Category Archives: Oral health
In 2009, budget shortfalls spurred California lawmakers to eliminate virtually all dental benefits under its Adult Denti-Cal program, leaving millions in the state without adequate dental care. But in late June, Governor Jerry Brown signed a budget that restores virtually all of those dental benefits to the 3 million low-income Californians who qualify for the program.
The 2013-2014 state budget also expands other health care services for low-income Californians through an expansion of the state’s Medicaid program (Medi-Cal) under the Affordable Care Act. An estimated 1.6 million additional Californians will receive coverage under this expansion by 2015.
The dental benefits won’t be available until May 1, 2014, but California Dental Association President Lindsey Robinson, DDS, issued a statement called it a significant achievement. “We look forward to working with the administration to effectively implement Adult Denti-Cal, a vital service that will benefit the health of millions of Californians,” she said.
A new research brief from the American Dental Association’s Health Policy Resources Center finds that an increasing number of Americans visited emergency departments (ED) for dental-related care between 2000 and 2010, as a percentage of total dental visits. ED visits for dental care increased from 1.1 million in 2000 to 2.1 million in 2010.
The increase was primarily among young adults (age 21 to 34), which the researchers hypothesize is due to a decline in dental benefits among this age group. Young adults were more likely than others to report that they could not afford dental care in the past 12 months, the brief says, and recent studies have shown that there has been a shift in the pattern of dental benefits.
“Unfortunately, the Affordable Care Act (ACA) did little to address the issue of dental utilization in emergency departments,” the brief says. The law does not mandate dental benefits for adults, and insurance plans sold through most states’ exchanges are unlikely to include dental benefits. However, pilot programs in some states have shown promise for diverting patients with dental complaints from EDs and increasing their access to dental care.
“In the coming years, advocates for oral health will have to consider other innovative ways to increase access to dental care in order to decrease dental care utilization in hospital emergency departments,” the brief concludes. “Without further interventions from policy makers, dental ED visits are likely to increase in the future, straining our health care system and increasing overall health care costs. Now more than ever, innovative solutions are needed to improve access and oral health.”
Kim D’Abreu is Senior Vice President for Access, Diversity, and Inclusion in the Policy Center at the American Dental Education Association. D’Abreu was previously the deputy director for the Pipeline Profession and Practice: Community-Based Dental Education program of the Robert Wood Johnson Foundation. This is part of a series of posts looking at diversity in the health care workforce.
The words we use matter. That’s why the American Dental Education Association (ADEA) is shifting the conversation away from the “deficit model” for recruiting students from underserved backgrounds. ADEA is specifically avoiding language that suggests “the numbers just aren’t there” or “the pool is not qualified.” When we describe underserved students as low-income or less prepared educationally, it suggests that the problem lies with them. It undervalues the students and ignores the wealth that they bring to the table in terms of cultural competence, initiative, and willingness to provide care to communities that need it most. But far worse, the deficit model allows the real institutional obstacles that these students face to remain in place.
Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. This is part of a series of posts looking at diversity in the health care workforce.
Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:
- Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
- According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
- Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.
Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.
Paul Glassman, DDS, MA, MBA, is director of the Dental Pipeline National Learning Institute, a program of the Robert Wood Johnson Foundation. Glassman is a professor of dental practice and director of community oral health at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.
I recently had the opportunity to visit the British Royal Observatory in Greenwich, UK, current home of John Harrison’s famous clocks, which provided the solution to one of the most vexing problems in 17th and 18th Century Europe. As eloquently chronicled in Dava Sobel’s book Longitude: The True Story of a Lone Genius Who Solved the Greatest Scientific Problem of His Time, the 17th and 18th Century naval fleets of the world were plagued by the inability to accurately measure longitude. A ship’s captain at sea could get very precise readings of the ship’s latitude by measuring the angle between the sun at noon and the horizon. However, measurement of longitude required knowing the current time at a known point, such as London, which would allow the captain to compare the position of stars as seen from the ship, to where they would have been at the known point at that precise time.
Unfortunately, timepieces of that day were too inaccurate to facilitate these measurements. As a result, inefficient routes were followed to increase safety, many ships ran aground anyway, lives were lost, and the economic consequences for the shipping industry were staggering. In 1714 the British Parliament offered the “Longitude Prize” of £20,000 for a solution to this problem. It was not until 1772, after many attempts and failures, that Harrison was awarded this prize for his 4th timekeeper, a clock that could keep accurate time aboard a moving ship, and Parliament declared that the problem had been solved. This development allowed the British naval fleet to obtain world dominance at the end of the 18th Century.
The oral health system in our country has its own longitude problem. Our inability to accurately measure where we are and chart a course forward has tremendous human and economic consequences.
