Millions of Americans are not receiving needed dental care services because of "persistent and systemic" barriers that limit their access to oral healthcare, says a new report by the Institute of Medicine and National Research Council.
Barriers are economic, structural, geographic and cultural. The report noted that approximately 33.3 million people live in areas with shortages of dental health professionals. In 2008, 4.6 million children did not obtain needed dental care because their families could not afford it. And in 2006, only 38 percent of retirees had dental coverage, which is not covered by Medicare.
To remove these barriers – which disproportionately affect children, seniors, minorities and other vulnerable populations – the report recommends changing funding and reimbursement for dental care; expanding the oral health work force by training doctors, nurses and other nondental professionals to recognize risk for oral diseases; and revamping regulatory, educational and administrative practices.
"The consequences of insufficient access to oral healthcare and resultant poor oral health – at both the individual and population levels – are far-reaching," said Frederick Rivara, Seattle Children's Guild Endowed Chair in Pediatrics at the University of Washington School of Medicine, Seattle, and chair of the committee that wrote the report. "As the nation struggles to address the larger systemic issues of access to healthcare, we need to ensure that oral health is recognized as a basic component of overall health."
Lack of regular oral health care has serious consequences, the report says, including increased risk of respiratory disease, cardiovascular disease, and diabetes, as well as inappropriate use of hospital emergency departments for preventable dental diseases.
"Oral health is integrally related to overall health. People who lack dental care are more likely to have diabetes, heart disease and other diseases," said Rivara. "There is a need for both the public and private sectors to address this enormous disparity."
Although all states must provide comprehensive dental benefits for children enrolled in Medicaid or the Children's Health Insurance Program (CHIP), they are not required to provide such benefits for adults. Because publicly funded programs are the primary source of health coverage for underserved populations, including dental benefits for all Medicaid beneficiaries is a critical and necessary goal, the report said.
The committee recommended that the Centers for Medicare and Medicaid Services fund and evaluate state-based demonstration projects that cover essential oral health benefits for adult Medicaid beneficiaries. In addition, Medicaid and CHIP reimbursement rates for providers should be increased and administrative practices need to be streamlined to increase use by both dental providers and patients, the report said.