National Academies Press: OpenBook

The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary (2009)

Chapter: 12 A Charge to Improve Children's Access to Oral Health Services

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Suggested Citation:"12 A Charge to Improve Children's Access to Oral Health Services." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
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Page 103
Suggested Citation:"12 A Charge to Improve Children's Access to Oral Health Services." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
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Page 104
Suggested Citation:"12 A Charge to Improve Children's Access to Oral Health Services." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
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Page 105
Suggested Citation:"12 A Charge to Improve Children's Access to Oral Health Services." Institute of Medicine. 2009. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12669.
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Page 106

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12 A Charge to Improve Children’s Access to Oral Health Services Representative Elijah E. Cummings U.S. House of Representatives “Our children are the living messages that we send to a future we will never see.” Improving access to oral health care services is a critical matter. Two years ago, in the state of Maryland, a 12-year-old boy named Deamonte Driver died from an untreated tooth infection that spread to his brain, an infection that could have been treated for about $80. How could this h ­ appen in the state of Maryland, the wealthiest state in the wealthiest coun- try of the world? Sadly, the answer is all too clear: it was the failure of all adults. Adults have a duty to care for children on this Earth, to provide for and protect children. However, when it comes to accessing dental services, the adults of the United States have failed in these duties. Deamonte’s illness was rare and extreme, but he was by no means alone in his suffering. Nine million children in this country do not have health insurance, and 20 million are without dental coverage (Paradise, 2008). Dental decay is the single most common chronic childhood disease in this country, and it is preventable. The public would not accept this sort of gross negligence for a preventable illness such as tuberculosis or small pox and should not accept it for dental decay. Hundreds of thousands of Deamonte Drivers walk the streets of the United States every day. Many of them will receive the emergency care that will save them from Deamonte’s fate, largely due to the efforts of unsung heroes who treat poor children for 103

104 THE U.S. ORAL HEALTH WORKFORCE little or nothing because it is the right thing to do. However, without regular dental visits, they are likely to be back in the dental chair for emergency care several more times in their lifetimes. Dental health is an integral part of overall health. Lack of treatment for dental disease has the potential to affect a child’s speech, nutrition, social development, and quality of life. Children with missing or decayed teeth are more likely to experience poor self-esteem and be reluctant to smile. Pain caused by dental decay affects a child’s ability to eat and receive the nutrition necessary for growth and development. Children with oral dis- eases are restricted in their daily activities and miss over 51 million hours of school each year (HHS, 2000). Oral diseases have also been linked to eye, ear, and sinus infections as well as weakened immune systems, heart disease, and lung disease. Infections of the mouth frequently spread to other organs, causing critical complications for children including blindness and even death. Dental disease is even transmissible—passing from a pregnant mother to a child or even through sharing a drink or food. Needless suffering occurs because the nation is failing to adequately provide children with access to the dental services they need. In February 2009, President Obama signed the Children’s Health Insurance Program (CHIP) into law. The legislation includes several critical provisions to improving children’s access to dental services. Specifically, the law guaran- tees a dental benefit for children that includes preventive, restorative, and emergency dental services; provides dental health education for the parents of newborns; allows community health centers to contract with private dentists for the purpose of providing dental services to these patients; improves access to dental provider information through the Insure Kids Now website and hotline; requires that the Government Accountability Office conduct a study assessing children’s access to dental services within 18 months of the bill’s enactment; and directs the secretary of Health and Human Services to establish a core set of child health quality measures for assessing states’ Medicaid and CHIP programs, including measures for the availability of dental services and the quality of pediatric dental care. The law also ­includes wraparound dental benefits for children who are eligible for CHIP but have private medical insurance that does not include dental services. However, much more needs to be done. Comprehensive health care reform must include oral health care. Incentives must be created for dentists to treat low-income and underserved patients by increasing reimbursement rates. Also, heavy investments in public education are needed to ensure that all parents understand the critical importance of oral health and to enhance prevention activities. Finally, the problem of access to oral health care    Children’s Health Insurance Act. Public Law 111-3. 111th Cong. (2009).

A CHARGE TO IMPROVE CHILDREN’S ACCESS 105 services cannot be addressed without looking at the workforce shortage. Many organizations have been key to helping address workforce ­shortages in dental professions. The American Dental Association has ­ facilitated the opening of new schools of dentistry and provides loan forgiveness to steer graduating dentists into working in underserved communities; the National Dental Association has historically provided safety nets to under­served populations; the Children’s Dental Health Project is the only group advocating exclusively for children’s oral health; and the American Academy of ­ Pediatric Dentistry formed a groundbreaking alliance last year with the national office of Head Start to ensure that young children in need are connected with dentists who can treat them. Even with all this effort, a coverage gap still exists that needs to be filled by other types of professionals. More types of practitioners are needed to improve access to needed services. These problems need to be solved; America’s children need to be taken care of. Our children are the living messages that we send to a future we will never see. The question remains, what type of message will we be sending? Members of Congress are not in the business of resolving scope of practice battles as it is the practitioners who are best positioned to make those decisions. However, something needs to be done now. A child died because of the failures of all adults. The Deamonte Drivers of the world are depending on the adults of the world to resolve these issues.

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Access to oral health services is a problem for all segments of the U.S. population, and especially problematic for vulnerable populations, such as rural and underserved populations. The many challenges to improving access to oral health services include the lack of coordination and integration among the oral health, public health, and medical health care systems; misaligned payment and education systems that focus on the treatment of dental disease rather than prevention; the lack of a robust evidence base for many dental procedures and workforce models; and regulatory barriers that prevent the exploration of alternative models of care.

This volume, the summary of a three-day workshop, evaluates the sufficiency of the U.S. oral health workforce to consider three key questions:

  • What is the current status of access to oral health services for the U.S. population?
  • What workforce strategies hold promise to improve access to oral health services?
  • How can policy makers, state and federal governments, and oral health care providers and practitioners improve the regulations and structure of the oral health care system to improve access to oral health services?
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