Dentists and nurses are the occupations that will offer the best employment opportunity, salary, work-life balance, and job security in 2013, according to an annual ranking released by U.S. News & World Report. Other health care jobs also made the top tier, including physicians at number five, out of 100 occupations listed.
The dental profession should grow 21.1 percent by 2020, the piece says, and physicians will see “abundant job growth” in that same period. Nurses will also be in greater demand as the population ages, but the rankings note that nurses “will almost always have great hiring opportunity” because of the expanse of the profession.
U.S. News gives each profession is given an overall score calculated from seven component measures: 10-year growth volume, 10-year growth percentage, median salary, employment rate, future job prospects, stress level, and work-life balance.
The U.S. Department of Health and Human Services (HHS) this week announced more than $100 million in new grants to expand and strengthen the nation’s health care workforce. The goal of the funding is to educate and strengthen training for health care workers, and provide fellowships and traineeships.
The grants include:
- Nursing ($30.2 million): Partial loan forgiveness for students who serve as full-time nursing faculty for a designated period of time after graduating from a master’s or doctoral program; grants for schools of nursing to provide financial aid and mentoring to students from disadvantaged backgrounds underrepresented in nursing; and funding for nurse anesthetist traineeship programs for licensed registered nurses enrolled in master’s or doctoral nurse anesthesia programs.
- Dental ($3.0 million): Grants to increase oral health care education capacity for programs that train future faculty in general, pediatric, or public health dentistry, or in dental hygiene.
- Public Health ($48.0 million): Funds for 37 Public Health Training Centers to train current and future public health workers in basic health skills and key public health issues; and grants to expand public health training programs and support medical residency-type fellowships at state and local health departments.
- Interdisciplinary and Geriatric Education ($6.6 million): Grants for projects to train and educate workers to provide geriatric care for the elderly; and support for the collaboration and integration of public health curricula in medical and clinical education.
- Centers of Excellence ($18.8 million): A five-year program to support the recruitment and performance of underrepresented minority students entering health careers, and to support research and the development of curricula, training and resources related to minority health issues.
“These grants and the programs they support are vital to achieving a comprehensive and culturally competent health professions workforce capable of meeting future health care challenges,” HHS Secretary Kathleen Sebelius said in a statement announcing the funds.
Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.
The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”
In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”
The Affordable Care Act will allow more Americans to access dental health services, former Surgeon General and Robert Wood Johnson Foundation Clinical Scholars almnus David Satcher, MD, PhD, said recently at forum on unmet oral health needs, but there are concerns that the current dental workforce will not be able to meet the increase in demand. Satcher spoke at “Unmet Oral Health Needs, Underserved Populations, and New Workforce Models: An Urgent Dialogue,” a July 17 forum sponsored by the Morehouse School of Medicine and the Sullivan Alliance.
“We now have an opportunity to dramatically increase coverage,” he said. “But adding dental benefits will not translate into access to care if we do not have providers in place to offer treatment.” More than five million additional children will be entitled to dental health benefits under the Affordable Care Act, according to a news release from the Morehouse School of Medicine.
“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,” Satcher said. He was referring to mid-level dental providers, known as dental therapists.
Though improvements have been made in the 12 years since then-Surgeon General Satcher issued a report offering a framework for improving access to oral health, problems persist. Tooth decay is still common among children, he said, and many people do not have easy access to oral health providers.
Former Health & Human Services Secretary Louis Sullivan, MD, penned an op-ed in yesterday’s New York Times making the case for devising more effective ways to deliver dental care to poor or rural communities across the nation.
The Secretary notes that, in 2009, 83,000 emergency room visits resulted from preventable dental problems. “In my state of Georgia,” he writes, “visits to the ER for oral health problems cost more than $23 million in 2007. According to more recent data from Florida, the bill exceeded $88 million. And dental disease is the No. 1 chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.”
He goes on to list several reasons: 50 million of us live in poor or rural areas without a dentist; most dentists do not accept Medicaid; and we have a dentist shortage that will only be exacerbated when 5.3 million children are added to Medicaid and the Children’s Health Insurance Program by way of the Affordable Care Act.
Sullivan argues that the federal government should put programs in place to train more dentists. But more than that, he argues for training dental therapists “who can provide preventive care and routine procedures like sealants, fillings and simple extractions outside the confines of a traditional dentist’s office.” He says such an approach has been particularly effective in Alaska, where the state has recruited and trained dental therapists to serve many of that state’s most remote communities, including many that are accessible only by plane, dogsled or snowmobile.
A recently announced effort by the Robert Wood Johnson Foundation (RWJF) takes aim at the very same problem. The Oral Health Workforce initiative is designed to improve access to oral health care by identifying and studying replicable models that make the best use of the health and health care workforce to provide preventive oral health services.