existing and proposed providers.

Breaking Down Barriers to Oral Health for All Americans: The Role of Workforce also emphasizes that workforce changes alone can never overcome the many barriers that prevent too many Americans from attaining good oral health. It warns that focusing on only this one barrier is “the policy equivalent of bailing a leaky boat.” Future ADA papers will address those other barriers, including the tattered public health safety net, and the need to dramatically increase both disease prevention and financing.

The paper disputes the conventional wisdom of a coming shortage of dentists, projecting that later-than-predicted retirement, increased numbers of dental school applicants and the opening of new dental schools will provide an adequate number of dentists through 2030. Instead it argues that the challenges are 1) placing dentists—whether in private practice or government-assisted clinics—in more so-called “underserved areas” that otherwise cannot support a full-time dental practice, and 2) addressing issues that impede securing and keeping dental appointments, such as excessive paperwork, transportation, child care and permission to take time off from work or school.

“We know that the existing delivery model can accommodate millions more people, provided that we address administrative and financing barriers, and workforce distribution,” said ADA President Raymond F. Gist, DDS. “Everyone deserves good oral health, and everyone deserves a dentist.”

Several examples are cited in which states or municipalities have dramatically increased dental services provided to disadvantaged children through a combination of relatively minor funding increases and administrative reforms. They include the children’s dental Medicaid programs in Tennessee, Alabama and Michigan and the creation of a public-private dental clinic in Vermont. The improvements in these programs made it possible for much greater numbers of patients to receive care from the same population of dentists as existed before the reforms occurred.

The paper cautions against a rush to create so-called “midlevel” dental providers who, with as little as 18 months of post-high school training, could be allowed to perform such irreversible/surgical procedures as extracting teeth. Such experiments, it argues, are likely to sap resources better directed toward proven methods for extending the availability of care from fully trained dentists. It does however endorse such workforce innovations as the ADA’s own Community Dental Health Coordinator (CDHC) pilot project. CDHCs follow the highly successful (medical) community health worker model, providing health education and preventive services, identifying patients needing dental care and helping those patients secure and keep appointments with fully trained dentists.

“When all stakeholders—and we are all stakeholders—set aside lesser differences and recognize our aligned purpose, set ambitious yet realistic short- and long-term goals, and pursue those goals with renewed vigor, we can effectively end untreated dental disease in America,” said Dr. Gist.