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Robert A. Faiella, D.M.D. Headshot

A Dentist's View on Tackling the National Dental Health Crisis

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This country is facing a dental health crisis -- a gap between those with good dental health and those without. Its causes are varied and complex, and it will only get worse without a comprehensive set of solutions. The good news is that increasing attention is being paid to dental health. But the proposed solutions have been too few and too narrow in scope.

A study by Harris Interactive with the American Dental Association (ADA) found that nearly half of lower-income adults say they haven't seen a dentist in a year or longer. Overall, more than 181 million Americans didn't visit the dentist in 2010. Nearly half of adults over age 30 have some form of gum disease, which can lead to bone and tooth loss.

The Harris/ADA study found that 40 percent of lower-income adults believe that the Affordable Care Act will help them obtain dental care. In fact, the new law will not provide substantial dental coverage for low-income adults (although it will dramatically increase children's coverage under Medicaid).

Dentists in America believe this crisis can be solved. How?

1. Provide care now to those suffering with untreated disease
People delay dental care for many reasons, ranging from a lack of insurance, education level, lack of awareness of dental health and how to stay healthy, geography, and age -- often in combination. We as a society need to find those who are delaying care and deliver it to them.

One place to look is the emergency room. According to the National Hospital Ambulatory Medical Care Survey, dental visits to ERs increased from 1.1 million in 2000 to 2.1 million in 2010. This is a burden on overworked ERs, the majority of which are not equipped for dental cases. Most can only provide temporary pain relief and treat infection but not address underlying problems.

The fix: programs that move ER patients to a dentist. For example, Community HealthCare Connections in Michigan refers patients from the Bronson Battle Creek ER to local dentists. More than 60 percent of the community's private practice dentists have signed on to provide free care to those patients, resulting in over $1 million of care to 4,000 people over six years. In turn, dental cases to the ER have fallen 70 percent, and the patients -- as part of this innovative exchange for dental care -- "pay it forward," with over 57,000 hours of service to non-profits.

Another place to look is nursing homes. Even though poor dental hygiene can lead to broader health issues like pneumonia, funding for care is often an issue. New programs are encouraging private practice dentists to devote part of their caseloads to nursing home residents by educating dentists how an existing but little-known provision in Medicaid can fund medically necessary dental care. One Texas dentist, for example, has built her practice around caring for the elderly. She treats 60 percent of her patients in nursing homes.

These programs are highly collaborative, bringing together dentists, administrators of hospitals and nursing homes, non-profit organizations and others. Dentists are working to expand them nationwide.

2. Strengthen and expand the safety net to provide more care to more Americans
Most state dental Medicaid programs are woefully underfunded, and on average state Medicaid budgets allocate only 1.31 percent for dental services.

Expanding dental services covered under Medicaid and reducing administrative burdens in the system are proven solutions. For example, Connecticut expanded its Medicaid program, increasing the number of children receiving care from 88,891 before 2008 to 171,871 in 2010. Vermont in 2012 expanded its Medicaid program to provide dental services to pregnant women.

Innovative solutions like dentist partnerships with Federally Qualified Health Centers are also in the works. These partnerships allow private practice dentists to help community health facilities expand capacity to provide care to underserved people without increasing clinics' expenses and overhead.

3. Bring dental health education and disease prevention into communities
Basic brushing and flossing practices may seem obvious to you, but many in the U.S. are unaware of their importance. To prevent dental problems before they start, we must encourage collaborations between health professionals and public programs to educate Americans.

The Community Dental Health Coordinators (CDHC) program places community health workers with dental training in underserved communities. Their functions are dental health education, disease prevention and helping patients navigate an often daunting public health system to receive that care from dentists. Most CDHCs come from the types of inner city, rural and Native American communities in which they work, helping eliminate cultural, educational and language barriers that could impede their effectiveness.

The CDHC program has been such a success that the ADA is working to increase the number of states with CDHCs from seven to 15 by 2015.

There are many ways to provide dental health education and preventive care to underserved populations, including school-based screening and referral programs, collaborations with physicians and other health professionals and mass media outreach, such as Kids' Healthy Mouths, a public service campaign created by a coalition of dental groups and the Ad Council.

Dentistry will continue to advocate for fluoridated drinking water, as we have for decades. Water fluoridation is the single most effective public health measure to prevent dental decay, and the Centers for Disease Control and Prevention has recognized water fluoridation as one of 10 great public health achievements of the 20th century. By one estimate, the cost of providing fluoridated water throughout someone's life is less than the cost of a single filling.

These are just a few steps we can take. In our nationwide campaign, Action for Dental Health, the American Dental Association is working with dentists in communities across the country, as well as other partners and allies, to implement a comprehensive approach to ending the dental health crisis in America.

We've made great progress, with each generation enjoying better dental health than the one before, but there's still a dangerous divide between those with good dental health and those without. Our mission is to close that divide, and we call on regulators, elected officials, health policy organizations and other community leaders to join us in bridging the dental divide and giving all Americans the opportunity to enjoy good oral health.

Dr. Faiella is a practicing periodontist in Osterville, Mass., and president of the American Dental Association.

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