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Oral health epidemic persists, former surgeon general says

On July 22, 2012

  • Satcher calls for expanding access, including midlevel providers, dental therapists.


Atlanta, GA - Twelve years after issuing a landmark report that offered a framework for improving access to oral health, formerSurgeon General David Satcher says profound oral health problems still exist for large portions of the population and has issued a renewed call to expand access to oral health care, especially to the millions of children expected to gain dental benefits through the Affordable Care Act in 2014.
Speaking at a conference on unmet oral health needs at Morehouse School of Medicine, Dr. Satcher detailed profoundoral health problems that persist.
"We now have an opportunity ACA to improve access to dental health services," said Satcher. "But how do we put in place a health care system that meets the needs of all? Can we increase the supply of oral health care providers by expanding the opportunity for people to serve? What the ACA said is that people should be able to practice to the full extent of their potential."
Oral health care in America continues to be a crisis, Dr. Satcher insists.  Tooth decay is the most common chronic disease among children, five times more prevalent than asthma. Close to 50 million people live in areas where they have difficulty reaching a dentist, and millions more can't get care due to cost.
Satcher is concerned about the ability of the current dental workforce to meet the demands for dental care. As part of the provisions enacted under the Affordable Care Act, more than five million additional children will be entitled to dental health benefits. But there are not enough providers to meet that need. Currently, just 20 percent of all practicing dentists accept Medicaid patients. The federal Health Resources Services Administration also estimates a current shortage of approximately 10,000 dentists.
"We now have an opportunity to dramatically increase coverage," Satcher said. "But adding dental benefits will not translate into access to care if we do not have providers to offer treatment."
Satcher wants states to expand access to dental care, including exploring creation of new dental providers.
He advocated launching workforce pilot programs to determine how best to expand access to dental care.
"I think we need more dentists and I think we need more professionals who are not dentists but who can contribute to oral health care services," said Satcher. "The real key is whether or not systems are going to ensure that everyone is allowed to practice to thelevel of their potential."
More than a dozen states are exploring creating new midlevel dental providers, also known as dental therapists, toexpand access to preventive and routine dental care. Dental therapists currently practice in Alaska and Minnesota. Connecticut and Oregon are launching pilot projects and numerous other states have introduced legislation to allow dental therapists. In Alaska, dental therapists have been able to provide care to 35,000 Alaska Natives who couldn't access it before.
"Access to oral health is not what it should be in this country," said Dr. Louis Sullivan, chairman of the Sullivan Alliance to Transform America's Health Professions, and former Secretary of the U.S. Department of Health and Services. "With the Affordable Care Act, millions more will have access to oral health care. We, as health professionals, must lead the effort so that we are prepared to meet the need. We need now to develop strategies to provide those services."
Poor oral health can lead to serious health consequences later in life, including diabetes and heart problems. Satcher emphasizes that oral health can dramatically affect how we speak, eat, or smile. He also stresses that children, minorities and the poor are disproportionately affected by the oral health care crisis:
•  37 percent of African American children and 41 percent of Hispanic children have untreated tooth decay, compared with 25 percent of white children
•  American Indians and Alaska Natives have the highest rate of tooth decay of any population: five times the national average for children ages 2 to 4.
•  Seventy-two percent of American Indian and Alaska Native children ages 6 to 8 have untreated cavities - more than twice the rate of the general population.
•  More than a third of all poor youngsters ages 2 to 9 have untreated cavities, compared with 17 percent of children who are not poor.

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