Individuals living in rural and urban underserved areas (Maserejian et al., 2008; Vargas et al., 2002, 2003a,b,c);

Uninsured and publicly insured individuals (GAO, 2008; Liu et al., 2007);

Homeless individuals (Conte et al., 2006; Gibson et al., 2003); and

Populations of lower socioeconomic status (Bloom et al., 2010; GAO, 2000; Vargas et al., 1998).

For example, in 2009, 4.6 million children did not obtain needed dental care because their families stated that they could not afford it (Bloom et al., 2009), and people with disabilities are less likely to have seen a dentist in the past year than people without disabilities (Armour et al., 2008).

Although other health conditions frequently draw attention in health policy and health services discussions, oral health issues seldom rise to the top of the national health and health policy agenda. As a result, oral health concerns have persisted as a major, largely preventable, health problem across the life span.

BARRIERS TO ORAL HEALTH CARE ACCESS

The factors that contribute to problems with access to oral health care are numerous and complex. These include social, cultural, economic, structural, and geographic factors, among others. A thorough review of these factors is included in the chapters that follow. For example, dental coverage (discussed in Chapter 5) is correlated to access to and utilization of oral health care (AHRQ, 2010; Decker, 2011; Sohn et al., 2007). One recent report found that individuals who lacked dental insurance were about two-thirds less likely than people with private insurance to have had a dental visit within the last year (16.1 percent compared with 50.9 percent) (AHRQ, 2010). In addition, poor oral health literacy of both individuals and all types of health care professionals (discussed in Chapter 2) contributes to poor access because individuals may not understand the importance of oral health care or their options for accessing such care (Caspary et al., 2008; Gussy et al., 2008; Jones et al., 2007; Kutner et al., 2006; Sakai et al., 2008).

Likewise, the geographic distribution of oral health professionals in relation to the general public (discussed in Chapter 3) has a considerable impact on access to oral health care (HHS, 2000; IOM, 2009b). For example, as of March 2011, there were 4,639 dental Health Professional Shortage Areas (HPSAs) (a geographic area, population group, or facility with a shortage of dental professionals) (HRSA, 2011). An estimated 9,642 additional dentists would be required to meet the need of unserved populations in these areas (based on a 3,000:1 population-to-practitioner ratio). It



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